Premonitory Symptoms of Migraine in Childhood and Adolescence

N. Karsan,P. J. Goadsby,P. Prabhakar

doi:10.1007/s11916-017-0631-y

Abstract

Purpose of ReviewPremonitory symptoms in migraine; symptoms occurring before the onset of migraine pain or aura, are an increasingly recognised area of interest within headache research. It has been recently documented in the literature that these symptoms also occur in children and adolescents, with a comparable phenotype to adults. This review discusses the wide presentation of premonitory symptoms in migraine in children and adolescents, and the importance of understanding how these early symptoms are mediated in order to ensure that targeted abortive therapies are developed in the future. Recognition of these symptoms by parents, guardians, teachers and carers is of importance in ensuring early and effective attack treatment.Recent FindingsA previous clinic-based questionnaire study in 103 children found a prevalence of premonitory symptoms in paediatric migraine of 67%, with a mean number of reported symptoms of two. A recent study found that in a clinic population of 100 children or adolescents with a migraine diagnosis who were preselected as having at least one premonitory symptom associated with their attacks, two or more premonitory symptoms were reported by 85% of patients. The most common symptoms were fatigue, mood change and neck stiffness.SummaryAlthough the population prevalence of premonitory symptoms in migraine within the paediatric population, or their ability to predict accurately the onset of an impending headache cannot be deduced from the retrospective studies performed to date, premonitory symptoms occur in children as young as 18 months old. Understanding the biological basis of these, and their heterogeneous phenotype may help future targeted therapeutic research, helping the development of drugs that act before the onset of pain, limiting the morbidity associated with the migraine attack.

Highlights

Migraine is a common neurological disorder, causing significant socioeconomic burden [1]
These syndromes comprise benign paroxysmal torticollis [5], benign paroxysmal vertigo [6], cyclical vomiting syndrome [7] and abdominal migraine [8], as well as infantile colic [9], which has recently been added to the International Classification of Headache Disorders-3 beta in the appendix [4]
These have alluded to migraine effects outside of the brain, and their recognition has broadened the heterogeneity of the phenotype of paediatric migraine

Summary

Introduction

Migraine is a common neurological disorder, causing significant socioeconomic burden [1]. The presence of non-headache symptomatology outside of aura accompanying migraine has been noted, in children, with the recognition of the episodic syndromes which may be associated with migraine [4] These syndromes comprise benign paroxysmal torticollis [5], benign paroxysmal vertigo [6], cyclical vomiting syndrome [7] and abdominal migraine [8], as well as infantile colic [9], which has recently been added to the International Classification of Headache Disorders-3 beta in the appendix [4].

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Findings

Conclusions