Do pre-school episodic syndromes predict migraine in primary school children? A retrospective cohort study on health care data

Research on sleep disorders in children with episodic idiopathic vertigo provides evidence supporting the connection to migraine

OBJECTIVES

Migraine is the most common etiology of episodic vertigo in pediatric populations. The characteristics of migraine headaches in children differ from those in adults, with initial manifestations frequently presenting as periodic syndromes. Sleep disorders are prevalent among individuals with migraines. Headaches may not be present in early childhood, and children may not easily report aura or phono-photophobia. Therefore, it is essential to identify clinical and anamnesic elements that can support the etiopathogenetic hypothesis of migraine in the assessment of episodic idiopathic vertigo. The objective of this study was to assess the validity of research concerning sleep disorders in children experiencing episodic vertigo, with the aim of providing evidence for a connection to migraine.

METHODS

The study included 25 participants diagnosed with episodic idiopathic vertigo, including 13 females and 12 males, aged between 5 and 14 years. A range of anamnestic parameters was analyzed, including the presence, type, and age of onset of sleep disorders; the presence, characteristics, and age of onset of headaches; and the presence of a family history of migraine. The data were compared with those of a control group matched for age and sex, which was affected by dysfunctional dysphonia and had no history of vertigo. The comparison of percentage values concerning the parameters under examination was conducted using the chi-square statistic test with Yates correction. A t-test was employed to compare the means and standard deviations. The significance limit is established for p values ≤ 0.05.

RESULTS

Sleep disorders were present in 15 out of 25 patients (60 %) with episodic vertigo, compared to 3 out of 25 (12 %) in the control group (p = 0.001). Somniloquy is the most prevalent disorder. Headache was reported by 12 out of 25 recruited patients (48 %), with 8 cases classified as migraine-type, 1 as tension-type, and 3 as mixed or indefinite-type. In the control group, 4 out of 25 (16 %) reported headaches, including 1 migraine-type, 2 tension-type, and 1 mixed or indefinite-type (p = 0.03). A family history of migraine was identified in 19 (76 %) of the 25 patients and in 7 (28 %) of the 25 subjects in the control group (p = 0.001). The average age of onset for sleep disorders was 6.28 ± 1.67 years, while for headaches it was 9.25 ± 3.01 years (p = 0.01). The comparative analysis of symptom distribution by patient age indicates that all patients with sleep disorders reported this clinical manifestation by the age of eight years. Conversely, only 26.6 % of these patients reported experiencing the headache for the first time at the same age.

CONCLUSIONS

Children with episodic idiopathic vertigo exhibit a high prevalence of sleep disorders, alongside a significant correlation with headaches and a familial history of migraine. In younger patients, migraine symptoms, particularly headache, necessary for diagnosing vestibular migraine, are frequently absent or unreported. Studies on sleep disorders in children experiencing episodic idiopathic vertigo indicate a correlation with migraine.

Headache in Children and Adolescents

OBJECTIVE

This article reviews the assessment of children and adolescents presenting with headache, provides an overview of primary headache disorders, and reviews evidence-based management of headache in this age group.

LATEST DEVELOPMENTS

In the last few years, new epidemiological data have shed light on less common pediatric headache disorders (eg, pediatric trigeminal autonomic cephalalgias) and psychosocial risk factors associated with primary headache disorders in children and adolescents. There has also recently been a substantial increase in interventions that target the calcitonin gene-related peptide pathway and that treat primary headache disorders using noninvasive neuromodulation. Although these interventions have primarily been studied in adults, there is emerging evidence of their use in the pediatric population.

ESSENTIAL POINTS

Primary headache disorders are very common in youth, and the most commonly encountered headache diagnosis in neurology practice is migraine, which affects approximately 10% of children and adolescents. Diagnosing and effectively treating primary headache disorders before adulthood may have a sustained impact on the patient by improving long-term headache and mental health outcomes, thereby significantly reducing the burden of disability over time. There are several available and emerging acute and preventive interventions for youth with primary headache disorders, and treatment decisions should be made in the context of available evidence using a shared decision-making approach.

Sudden onset headaches in paediatric emergency departments: diagnosis and management

Headache is one of the most common pain syndromes in the paediatric population. Headaches are classified as primary (migraine, tension-type headaches, trigeminal autonomic cephalalgia and other primary headaches) or secondary (e.g. post-traumatic). Non-febrile, non-traumatic headaches represent 1% of all paediatric emergency departments (PED) visits. Many patients present with an acute, moderate to severe pain, sometimes with a sudden onset. Sudden onset headache can be the main symptom of life-threatening neurological conditions as well as a sign of primary headaches such as thunderclap or stabbing headaches. This review aims to describe the presentation of sudden primary headaches in children, in order to help the physician to provide effective management in the emergency setting.

Brain to Belly: Abdominal Variants of Migraine and Functional Abdominal Pain Disorders Associated With Migraine

Migraine is one of the most frequent causes of primary headache and 9% of children suffer from migraines. Most children will continue to experience migraine attacks as adults, therefore it is imperative that we have a thorough understanding of this major health issue. This article considers the so-called abdominal variants of migraine, which are more commonly seen in children rather than adults: abdominal migraine, cyclic vomiting syndrome, and infantile colic. Other functional abdominal pain disorders such as irritable bowel syndrome and functional dyspepsia have also been linked to migraine in clinical studies. The common pathophysiological root of these diseases seems to be the gut-brain axis mechanism. Abdominal variants of migraine are considered pediatric precursors of migraine whereas the functional abdominal pain disorders related to migraine seem to share a pathophysiological root with no temporarily link as for today. In this review we aim to describe the epidemiological background, the current pathophysiological theories and the relationship of each disease to migraine. This review is the first to compile abdominal variants of migraine and functional abdominal pain disorders associated with migraine and we endeavor to elucidate the broad spectrum of migraine-related episodes in children.

Primary headaches during lifespan

Primary headaches are one of the most prevalent neurological disorders and can occur during a wide range of lifespan. Primary headaches, especially migraine, are cyclic disorders with a complex sequence of symptoms within every headache attack. There is no systematic review of whether these symptoms changes during lifespan. Indeed, the clinical presentation of migraine shows an age-dependent change with a significantly shorter duration of the attacks and occurrence of different paroxysmal symptoms, such as vomiting, abdominal pain or vertigo, in childhood and, in contrast, largely an absence of autonomic signs and a more often bilateral headache in the elderly. The age-dependent differences in the clinical presentation are less distinct in cluster headache and, especially, in tension-type headache. The differences in the clinical presentation are in agreement with the idea that the connectivity of hypothalamic areas with different brainstem areas, especially the central parasympathetic areas, is important for the clinical manifestation of migraine, as well as, the change during lifespan.