Migraine-related symptoms in childhood.
ABSTRACT Periodic disorders of childhood often represent precursors of migraine. As we advance our knowledge of migraine and its complicated phenotypic presentation in childhood, we have noted the similarities in overlapping symptoms of children presenting with childhood periodic syndromes. There is often a positive family history of migraine in children that present with periodic syndromes. There is a known transformation of periodic syndromes from childhood into adult migraine with and without aura phenotype. There has been an evolution of our understanding of what was initially referred to as periodic symptoms of childhood and more recently been called childhood periodic syndromes and is now evolving into the terminology of episodic symptoms that are associated with migraine. International classification of headache disorders has been instrumental in the evolution of the classification of headache and children adults. The most recent classification utilizes and replaces the periodic symptom terminology with episodic symptoms that will no longer be limited to just childhood. This article will address the evolution of our understanding of the diagnostic criteria, pathophysiology and management of the episodic syndromes that may be associated with migraine.
Article: Vertigo and dizziness in children[Show abstract] [Hide abstract]
ABSTRACT: Vertigo and dizziness occur with considerable frequency in childhood and adolescence. Most causes are benign and treatable. This review aims to make physicians more alert to the frequent causes of dizziness in the young. Epidemiological data confirm that migraine-related syndromes are the most common cause of vertigo in children. Vestibular migraine and benign paroxysmal vertigo have now been defined by the International Classification of Headache Disorders. About half of the adolescents with vertigo and dizziness show psychiatric comorbidity and somatization. Vestibular paroxysmia has been described as a new entity in children that can be treated with low doses of carbamazepine. To assess vestibular deficits, video head impulses (for the semicircular canals) and vestibular-evoked myogenic potentials (for the otoliths) are increasingly being used. Pediatricians and neuro-otologists should be aware of the full spectrum of causes of vertigo and dizziness in children and adolescents. Vestibular function can reliably be tested nowadays. Although treatment for the common migraine-related syndromes can be done in analogy to the treatment of migraine in general, specific approaches are required for somatoform vertigo, the most frequent diagnosis in adolescent girls.Current Opinion in Neurology 12/2014; 28(1). DOI:10.1097/WCO.0000000000000157 · 5.73 Impact Factor
Article: Sex and the Migraine Brain[Show abstract] [Hide abstract]
ABSTRACT: The brain responds differently to environmental and internal signals that relates to the stage of development of neural systems. While genetic and epigenetic factors contribute to a premorbid state, hormonal fluctuations in women may alter the set point of migraine. The cyclic surges of gonadal hormones may directly alter neuronal, glial and astrocyte function throughout the brain. Estrogen is mainly excitatory and progesterone inhibitory on brain neuronal systems. These changes contribute to the allostatic load of the migraine condition that most notably starts at puberty in girls.Neurobiology of Disease 08/2014; 68. DOI:10.1016/j.nbd.2014.03.008 · 5.20 Impact Factor
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ABSTRACT: Background Migraine equivalents are common clinical conditions without headache component, occurring as repeated attacks with complete remission between episodes. They include abdominal migraine, cyclical vomiting, benign paroxysmal vertigo, and benign paroxysmal torticollis. Other clinical entities, such as motion sickness and limb pain have been associated with migraine. We aimed to investigate the migraine equivalents prevalence in a large population of children referred to a pediatric headache centre and to reveal a possible relationship between migraine equivalents and headache features. Methods A total of 1.134 of children/adolescents (73.2% with migraine and 26.8% with tension-type headache) was included. Patients were divided into two groups according to the attack frequency (high and low). Pain intensity was rated on a 3-levels graduate scale (mild, moderate and severe pain). Results Migraine equivalents were reported in 70.3% of patients. Abdominal migraine (48.9%), limb pain (43.9%), and motion sickness (40.5%) were the most common migraine equivalents. While headache type (migraine or tension-type headache) did not correlate with migraine equivalents presence (χ2=33.2; P=0.27), high frequency of headache attacks correlated with migraine equivalents presence. Moreover, migraine equivalents showed a protective role for some accompanying symptom of the headache attack. Conclusions Our results suggest that migraine equivalents should not be considered merely as headache precursors, but they are part of the migrainous syndrome. Thus, their inclusion among the diagnostic criteria for pediatric migraine/tension-type headache is hopeful.Pediatric Neurology 11/2014; 51(5). DOI:10.1016/j.pediatrneurol.2014.07.018 · 1.50 Impact Factor