Migraña pediatrica

Pediatric Migraine Donald W. Lewis Pediatr. Rev. 2007;28;43-53

The online version of this article, along with updated information and services, is located on the World Wide Web at: http://pedsinreview.aappublications.org/cgi/content/full/28/2/43

Pediatrics in Review is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since1979. Pediatrics in Review is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2007 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0191-9601. Online ISSN: 1526-3347.

Downloaded from http://pedsinreview.aappublications.org at Health Internetwork on August 10, 2007Article neurology

Pediatric Migraine
Donald W. Lewis, MD*

Learning Objectives

After completing this article, readers should be able to:

Author Disclosure Dr Lewis disclosed that he has clinical research grants from Abbott Laboratories, AstraZeneca, and Ortho-McNeil Pharmaceutical.

1. Recognize the diagnostic criteria for pediatric migraine. 2. Describe the clinical spectrum ofmigraine in children and adolescents. 3. Discuss the acute and preventive treatments of migraine.

Introduction
Headache is a common chief complaint in pediatric offices and may be a symptom of a host of illnesses from viral infection to intracranial neoplasm to migraine. The clinical spectrum of migraine represents a significant subset of headache, occurring typically as recurrent, episodic attacksof head pain plus a variety of accompanying symptoms, separated by symptom-free intervals. Its most common form, migraine without aura, is characterized as intense frontal or temporal headache lasting from 1 to 48 hours, accompanied by autonomic symptoms such as nausea, vomiting, and sensitivity to light and sound. Occasionally, migraine with aura in children is accompanied by dramatic neurologicsigns and symptoms such as hemiparesis, language or mental status disturbances, visual disorders, or oculomotor dysfunction. This review provides an update on the current understanding of the evaluation, classification, pathophysiology, diagnostic criteria, and management of the migraine spectrum in children.

Evaluation
The evaluation of a child who has recurrent headaches begins, and in mostcases ends, with a thorough medical history and complete physical and neurologic examinations. Clues to the presence of secondary causes of headache such as tumors, infection, intoxication, or hydrocephalus are uncovered through this systematic process, as is the delineation of primary headache syndromes. The first step is taking a history. Twelve key questions that can aid in distinguishingmigraine from other primary headaches (ie, tension-type or cluster) or secondary causes of headache include: 1. What is the time pattern of your headache: sudden first headache, episodes of headache, everyday headache, gradually worsening, or a mixture? 2. How and when did your headache begin? 3. How often does the headache occur, and how long does it last? 4. Do you have one type of headache or more thanone type? 5. How often does the headache occur and how long does it last? 6. Are there warning signs or can you tell that a headache is coming? 7. Where is the pain located and what is the quality of the pain: pounding, squeezing, stabbing, or other? 8. Are there any other symptoms that accompany your headache: nausea, vomiting, dizziness, numbness, weakness, or other? 9. What makes the headachebetter or worse? Do any activities, medications, or foods tend to cause or aggravate your headaches? 10. What do you do when you get a headache or do you have to stop your activities when you get a headache? 11. Do the headaches occur under any special circumstances or at any particular time? 12. Do you have other symptoms between headaches?
*Professor of Pediatrics and Neurology, Children’s...