Childhood migraine

Article section 7 of 16.  Previous  Next

By Raymond S Kandt MD

Migraine is common during childhood. Migraine affects about 4% of children (Mortimer et al 1992), as contrasted with 6% of men and 18% of women (Lipton et al 2007). In general, prior to puberty, boys and girls are affected equally, but after puberty, girls are affected roughly 3-fold more than boys (Mortimer et al 1992; Lipton et al 2007). However, boys aged 3 to 5 years are more likely to complain of headache than girls (Mortimer et al 1992). As a chronic problem, childhood headaches (migraine and other types) are more prevalent than asthma, with headaches occurring in 20% and asthma in 13% of 11-year-old children (Sweeting and West 1998). Adolescents with migraine, however, have several comorbidities. They have higher rates of inflammatory conditions, such as asthma and seasonal allergies, and have higher rates of epilepsy, persistent nightmares, and motion sickness (Lateef et al 2012). Migraine age-of-onset has an influence on familial clustering of migraine. If a patient has onset of migraine headaches prior to 16 years of age, it is more likely that other family members will have migraine (Stewart et al 2006).

The 2 basic types of migraine occur in children. Overall, 1.5% of children report migraine with aura, regardless of the criteria used, whereas the prevalence of migraine without aura varies from 2.2% to 3.4% depending on the diagnostic criteria (Mortimer et al 1992). The prevalence of both migraine without aura and migraine with aura increases with increasing age (Mortimer et al 1992). Thus, incidence rates for migraine in children were estimated as 9 per 100,000 person-years in 0 to 4 year olds and 151 per 100,000 in 15 to 19 year olds (Stang et al 1992). Note that the age of peak incidence of migraine varies by sex; for males of all ages (including adults), the peak incidence is 246 per 100,000 person-years for 10 to 14 year olds, whereas for females the peak is 689 per 100,000 for 20 to 24 year olds (Stang et al 1992). Adult migraine often starts in childhood. When adults with migraine are questioned regarding onset, half report onset before 20 years of age, whereas one fourth report onset before the age of 10 years (Raskin and Appenzeller 1980). The prevalence of abdominal migraine, for which diagnostic criteria and a verifiable relationship with migraine remain controversial, peaks at the ages of 5 to 9 years (Mortimer et al 1993).

In This Article

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