MIGRAINE EQUIVALENTS

Abstract

Objectives: Migraine headaches in children are common and the incidence may be increasing. The nature of the headache in children may differ in many respects from adults. It has long been recognised that episodic conditions in children, unaccompanied by headache, but involving other body systems, nevertheless have associations with migraine headaches. These associations include an increased risk of the child having or subsequently developing migraine headaches and an increased family history of migraine. There has however been great controversy as to whether the associations are genuine. In its 2004 “Classification of Headache Disorders” the International Headache Society at last includes “Childhood periodic syndromes that are common precursors of migraine”. The three conditions listed are cyclical vomiting, abdominal migraine, and benign paroxysmal vertigo. There are other conditions which are thought, with varying levels of evidence, also to be associated with migraine. Whereas previously it was considered there was a primary vascular aetiology for migraine, this is now challenged and it is likely that whilst blood vessels are involved in manifestations of migraine there is a greater role for primary neurological mechanisms. In particular there is evidence that the brain stem may play a leading role in terms of generation, or at least modulation of migraine headaches. In this context it looks increasingly possible that primary neurological mechanisms may have an important role in the genesis of “migraine equivalents” in children. This paper will describe some of the clinical features, as well as genetic and other possible aetiological factors, and review attempts at treatment, both acute and prophylactic, for some of these conditions.