Karsan N, Prabhakar P, Goadsby P J
NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, Denmark Hill, London, SE5 9PJ, UK.
Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, London, SE5 9PJ, UK.
Curr Pain Headache Rep. 2017 Jul;21(7):34. doi: 10.1007/s11916-017-0631-y.
Premonitory symptoms in migraine; symptoms occurring before the onset of migraine pain or aura, are an increasingly recognised area of interest within headache research. It has been recently documented in the literature that these symptoms also occur in children and adolescents, with a comparable phenotype to adults. This review discusses the wide presentation of premonitory symptoms in migraine in children and adolescents, and the importance of understanding how these early symptoms are mediated in order to ensure that targeted abortive therapies are developed in the future. Recognition of these symptoms by parents, guardians, teachers and carers is of importance in ensuring early and effective attack treatment.
A previous clinic-based questionnaire study in 103 children found a prevalence of premonitory symptoms in paediatric migraine of 67%, with a mean number of reported symptoms of two. A recent study found that in a clinic population of 100 children or adolescents with a migraine diagnosis who were preselected as having at least one premonitory symptom associated with their attacks, two or more premonitory symptoms were reported by 85% of patients. The most common symptoms were fatigue, mood change and neck stiffness. Although the population prevalence of premonitory symptoms in migraine within the paediatric population, or their ability to predict accurately the onset of an impending headache cannot be deduced from the retrospective studies performed to date, premonitory symptoms occur in children as young as 18 months old. Understanding the biological basis of these, and their heterogeneous phenotype may help future targeted therapeutic research, helping the development of drugs that act before the onset of pain, limiting the morbidity associated with the migraine attack.
偏头痛的前驱症状，即在偏头痛疼痛或先兆发作之前出现的症状，是头痛研究中一个越来越受关注的领域。最近文献记载，这些症状也见于儿童和青少年，其表型与成人相似。本综述讨论了儿童和青少年偏头痛前驱症状的广泛表现，以及理解这些早期症状如何介导的重要性，以便确保未来开发出有针对性的缓解治疗方法。家长、监护人、教师和护理人员对这些症状的识别对于确保早期和有效的发作治疗至关重要。
之前一项针对103名儿童的基于诊所的问卷调查研究发现，儿童偏头痛前驱症状的患病率为67%，报告症状的平均数为2个。最近一项研究发现，在100名被诊断为偏头痛的儿童或青少年的诊所人群中，这些人被预先选定为至少有一种与其发作相关的前驱症状，85%的患者报告有两种或更多的前驱症状。最常见的症状是疲劳、情绪变化和颈部僵硬。虽然从迄今为止进行的回顾性研究中无法推断出儿童人群中偏头痛前驱症状的总体患病率，或其准确预测即将发生头痛发作的能力，但18个月大的儿童就会出现前驱症状。了解这些症状的生物学基础及其异质性表型可能有助于未来的靶向治疗研究，有助于开发在疼痛发作前起作用的药物，限制与偏头痛发作相关的发病率。
