Karsan N, Prabhakar P, Goadsby P J
Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Department of Paediatric Neurology, Great Ormond Hospital for Children NHS Foundation Trust, London, UK.
J Headache Pain. 2016 Dec;17(1):94. doi: 10.1186/s10194-016-0689-7. Epub 2016 Oct 21.
The premonitory stage of migraine attacks, when symptomatology outside of pain can manifest hours to days before the onset of the headache, is well recognised. Such symptoms have been reported in adults in a number of studies, and have value in predicting an impending headache. These symptoms have not been extensively studied in children. We aimed to characterise which, if any, of these symptoms are reported in children seen within a Specialist Headache Service.
We reviewed clinic letters from the initial consultation of children and adolescents seen within the Specialist Headache Service at Great Ormond Street Hospital between 1999 and 2015 with migraine in whom we had prospectively assessed clinical phenotype data. We randomly selected 100 cases with at least one premonitory symptom recorded in the letter. For these patients, the age at headache onset, presence of family history of headache, headache diagnosis, presence of episodic syndromes which may be associated with headache, developmental milestones, gestation at birth, mode of delivery and presence of premonitory symptoms occurring before or during headache were recorded.
Of the 100 patients selected, 65 % were female. The age range of the patients was 18 months to 15 years at the time of headache onset. The most common diagnosis was chronic migraine in 58 %, followed by episodic migraine (29 %), New Daily Persistent Headache with migrainous features (8 %) and hemiplegic migraine (5 %). A history of infantile colic was noted in 31 % and was the most common childhood episodic syndrome associated with migraine. The most common premonitory symptoms recorded were fatigue, mood change and neck stiffness. The commonest number of reported premonitory symptoms was two.
Premonitory symptoms associated with migraine are reported in children as young as 18 months, with an overall clinical phenotype comparable to adults. Better documentation of this stage will aid parents and clinicians to better understand the phenotype of attacks, better recognise migraine and thus initiate appropriate management. Larger studies with a broader base are warranted to understand the extent and implications of these symptoms for childhood and adolescent migraine.
偏头痛发作的前驱期是众所周知的，此时疼痛以外的症状可在头痛发作前数小时至数天出现。在许多针对成人的研究中已报告了此类症状，且这些症状在预测即将发生的头痛方面具有价值。但这些症状在儿童中尚未得到广泛研究。我们旨在确定在专科头痛服务机构就诊的儿童中报告了哪些此类症状（若有）。
我们回顾了1999年至2015年间在大奥蒙德街医院专科头痛服务机构初诊的患有偏头痛的儿童和青少年的临床信件，我们已前瞻性地评估了这些患者的临床表型数据。我们随机选择了100例在信件中记录了至少一种前驱症状的病例。对于这些患者，记录了头痛发作时的年龄、头痛家族史、头痛诊断、可能与头痛相关的发作性综合征、发育里程碑、出生时的孕周、分娩方式以及头痛前或头痛期间出现的前驱症状。
在所选的100例患者中，65%为女性。头痛发作时患者的年龄范围为18个月至15岁。最常见的诊断是慢性偏头痛（58%），其次是发作性偏头痛（29%）、具有偏头痛特征的新发性每日持续性头痛（8%）和偏瘫性偏头痛（5%）。31%的患者有婴儿腹绞痛病史，这是与偏头痛相关的最常见的儿童发作性综合征。记录的最常见的前驱症状是疲劳、情绪变化和颈部僵硬。报告的前驱症状最常见的数量是两种。
18个月大的儿童就报告了与偏头痛相关的前驱症状，其总体临床表型与成人相当。更好地记录这一阶段将有助于家长和临床医生更好地理解发作的表型，更好地识别偏头痛，从而启动适当的管理。有必要进行更大规模、更广泛基础的研究，以了解这些症状对儿童和青少年偏头痛的程度及影响。
