History and exam

Key diagnostic factors

common

severe episodic headache

Moderate to severe episodic headaches and a complete return to baseline between attacks are typical for migraine.

nausea and vomiting

Vomiting is common in pediatric migraine. Nausea as a symptom might be difficult to elicit from the younger patient.

light and noise sensitivity

Photophobia and phonophobia are common symptoms in pediatric migraine. In younger children, these symptoms are inferred from their behavior.

functional impact

Children and adolescents are often unable to function (attend school and after-school activities) during a migraine attack.

uncommon

aura symptoms

It is unusual to identify aura symptoms other than "blurry vision" in younger children. Visual aura can take the form of scotomas or scintillation spectra.

throbbing character

Assessing the character of a headache in pediatric patients can be difficult, and the absence of the throbbing character should not direct the clinician away from migraines as a diagnosis.

Risk factors

strong

family history of migraine

Migraine is 50% more likely in relatives of people with the condition than in those without migraines in their family.[8]

The majority of migraine cases are inherited on a polygenic basis. The susceptibility genes identified through genome-wide association studies often encode proteins affecting complex, poorly understood neuronal and vascular networks.[17]

female sex and hormonal changes

While before puberty the incidence of migraine is equal between the two sexes, after puberty more females are affected than males. In mid-adolescence, twice as many females as males experience migraine.[6]

Perimenstrual migraine incidence increases during adolescence and can precede the occurrence of menses, as demonstrated by their monthly, recurring pattern.[18]

poor sleep quality

There is a strong association between various sleep disorders and migraine both in adults and in children.[19][20]​​​ Moreover, poor sleep is associated with increased migraine attack frequency.[20]

stress

Stress, usually related to academic difficulties and interpersonal relationships, may play a role in frequency and severity of migraine attacks in up to 25% of children with migraine.[21]

Much of the evidence for risk factors in pediatric migraine has been extrapolated from data from adult studies.

medication overuse

Frequent use of abortive drugs often leads to rebound headaches and is one of the factors responsible for the transformation of episodic migraine to chronic migraine.[22]

weak

periodic syndromes

There is an association between various periodic childhood syndromes and the development of migraine headaches. Better-characterized entities that precede the development of migraine include benign paroxysmal torticollis, benign paroxysmal vertigo of childhood, abdominal migraine, and cyclical vomiting.[23]​ Other entities, such as epistaxis and motion sickness, are often associated with pediatric migraine.[24]

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