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Pediatric Migraine Phenomena and Variants: Don’t Let Them Go Over Your Head

  • Uncommon and/or Unusual Headaches and Syndromes (J Ailani, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Primary care providers, general pediatric neurologists, and other related subspecialty providers require a clear understanding of pediatric migraine with typical aura and its variants.

Recent Findings

We highlight some of the genetic mutations known to contribute to specific types of migraine with aura, discuss the ophthalmologic phenomena of migraine and call attention to some of the earliest manifestations of migraine in children, many of which have correlates in adulthood.

Summary

While the majority of headaches in children are migraine with or without aura or tension type, many migraine and aura variants exist. Early and accurate diagnosis of episodic syndromes associated with migraine, as defined by the 2018 ICHD-3 criteria, can help to reduce unnecessary imaging, referrals, cost and anxiety, thereby benefiting patients and their families.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Greene K, Irwin SL, Gelfand AA. Pediatric migraine: an update. Neurol Clin. 2019;37(4):815–33. https://doi.org/10.1016/j.ncl.2019.07.009. Thorough review of the pediatric migraine spectrum and therapeutic options.

    Article  PubMed  Google Scholar 

  2. Balestri M, Papetti L, Maiorani D, Capuano A, Tarantino S, Battan B, et al. Features of aura in paediatric migraine diagnosed using the ICHD 3 beta criteria. Cephalalgia. 2018;38(11):1742–7. https://doi.org/10.1177/0333102417748571.

    Article  PubMed  Google Scholar 

  3. •• Headache classification committee of the international headache society (ihs) the international classification of headache disorders, 3rd edition. Cephalalgia. 2018;38(1):1–211. https://doi.org/10.1177/0333102417738202. The latest international headache classification system.

  4. Russell MB, Ducros A. Sporadic and familial hemiplegic migraine: pathophysiological mechanisms, clinical characteristics, diagnosis, and management. Lancet Neurol. 2011;10(5):457–70. https://doi.org/10.1016/S1474-4422(11)70048-5.

    Article  PubMed  Google Scholar 

  5. Pelzer N, Haan J, Stam AH, Vijfhuizen LS, Koelewijn SC, Smagge A, et al. Clinical spectrum of hemiplegic migraine and chances of finding a pathogenic mutation. Neurology. 2018;90(7):e575–e82. https://doi.org/10.1212/WNL.0000000000004966.

    Article  PubMed  Google Scholar 

  6. • Sutherland HG, Albury CL, Griffiths LR. Advances in genetics of migraine. J Headache Pain. 2019;20(1):72. https://doi.org/10.1186/s10194-019-1017-9. Summarizes putative genes and channelopathies associated with mongenic and polygenic migraine.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Blumenfeld AE, Victorio MC, Berenson FR. Complicated migraines. Semin Pediatr Neurol. 2016;23(1):18–22. https://doi.org/10.1016/j.spen.2016.01.007.

    Article  PubMed  Google Scholar 

  8. Toldo I, Brunello F, Morao V, Perissinotto E, Valeriani M, Pruna D, et al. First attack and clinical presentation of hemiplegic migraine in pediatric age: a multicenter retrospective study and literature review. Front Neurol. 2019;10:1079. https://doi.org/10.3389/fneur.2019.01079.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Pelzer N, Stam AH, Haan J, Ferrari MD, Terwindt GM. Familial and sporadic hemiplegic migraine: diagnosis and treatment. Curr Treat Options Neurol. 2013;15(1):13–27. https://doi.org/10.1007/s11940-012-0208-3.

    Article  PubMed  Google Scholar 

  10. Artto V, Nissila M, Wessman M, Palotie A, Farkkila M, Kallela M. Treatment of hemiplegic migraine with triptans. Eur J Neurol. 2007;14(9):1053–6. https://doi.org/10.1111/j.1468-1331.2007.01900.x.

    Article  PubMed  CAS  Google Scholar 

  11. Papetti L, Ursitti F, Moavero R, Ferilli MAN, Sforza G, Tarantino S, et al. Prophylactic treatment of pediatric migraine: is there anything new in the last decade? Front Neurol. 2019;10:771. https://doi.org/10.3389/fneur.2019.00771.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Olesen J. International classification of headache disorders. Lancet Neurol. 2018;17(5):396–7. https://doi.org/10.1016/S1474-4422(18)30085-1.

