Diagnosis and Treatment of Migraine in Children Should Consider Atopy

Clinical evidence supporting a strong relationship between cephalalgic migraine and allergic rhinitis in children suggests that utilizing different diagnostic and therapeutic approaches, including antihistamines or nasal decongestant sprays for treating migraine attacks, will reduce the onset of headaches and provide better health outcomes, according to a study published in the Polish Journal of Otolarynogology.

The study population included 96 children who reported cephalalagic symptoms in a questionnaire filled out by the parents. Of these, 67 children also suffered from allergies when tested in accordance with international guidelines.

The entire study sample underwent standard procedures used to diagnose the allergic condition (anterior rhinoscopy, nasal endoscopy, rhinomanometry, nasal cytology) and various clinical characteristics of cephalalagy to determine any correlation between allergy and headache onset. Duration of headache, frequency of attacks, time of headache occurrence, age and gender, family history, presence of prodromal symptoms, and therapies administered were examined.

A relationship between age and gender was determined in subjects >13 years, in which more girls experienced headache and allergy than boys; no statistical difference between boys and girls was observed in children younger <13 years. Time of day also showed significant correlation between migraine pain and presence of allergy: subjects with allergy reported headaches in the morning, whereas those without allergy experienced headaches in the evening. Other clinical characteristics were not significant.

The study findings support a relationship between headache and allergic rhinitis in children, with 67% of the study sample presenting both conditions. This indicates that pediatricians should consider symptoms related to allergy when diagnosing cephalalgic triggers. Understanding this relationship provides new opportunities to treat childhood migraine with drugs traditionally used for allergy relief.

Reference

Passali FM, Spinosi MC, Mignacco G, Cingi C, Rodriguez HA, Passali D. Influence of allergic rhinitis in children and adolescents with recurrent headache [published online April 30, 2018]. Pol J Otolarynogol. doi: 10.1007/s40263-018-0522-8