Migraine in Children: Epidemiology and Classification

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Migraine is a common headache disorder occurring in children. It is characterized by periodic paroxysmal headache, often with nausea, vomiting, and abdominal pain.


Epidemiology

Migraine may occur at any age, even in infancy.[1, 2] Boys tend to experience the onset of migraine earlier than girls, at age 7 versus 10 years of age.[3] Among children with migraine, boys outnumber girls roughly until puberty (12 years of age). Thereafter, prevalence is higher for girls than boys (Table 1).[4, 5] The American Migraine Prevalence and Prevention (AMPP) Study estimated the 1-year prevalence of migraine among US children ages 12 to 19 years at 6.3%, with prevalence among boys at 5.0% and among girls 7.7%.[4] Family history of migraine appears to be an important determining factor in risk for childhood migraine. In a study of the clinical and demographic characteristics of migraine among children 5 to 13 years of age, 66% of subjects were positive for a family history of migraine.[6]

Table 1. Gender-Specific Prevalence Rates From AMPP

Age (years)

Male

Female

12

3.4

3.2

13

3.6

4.4

14

4.0

4.6

15

3.9

6.0

16

2.9

6.2

17

4.1

9.8

18

3.9

7.8

19

3.2

6.3

From Bigal ME, Lipton RB, Winner P, et al. Neurology. 2007;69:16-25.

Classification

Diagnosis of migraine in children is complicated by the difficulty of obtaining headache history and description of symptoms in this population. Additionally, migraine manifests differently in children compared with adults, with fewer episodes per month and episodes of shorter duration and lower severity. Given these differences, application of adult diagnostic criteria in classifying pediatric migraine would appear to be less than optimal. However, early published definitions of childhood migraine failed to specify the features necessary to make a diagnosis in children. The 1988 International Headache Society (IHS) International Classification of Headache Disorders (ICHD) criteria for classification and diagnosis of headache disorders marked the first attempt to differentiate diagnostic criteria for childhood migraine from adult criteria by acknowledging the shorter duration of pediatric migraine (Table 2). Overall revision of ICHD criteria, published in 2004, further modified diagnostic criteria for duration in children, as well as specifying features that differentiate pediatric from adult migraine.[7, 8]

In this revision, conditions unique to pediatric migraine patients, including cyclical vomiting, abdominal migraine, benign paroxysmal vertigo of childhood, which had been considered manifestations of migraine, were revised and termed “childhood periodic syndromes that are commonly precursors of migraine.” Additionally, the 2004 ICHD acknowledged (1) that migraine in young children is often bilateral, with unilateral pain emerging only in late adolescence; (2) that migraine is typically frontotemporal in children; and (3) that photophobia and phonophobia may be inferred from behavior in young children.[8] The most recent ICHD guidelines, published in 2013, maintain the diagnostic criteria from the 2004 publication.[9]

Table 2. 1988 and 2004 ICHD Definitions of Childhood Migraine

Guideline

Temporal Pattern

Pain and Associated Features

ICHD-1 (1988)
  • ≥5 attacks
  • Headache duration: 2-48 hours (children <15 years); 4 to 72 hours (children >15 years)
  • ≥2 of 4: unilateral, pulsating quality, moderate to severe pain intensity, exacerbation by routine physical activity
ICHD-2 (2004)ICHD-3 (2013)
  • ≥5 attacks
  • Headache duration: 1-72 hours
  • ≥2 of 4: unilateral, pulsating quality, moderate to severe pain intensity, aggravation by routine physical activity
  • ≥1 of 2: photophobia and phonophobia, nausea or vomiting
Adapted from Bigal ME, Arruda MA. Headache. 2010;50:1130-43.
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view references
1. Abu-Arefeh, I. and G. Russell, Prevalence of headache and migraine in schoolchildren. BMJ, 1994. 309(6957): p. 765-9. 2. Elser, J.M. and R.C. Woody, Migraine headache in the infant and young child. Headache, 1990. 30(6): p. 366-8. 3. Sillanpaa, M., Changes in the prevalence of migraine and other headaches during the first seven school years. Headache, 1983. 23(1): p. 15-9. 4. Bigal, M.E., et al., Migraine in adolescents: association with socioeconomic status and family history. Neurology, 2007. 69(1): p. 16-25. 5. Zwart, J.A., et al., The prevalence of migraine and tension-type headaches among adolescents in Norway. The Nord-Trondelag Health Study (Head-HUNT-Youth), a large population-based epidemiological study. Cephalalgia, 2004. 24(5): p. 373-9. 6. Lee, L.H. and K.N. Olness, Clinical and Demographic Characteristics of Migraine in Urban Children. Headache: The Journal of Head and Face Pain, 1997. 37(5): p. 269-276. 7. Bigal, M.E. and M.A. Arruda, Migraine in the pediatric population–evolving concepts. Headache, 2010. 50(7): p. 1130-43. 8. Headache Classification Committee of The International Headache Society. The international classification of headache disorders. Cephalalgia. 2004;24(Suppl 1): p. 1-160. 9. Headache Classification Committee of The International Headache Society. The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9): 629-808.
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Written by: Jonathan Simmons, PhD | Updated by Kristine Zerkowski | Last update: August 2014.
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