Pathophysiology, clinical features, and diagnosis of migraine in children
- Amy Gelfand, MD
Amy Gelfand, MD
- Assistant Professor of Neurology and Pediatrics
- Director of Pediatric Headache
- University of California, San Francisco (UCSF)
- Section Editors
- Marc C Patterson, MD, FRACP
Marc C Patterson, MD, FRACP
- Section Editor — Pediatric Neurology
- Professor of Neurology, Pediatrics, and Medical Genetics
- Chair, Division of Child and Adolescent Neurology
- Mayo Clinic College of Medicine
- Jerry W Swanson, MD, MHPE
Jerry W Swanson, MD, MHPE
- Section Editor — Headache
- Professor of Neurology
- Mayo Clinic College of Medicine
Migraine is the most common disabling primary headache disorder that occurs in children and adolescents. It is characterized by headache that is often throbbing in character and accompanied by symptoms such as photophobia, phonophobia, nausea, vomiting, and movement sensitivity.
The epidemiology, pathophysiology, clinical features, and diagnosis of migraine headaches in children are reviewed here. Classification and treatment of migraine headaches in children and an approach to the general evaluation of headaches in children are discussed separately. (See "Classification of migraine in children" and "Acute treatment of migraine in children" and "Headache in children: Approach to evaluation and general management strategies".)
The classification of migraine in children is discussed in detail separately. (See "Classification of migraine in children".)
Migraine is thought to have a polygenetic and multifactorial etiology . Despite the strong genetic underpinnings of migraine, the specific genes underlying migraine have not been fully delineated, with the exception of the rare subform of familial hemiplegic migraine. (See "Hemiplegic migraine", section on 'Familial hemiplegic migraine'.)
No single theory or hypothesis has yet explained all of the phenomena that occur with migraine. The once popular vascular theory of migraine, which suggested that the headaches were caused by the dilatation of blood vessels while the aura resulted from vasoconstriction, has been discredited. In spontaneous migraine attacks imaged with magnetic resonance angiography, there is no extracranial artery dilation and only minimal intracranial artery dilation . Successful treatment of the attacks with sumatriptan did not cause intracranial vasoconstriction. The throbbing nature of migraine head pain does not represent perception of one's own arterial pulse, as the throbbing percept rhythm and the arterial pulse rhythm are distinct from, and out of phase with, one another . A central oscillation in nociceptive processing may underlie the throbbing percept of migraine head pain.
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- Cortical spreading depression
- Role of serotonin
- Role of CGRP
- Right to left cardiac shunt
- CLINICAL FEATURES
- Premonitory phase
- Migraine aura
- Migraine headache phase
- Migraine postdrome
- Laboratory evaluation
- DIFFERENTIAL DIAGNOSIS
- INFORMATION FOR PATIENTS