Childhood migraine

Historical note and nomenclature
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By Raymond S Kandt MD

Although headache with fever was mentioned in Sumerian and other ancient literatures, these references were probably to malaria rather than to migraine. The first reliable description of migraine was probably given by Aretaios of Kappadokia in the first century A.D., when he described "heterocrania." In the second century A.D., Galen used the word "hemicrania," from which the word "migraine" derives, as a synonym for "heterocrania." In Medieval Europe, Hildegard von Bingen suggested that migraine was often unilateral because the pain was so severe that it could not be tolerated if it were on both sides of the head. During the Renaissance, explanations for unilaterality included the separation by the falx cerebri. In addition, during this time it was postulated that migraine was caused by yellow bile, and furthermore that the vapors proposed by the Galenic theorists could ascend (as from the stomach to the brain). In this theory, anatomic connections were not necessary (Isler 1993). The first unmistakable descriptions of migraine with aura were from the 17th century and included the observations of Charles Le Pois, who described premonitory symptoms of his own migraine. Since then, many other investigators have described their own auras. In the 19th century, Liveing and Gowers contributed to the knowledge of the relationship of migraine with epilepsy. In the early 20th century, Moebius coined the term "status migrainosus," which was similar to the term for the prolonged epileptic state (Isler 1993).

Even though Tissot, Calmeil, and Liveing mentioned patients whose migraine started during childhood (Bille 1962), the onset of migraine in early childhood (between the ages of 1 and 4 years) was not well described until the early 20th century (Vahlquist and Hackzell 1949). Edward Flatau's book, La Migrane, published in 1912, was the most comprehensive review to that time. Among the therapies he reviewed, ergotamine is the primary one that is still used. In 1926 Maier reported a successful clinical trial of ergotamine in migraine. The work of H G Wolff, Headache and Other Head Pain, published in 1948, is considered a classic, and was a forerunner to much of the successful migraine research of the 20th century. Traditionally, many doubted that migraine was much of a problem in childhood, but the important epidemiological studies of Bille established the high prevalence of childhood migraine (Bille 1962).

In This Article

Historical note and nomenclature
Clinical manifestations
Clinical vignette
Pathogenesis and pathophysiology
Differential diagnosis
Diagnostic workup
Prognosis and complications
References cited