Childhood migraine

Abstract

Starting in childhood, headache represents a common reason for consulting a doctor. A thorough anamnesis with the child and its parents is the basis for every successful treatment. The prevalence of childhood headache increases with age. At puberty, headache becomes more common in girls than in boys. Headache disorders are classified in primary and secondary types. The primary headaches comprise of migraine, as well as tension-type headache and trigeminal autonomic headache. Depending on the headache frequency, migraine can be divided in episodic and chronic migraine. Furthermore, we classify migraine with and without aura. Childhood migraine predominantly overlaps with adult migraine, although some distinctions exist such as shorter attack duration, more bilateral pain distribution and less specific attendant symptoms. In addition to the classic migraine presentation, there are episodic syndromes such as cyclic vomiting syndrome, abdominal migraine, BPVC and BPTI. These episodic syndromes represent early migraine variants and often develop into classic migraine with age. Treatment is commonly equivalent to that of classic migraine. In treating migraine, we distinguish the acute therapy of a migraine attack from migraine prophylaxis. Ibuprofen is the first-line-treatment, followed by Sumatriptan (approved over the age of 12) as second-line-treatment, should escalation be necessary. As prophylaxis, measures such as relaxation-techniques, biofeedback or behavioral therapy are to be implemented first. Should medication be required, Flunarizin and beta-blockers are primary recommendations.