Childhood Migraine: A Practical Review

Abstract & Introduction

Headache is a common presenting complaint in childhood that requires an organized clinical approach for diagnosis and for determining optimal therapy. Because childhood migraine is affected by developmental factors not operant in adult migraine, the criteria established by the International Headache Society for childhood migraine without aura are being reassessed. Cost-effective clinical pathways developed in the current healthcare environment place great emphasis on concise clinical diagnosis and limited use of testing resources. Newer-generation drugs are expensive and thus increase the need for a rational paradigm for choosing treatments. Desirable goals to minimize drug-related complications in this population include constructing strategies for recognizing and avoiding specific headache triggers and developing effective nonpharmacologic therapies. Understanding the generally good prognosis of childhood migraine is central to patient and parent education as well as improved patient compliance.

Migraine headache is a specific clinical entity that has been classified by the International Headache Society (IHS) by relatively strict criteria.^[1] Clinical acumen in triaging the child or adolescent with headache should allow accurate diagnosis while minimizing the use of expensive diagnostic resources. Although many serious illnesses may present with headache^[2,3] and definitely warrant sophisticated neuroimaging, such as magnetic resonance imaging (MRI) and computed tomography (CT) scan, or invasive studies, such as lumbar puncture or cerebral angiography, these approaches are the exceptions in clinical practice.

Knowing potential headache triggers and how to avoid them are important to headache control.^[4] Psychological issues also may be key to understanding causal factors and selecting appropriate diagnostic and pharmacologic pathways. Patient and parent education is an integral part of the successful treatment of migraine in the pediatric population.

Friedman,^[5] Rose,^[6] Singer,^[7] and Rothner^[8] have reviewed the historical aspects of migraine -- Hippocrates suffered from migraine headaches and Galen described hemicrania, emphasizing the laterality observed in migraine. Sentinel descriptions of childhood migraine by several authors^{[8,9,10,11,12,13]} have added greatly to our understanding of childhood migraine.

Medscape Neurology. 2001;3(1) © 2001 Medscape

Cite this: Gerald Silverboard. Childhood Migraine: A Practical Review - Medscape - Feb 02, 2001.