As part of the Case-based Workshop “Coping with refractory headache disorders of children and adolescents” at the 5th Congress of the European Academy of Neurology (EAN), Prof. Aynur Özge (Mersin University, Turkey) provided an overview of migraine in children and its management. Prof. Özge started her presentation by stating that migraine in children and adolescents presents as more than just a headache. Several manifestations can precede a migraine attack, including abdominal discomfort, dizziness, vertigo, motion sickness, and behavioural and sleep disturbances. Medical comorbidities such as atopy, epilepsy, psychiatric and rheumatological disorders have been reported in young patients with migraine. Additionally, cranial autonomic symptoms often occur prior to the migraine attack.

Chronic migraine in children

Migraine has an estimated prevalence of 7.7%–17.8% in children1 and is greatly disruptive for patients and their families. Chronic migraine (CM) affects 1.7% of chidren1; additionally, episodic migraine in children can evolve into the chronic condition. Identified risk factors for CM in children are increasing age, female sex, and father and sibling headache histories.2

“Migraine in children is not just the headache.”  

Aynur Özge (Mersin University, Turkey)

The diagnosis of CM is not differentiated between adults and children. The two main diagnostic criteria for CM are 1) headache on 15 or more days per month for at least three months, and 2) occurring in patients who have had at least five attacks fulfilling the criteria of migraine without aura and/or migraine with aura.3 There are, nonetheless, key differentiating features between migraine in children and that in adults. Migraine attacks in children tend to be frontal and bilateral, which is in sharp contrast to the temporal and unilateral migraine in adults. Furthermore, a migraine attack in children can last minutes to hours, while in adults the duration range is 4–72 hours.

The features of the premonitory phase also differentiate migraine in children to that in adults. Episodic syndromes that may be associated with migraine – previously known as childhood periodic syndromes or periodic syndromes of childhood – include cyclic vomiting syndrome, abdominal migraine, benign paroxysmal vertigo and benign paroxysmal torticollis.3

Management of migraine in children

Management of migraine in children starts with education. Physicians, patients and their families, need to be aware of the vast number of syndromes and comorbidities that can occur in children and adolescents with migraine. Prof. Özge stressed that the management plan should be inclusive of the patient’s entire social circle. Indeed, migraine has a disruptive impact on the patient, their families as well as their schools and friends.

The goals of migraine treatment in children are to improve quality of life, to develop adaptive pain-coping strategies, and to reduce disability and the risk of disease progression. Preventative treatment is recommended when migraine attacks occur 3–4 times per month and their severity impacts daily function or quality of life. An in-depth investigation of effective attack medication, potential triggers, life-style related aspects and analgesic overuse should be conducted. Additionally, a rigorous tracking of phenotypic changes is necessary because episodic syndromes change as children grow older. In Prof. Özge’s opinion, there is no perfect treatment for migraine in children. Physicians need to consider comorbidities as well as patient-specific aspects when deciding on a treatment course.

  1. Özge A, et al. Experts’ opinion about the primary headache diagnostic criteria of the ICHD-3rd edition beta in children and adolescents. J Headache Pain. 2017;18:109.
  2. Özge A, et al. The prevalence of chronic and episodic migraine in children and adolescents. Eur J Neurol. 2013;20:95–101.
  3. Headache Classification Committee of the International Headache Society. The international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38:1–211.