Department of Pediatrics and Adolescent Medicine, Tokyo Medical University, Tokyo, Japan.
J Child Neurol. 2020 Sep;35(10):667-673. doi: 10.1177/0883073820927840. Epub 2020 Jun 1.
Migraines are a broad spectrum of disorders classified by the type of aura with some requiring attentive treatment. Vasoconstrictors, including triptans, should be avoided in the acute phase of migraines with brainstem aura, in hemiplegic migraine, and in retinal migraine. This study investigated the characteristics and burden of these migraines.
Medical charts of 278 Japanese pediatric patients with migraines were retrospectively reviewed. Migraine burden of migraines with brainstem aura, hemiplegic migraines, and retinal migraine was assessed using the Headache Impact Test-6™ (HIT-6) and the Pediatric Migraine Disability Assessment scale (PedMIDAS).
Of 278 patients screened, 12 (4.3%) patients with migraines with brainstem aura (n = 5), hemiplegic migraines (n = 2), and retinal migraine (n = 5) were enrolled in the study. All patients had migraine with/without typical aura, whereas some patients had coexisting migraine with another type of headache (chronic tension-type headache in 3 patients, and 1 each with frequent episodic tension-type headache, headache owing to medication overuse, and chronic migraine). Migraines with brainstem aura, hemiplegic migraines, and retinal migraine patients with coexisting headaches had higher HIT-6 or PedMIDAS scores, whereas migraines with brainstem aura, hemiplegic migraines, and retinal migraine patients without coexisting headache did not show high HIT-6 or PedMIDAS scores.
All migraines with brainstem aura, hemiplegic migraines, and retinal migraine patients experienced migraine with or without typical aura, and some patients having other coexisting headaches also had high PedMIDAS and HIT-6 scores. PedMIDAS and HIT-6 should not be considered diagnostic indicators of migraines with brainstem aura, hemiplegic migraines, or retinal migraine. In clinical practice for headaches in children, careful history taking and proactive assessment of the aura are needed for accurate diagnosis of migraines with brainstem aura, hemiplegic migraines, and retinal migraine.
偏头痛是一种广泛的疾病谱，根据先兆类型进行分类，其中一些需要进行关注治疗。在伴有脑干先兆的偏头痛、偏瘫性偏头痛和视网膜性偏头痛的急性发作期，应避免使用血管收缩剂，包括曲普坦类药物。本研究调查了这些偏头痛的特征和负担。
回顾性分析 278 例日本儿科偏头痛患者的病历。使用头痛影响测试-6 （HIT-6）和儿科偏头痛残疾评估量表（PedMIDAS）评估伴有脑干先兆、偏瘫性偏头痛和视网膜性偏头痛的偏头痛负担。
在筛查的 278 例患者中，有 12 例（4.3%）伴有脑干先兆（n=5）、偏瘫性偏头痛（n=2）和视网膜性偏头痛（n=5）的偏头痛患者被纳入研究。所有患者均有伴或不伴典型先兆的偏头痛，而一些患者还伴有其他类型的头痛（3 例为慢性紧张型头痛，1 例为频繁发作性紧张型头痛、药物过度使用性头痛和慢性偏头痛各 1 例）。伴有脑干先兆、偏瘫性偏头痛和视网膜性偏头痛且伴有共存头痛的患者 HIT-6 或 PedMIDAS 评分较高，而伴有脑干先兆、偏瘫性偏头痛和视网膜性偏头痛且无共存头痛的患者 HIT-6 或 PedMIDAS 评分不高。
所有伴有脑干先兆、偏瘫性偏头痛和视网膜性偏头痛的患者均经历了伴或不伴典型先兆的偏头痛，一些伴有其他共存头痛的患者也有较高的 PedMIDAS 和 HIT-6 评分。PedMIDAS 和 HIT-6 不应作为伴有脑干先兆、偏瘫性偏头痛或视网膜性偏头痛的偏头痛的诊断指标。在儿童头痛的临床实践中，需要仔细询问病史并主动评估先兆，以准确诊断伴有脑干先兆、偏瘫性偏头痛和视网膜性偏头痛的偏头痛。