    Article  PubMed  Google Scholar 

  13. Demarquay G, Ducros A, Montavont A, Mauguiere F. Migraine with brainstem aura: why not a cortical origin? Cephalalgia. 2018;38(10):1687–95. https://doi.org/10.1177/0333102417738251.

    Article  PubMed  Google Scholar 

  14. Ambrosini A, D'Onofrio M, Grieco GS, Di Mambro A, Montagna G, Fortini D, et al. Familial basilar migraine associated with a new mutation in the ATP1A2 gene. Neurology. 2005;65(11):1826–8. https://doi.org/10.1212/01.wnl.0000187072.71931.c0.

    Article  PubMed  CAS  Google Scholar 

  15. Sweney MT, Newcomb TM, Swoboda KJ. The expanding spectrum of neurological phenotypes in children with ATP1A3 mutations, alternating hemiplegia of childhood, rapid-onset dystonia-parkinsonism, CAPOS and beyond. Pediatr Neurol. 2015;52(1):56–64. https://doi.org/10.1016/j.pediatrneurol.2014.09.015.

    Article  PubMed  Google Scholar 

  16. Dundar NO, Cavusoglu D, Kaplan YC, Hasturk MO. An option to consider for alternating hemiplegia of childhood: aripiprazole. Clin Neuropharmacol. 2019;42(3):88–90. https://doi.org/10.1097/WNF.0000000000000339.

    Article  PubMed  CAS  Google Scholar 

  17. Sergeev AV. Migraine masks’: differential diagnosis of acute headache. Zh Nevrol Psikhiatr Im S S Korsakova. 2018;118(1):96–102. https://doi.org/10.17116/jnevro20181181196-102.

    Article  PubMed  CAS  Google Scholar 

  18. Vollono C, Primiano G, Della Marca G, Losurdo A, Servidei S. Migraine in mitochondrial disorders: prevalence and characteristics. Cephalalgia. 2018;38(6):1093–106. https://doi.org/10.1177/0333102417723568.

    Article  PubMed  Google Scholar 

  19. de Boer I, Stam AH, Buntinx L, Zielman R, van der Steen I, van den Maagdenberg M, et al. RVCL-S and CADASIL display distinct impaired vascular function. Neurology. 2018;91(10):956–63.

    Article  Google Scholar 

  20. El-Hattab AW, Adesina AM, Jones J, Scaglia F. MELAS syndrome: clinical manifestations, pathogenesis, and treatment options. Mol Genet Metab. 2015;116(1–2):4–12. https://doi.org/10.1016/j.ymgme.2015.06.004.

    Article  PubMed  CAS  Google Scholar 

  21. Ikawa M, Povalko N, Koga Y. Arginine therapy in mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes. Curr Opin Clin Nutr Metab Care. 2020;23(1):17–22. https://doi.org/10.1097/MCO.0000000000000610.

    Article  PubMed  CAS  Google Scholar 

  22. Rastogi RG, VanderPluym J, Lewis KS. Migrainous aura, visual snow, and “Alice in wonderland” syndrome in childhood. Semin Pediatr Neurol. 2016;23(1):14–7. https://doi.org/10.1016/j.spen.2016.01.006.

    Article  PubMed  Google Scholar 

  23. Dooley JM, Augustine HF, Gordon KE, Brna PM, Westby E. Alice in wonderland and other migraine associated phenomena-evolution over 30 years after headache diagnosis. Pediatr Neurol. 2014;51(3):321–3. https://doi.org/10.1016/j.pediatrneurol.2014.05.032.

    Article  PubMed  Google Scholar 

  24. Smith RA, Wright B, Bennett S. Hallucinations and illusions in migraine in children and the Alice in wonderland syndrome. Arch Dis Child. 2015;100(3):296–8. https://doi.org/10.1136/archdischild-2013-305283.

    Article  PubMed  CAS  Google Scholar 

  25. Dubey R, Chakrabarty B, Saini L, Madaan P, Gulati S. Bilateral ophthalmoplegia in a child with migraine. Brain and Development. 2016;38(5):525–8. https://doi.org/10.1016/j.braindev.2015.10.014.

