Migraine Location, Quality Different in Pediatric vs Adult Populations

The following article is part of live conference coverage from the 2017 American Headache Society (AHS) Annual Meeting in Boston, Massachusetts. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AHS 2017.

BOSTON – Children may exhibit different patterns of migraine location and quality than adolescents and adults, according to a study presented at the 59^th annual scientific meeting of the American Headache Society.¹

Migraine affects an estimated 2.5% of children aged ≤7 years, 5% of children aged between 7 years and puberty onset (with a greater prevalence in girls), and 10% of girls and 5% of boys post puberty.²

Although some migraine criteria specific to pediatric populations have been included in the International Classification of Headache Disorders (ICHD)-3 beta version,³ the majority have been established based on the observation of adult patients (eg, unilateral location, pulsating quality for migraine without aura), and may therefore not apply to children.

Researchers at Boston Children’s Hospital sought to compare location and quality of migraine-related pain in children (ages 7 to 11 years), adolescents (ages 12 to 18 years), and young adults (ages 19 to 26 years; n=20 in each group). Study participants were asked to locate their headache pain on a diagram. They were instructed to communicate the type of pain they were experiencing by choosing from an array of descriptors and responding to a questionnaire. In addition, they were asked to “map the progression of their headache pain, from start to finish, regardless of pain quality descriptor.”

The main 3 descriptors of pain quality that were reported across all 3 groups were “throbbing,” “pounding,” and “pressing.” Children described throbbing sensations to a lesser extent than adolescents (P =.0079) or young adults (P =.0004). No differences were found for pounding or pressing sensations between the 3 groups. Unlike for adolescents and young adults, children reported “tightening” in addition to pounding and pressing as their main migraine-associated pain qualities.

A majority of adolescents (60%) and young adults (85%) noted a bilateral distribution of headache pain, in contrast with previous studies; this was also the case in children (75%).

The researchers note that “a majority of migraineurs reported bilateral headache pain, and pulsating was not included in the top three pain descriptors for any of the groups [in the ICHD-3 beta diagnostic criteria for migraine].” They conclude that “These results demonstrate differences in migraine presentation between the pediatric and adult populations. Although it is unclear when the shift from the pediatric to adult clinical presentation occurs, there is a continued need to reevaluate the ICHD diagnostic criteria to address differences between the two patient populations.”

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References

1. Ludwick A. Mapping pain in pediatric migraine. Presented at: The American Headache Society 59th Annual Meeting. June 8-11, 2017; Boston, Massachusetts.
2. Raluca Ioana T, Oana V, Mihai TD, Epure DA. Treatment of pediatric migraine: a review. Maedica (Buchar). 2016;11(2):136-143.
3. McAbee GN, Morse AM, Assadi M. Pediatric aspects of headache classification in the International Classification of Headache Disorders-3 (ICHD-3 beta version). Curr Pain Headache Rep. 2016;20(1):7.