Migraine Premonitory Signs in Pediatric Patients

Child with headache
Child with headache
Children with headache and migraine, particularly girls younger than12 years of age, experience premonitory signs.
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BOSTON — Children with headache and migraine, particularly girls younger than 12 years of age, experience premonitory symptoms, according to a study presented at the American Headache Society (AHS) 56th Annual Scientific Meeting.1

A cross-sectional study published in 2016 found the prevalence of premonitory signs of migraine among adults to be 77% (n=2714),2 and a retrospective study focusing on pediatric patients found it to be 67% in this population (n=103).3 Dr Jacobs and colleagues conducted a prospective study in which they surveyed all new pediatric patients coming to their clinic at the Nationwide Children’s Hospital in Columbus, Ohio, between June and December 2016 (n=207; 53.3% girls; ages 5 to 18 years). The only exclusion criteria for this study was prior treatment for migraine.

The survey was based on the most common premonitory signs previously identified. The child or his/her parents were asked whether prior to headaches they had experienced fatigue, yawning, mood changes, neck stiffness, food cravings, urinary changes, or none of those signs. Out of the 207 patients enrolled, 185 were diagnosed with migraine or new daily persistent headache and 22 with tension-type headache, chronic tension-type headache, post-concussion syndrome, or primary stabbing headache. Among the patients, 79 (38.8%) noted premonitory signs; in the migraine or new daily persistent headache group, the prevalence was 41.1%. The most common premonitory symptoms were fatigue (68.4%) and mood changes (56.6%). Yawning, neck stiffness, food cravings, and urinary changes were not significant, with either 1 or no report. In addition, the researchers found the premonitory signs to be more likely to be present in patients with chronic migraine (60%) and migraine with aura (57.1%) vs migraine without aura (31.2%). These symptoms were also more likely in female vs male patients (44.9% vs 34.3%), and slightly more likely in patients ≤12 years of age (42.5% vs 39.8% for patients >12 years). Girls ≤12 years of age were the group with the highest prevalence of premonitory signs (48.4%).

For 75% of patients, there was a family history of migraine, with the patient’s mother experiencing migraine or headache. This prevalence rose to 92% for the mother’s family and was 38% for the father’s family. Medication was overused by 19% of all patients and by 35% of patients with migraine. Dr Jacobs noted that the study is limited by recall and suggestion biases. The data are currently being analyzed for statistical significance.

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  1. Jacobs H. Premonitory symptoms in pediatric migraine: a prospective study. Presented at: American Headache Society (AHS) 56th Annual Scientific Meeting; June 8-11, 2017; Boston, MA.
  2. Laurell K, Artto V, Bendtsen L, et al. Premonitory symptoms in migraine: A cross-sectional study in 2714 persons. Cephalalgia. 2016;36(10):951-959.
  3. Cuvellier JC, Mars A, Vallée L. The prevalence of premonitory symptoms in paediatric migraine: a questionnaire study in 103 children and adolescents. Cephalalgia. 2009;29(11):1197-1201.