    Article  PubMed  Google Scholar 

  26. Okura Y, Wakayama A, Yoshizawa C, Kobayashi I, Takahashi Y. Recurrent painful ophthalmoplegic neuropathy in a 12-year-old boy. Pediatr Int. 2017;59(11):1208–10. https://doi.org/10.1111/ped.13393.

    Article  PubMed  Google Scholar 

  27. Petruzzelli MG, Margari M, Furente F, Costanza MC, Legrottaglie AR, Dicuonzo F, et al. Recurrent painful ophthalmoplegic neuropathy and oculomotor nerve schwannoma: a pediatric case report with long-term MRI follow-up and literature review. Pain Res Manag. 2019;2019:5392945–11. https://doi.org/10.1155/2019/5392945.

    Article  PubMed  PubMed Central  Google Scholar 

  28. • Gelfand AA. Infant Colic. Semin Pediatr Neurol. 2016;23(1):79–82. https://doi.org/10.1016/j.spen.2015.08.003. Characterizes infant colic as the earliest manifestation of the childhood periodic syndromes (associated with migraine).

    Article  PubMed  Google Scholar 

  29. Gelfand AA. Episodic syndromes that may be associated with migraine: a.k.a. “the childhood periodic syndromes”. Headache. 2015;55(10):1358–64. https://doi.org/10.1111/head.12624.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Rosman NP, Douglass LM, Sharif UM, Paolini J. The neurology of benign paroxysmal torticollis of infancy: report of 10 new cases and review of the literature. J Child Neurol. 2009;24(2):155–60. https://doi.org/10.1177/0883073808322338.

    Article  PubMed  Google Scholar 

  31. Rothner AD, Parikh S. Headache currents: migraine variants or episodic syndromes that may be associated with migraine and other unusual pediatric headache syndromes. Headache. 2015;56(1):206–14.

    Article  Google Scholar 

  32. Gelfand AA. Episodic syndromes of childhood associated with migraine. Curr Opin Neurol. 2018;31(3):281–5. https://doi.org/10.1097/WCO.0000000000000558.

    Article  PubMed  Google Scholar 

  33. Irwin S, Barmherzig R, Gelfand A. Recurrent gastrointestinal disturbance: abdominal migraine and cyclic vomiting syndrome. Curr Neurol Neurosci Rep. 2017;17(3):21. https://doi.org/10.1007/s11910-017-0731-4.

    Article  PubMed  Google Scholar 

  34. •• Gelfand A, Gallagher RC. Headache currents: cyclic vomiting syndrome versus inborn errors of metabolism: a review with clinical recommendations. Headache. 2016;56(1):215–21. Highlights red flags which may favor inborn errors of metabolism in the setting of suspected cyclic vomiting syndrome.

    Article  Google Scholar 

  35. Palmer GM, Cameron DJ. Use of intravenous midazolam and clonidine in cyclical vomiting syndrome: a case report. Pediatr Anaesth. 2005;15(1):68–72.

    Article  Google Scholar 

  36. Cristofori F, Thapar N, Saliakellis E, Kumaraguru N, Elawad M, Kiparissi F, et al. Efficacy of the neurokinin-1 receptor antagonist aprepitant in children with cyclical vomiting syndrome. Aliment Pharmacol Ther. 2014;40(3):309–17. https://doi.org/10.1111/apt.12822.

    Article  PubMed  CAS  Google Scholar 

  37. Abu-Arafeh I, Russell G. Prevalence and clinical features of abdominal migraine compared with those of migraine headache. Arch Dis Child. 1995;72(5):413–7. https://doi.org/10.1136/adc.72.5.413.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Dignan F, Abu-Arafeh I, Russell G. The prognosis of childhood abdominal migraine. Arch Dis Child. 2001;84(5):415–8. https://doi.org/10.1136/adc.84.5.415.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Neurology, Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, UT, USA

    Shanna Swartwood & Meghan S. Candee

  2. Department of Neurology, University of Utah, Salt Lake City, UT, USA

    Kendra Pham

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  1. Shanna Swartwood
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Correspondence to Meghan S. Candee.

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Swartwood, S., Pham, K. & Candee, M.S. Pediatric Migraine Phenomena and Variants: Don’t Let Them Go Over Your Head. Curr Pain Headache Rep 24, 47 (2020). https://doi.org/10.1007/s11916-020-00879-3

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  • DOI: https://doi.org/10.1007/s11916-020-00879-3

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