Migraine Headache in Children Clinical and Epidemiological Study

Abstract

ABSTRACT
Background: Migraine is a recurrent headache that occurs with or without aura and lasts
in children from 30 minutes to 48 hours. It is the most common cause of primary headache
in children. It differs from migraine in adults and is likely to be underdiagnosed. Childhood
migraine can significantly impair a child’s quality of life. In addition to the attack-related
disability itself, children and adolescents may develop anticipatory anxiety, knowing that at
any time an attack could disrupt their ability to go to school or enjoy social activities. It is
quite common for children who suffer to be absent from school and unable to participate in
after-school and week end activities. In fact, children who suffer are absent from school
twice as often as children who don’t. These and other issues often result in family discord.
Objectives: To review systematically the prevalence of migraine headache in children
and to study the influence of sex and age, clinical presentation and familial predisposition.
Methods: A case series study of 125 patients between ages of 5-15 years old
complaining of migraine headache diagnosed on clinical basis according to criteria applied
by international diagnostic criteria for migraine headache (ICHD-II) between 1st of Jan
2012 and 31st of Dec 2013. All patients subjected to a detailed neurological examination to
exclude secondary causes of headache. Information regarding headache location,
severity, duration, frequency, quality, associated symptoms (nausea, vomiting,
photophobia, phonophobia), precipitating and aggravating factors, presence of aura,
family history of migraine, effect of headache on child’s activity and school performance
were taken from the patients or their parents. Head imaging done only for those clinically
suspected to have intracranial lesion or for the family assurance.
Results: The study revealed that 81(64.8%) were females and 44(35.2%) were males,
(male/female ratio 1/1.8); most common age affected was those at 15 years old. Location
of headache in 78(62.4%) was unilateral and in 47(37.6%) was bilateral frontal. Onset of
headache in of 90% of cases was gradual and increase in severity over one hour and last
4-24 hour. Frequency of headache in majority of patients 2-3 attack /month. Aura reported
in only 15(12%) patients. Associated clinical symptoms with headache include nausea
(68%), vomiting (20%), photophobia and phonophobia (80%) of cases. Aggravating
factors for headache include stress (56%), lack of sleep or sleep deprivation (76%),
fasting (24%), and exercise (17.6%). Relieving factors include analgesia (72%), sleep
(16%), vomiting (20%). Family history of migraine detected in 46 (36.8%) patients. The
effect of migraine headache on child’s activity was seen in form of change of mood,
decline in physical activity, loss of appetite and change in the sleep pattern. The 1-year
prevalence rate was 3.4%.
Conclusion: Migraine is a common cause of headache in children, with a prevalence of
about 3.4%. It is an important cause of decline in child’s activity, learning performance and
change of sleep pattern. Common age is 15 years and the prevalence increase with age
towards puberty or adolescence and it is more in females than males in almost all ages.
The most triggering factors are stress and sleep deprivation. Analgesia, sleep and
vomiting are main relieving factors. Family history of migraine is a significant factor in the
occurrence of migraine headache in children.