Migraine and its childhood equivalents

Abstract

Migraine is one of the most common causes of primary headache in the pediatric population. In addition to pain manifestations, episodic syndromes are also found in children, which often lack cephalgic manifestations and are difficult to verify in clinical practice.Objective: to determine the characteristics of the migraine and episodic syndromes associated with migraine in children of different age groups.Material and methods. The study included 250 children complaining of headaches (166 girls and 84 boys aged 5 to 18 years, mean age 13 years). The patients were divided into groups: Group 1 – preschool age (5–6 years) and elementary school age (7–10 years) – 20.8% (n=52) of patients; Group 2 – middle school age (11–14 years) – 45.2% (n=113) of patients; Group 3 – high school age (15–18 years) – 34% (n=85) of patients. A structured diagnostic interview was conducted with all study participants (or their parents) and pain and anxiety were assessed using special scales and tests adapted for children (visual analog scale (VAS); Digital Pain Rating Scale (DPS); Verbal Rating Pain Scale (VRPS), Faces Pain Scale (FPS), MIDAS scales, Hands scale, depression scales adapted by T.I. Balashova, Spielberger-Khanin anxiety scale).Results. The average age at onset of headache in the general structure was 11 [9; 13] years. Migraine was diagnosed in 40.4% (n=21) of the patients in Group 1, in 31.9% (n=36) of the patients in Group 2 and in 29.4% (n=25) of the patients in Group 3. An increase in age by 1 year leads to a 1.17-fold decrease in complaints for headache in combination with vomiting. With an increase in the age of the patients by 1 year, excessive sleep is significantly less likely to be a factor provoking headaches. A statistically significant inverse association was found between age and FPS scores (ρ =-0.13, 95% CI: -0.25; -0.002; p=0.0457), VAS (ρ =-0.13, 95% CI: -0.25; -0.004, p=0.0425) and Balashova scale score (ρ =-0.14, 95% CI: -0.26; -0.01, p=0.0327). The mean values for the intensity and severity of headaches decrease with age. Analysis of the prevalence of episodic syndromes associated with migraine revealed that in the general group, intestinal colic in infancy was found in 49.6% (n=124) of cases, in Group 1 – in 51.9% (n=27), in Group 2 – in 47.8% (n=54) and in Group 3 – in 50.6% (n=43) of patients. In the general group, torticollis was found in 14.4% (n=36) of patients, which increased slightly with age. Intermittent abdominal pain was found in a total of 33.2% (n=83) and spontaneous vomiting in 18% of children, and its prevalence decreased with age.Conclusion. The prevalence of migraine in children of different age groups suffering from headache varies between 40.4% and 29.4% of cases. Frequency of gastrointestinal symptoms accompanying a headache attack and the provoking effect of sleep decrease continuously with increasing age. Episodic childhood syndromes associated with migraine may vary in their characteristics between different age groups of pediatric patients.