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Pediatric Migraine: Clinical Advances in Diagnosis and Treatment

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (25 August 2023) | Viewed by 25284

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Special Issue Editors

Dr. Vincenzo Raieli

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Guest Editor

Child Neuropsychiatry Unit, ISMEP, ARNAS Civico, Palermo, Italy
Interests: aura and migraine; headaches in younger children; cranial autonomic symptoms and pediatric migraine; primary pediatric headaches
Special Issues, Collections and Topics in MDPI journals

Dr. Vittorio Sciruicchio

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Children Epilepsy and EEG Center, San Paolo Hospital, ASL Bari, 70132 Bari, Italy
Interests: pediatric migraine; epilepsy in childhood; EEG and neurological diseases; fibromyalgia and children
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Migraine is a common and crippling neurological disorder in the paediatric population. Despite the significant amount of data on paediatric headaches, they continue to be an important challenge for clinicians. In fact, they are probably the most frequent neurological symptom because of the frequency with which children and adolescents are referred to a doctor or an emergency department.

The child is not only a “little adult"; during childhood and adolescence, migraine can vary significantly according to different ages, not only in clinical and prognostic aspects but also in the response to therapy. There is also evidence that the pathophysiological mechanisms can depend on the patients' age and we can obtain new information through neurophysiological and functional instruments. Therefore, it would be important to have more information about its characteristic clinical aspects, especially in early childhood, the adaptability of the diagnostic criteria of the latest HIS classification, and the outcome at later ages. Furthermore, it is crucial to investigate possible changes in the COVID-19 era, related comorbidities, the response to pharmacological and non-pharmacological therapies, the functioning and role of placebos, etc.

The main aim of the present Special Issue is to collect clinical observations and experimental evidence showing the peculiarity of migraine at this early stage of life. We hope that this collection can help our fellow clinicians to recognize and efficaciously treat migraine in younger patients.

Dr. Vincenzo Raieli
Dr. Vittorio Sciruicchio
Guest Editors

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Keywords

migraine
headache
preventive treatment
acute treatment
clinical features
children
aura
non pharmacological treatment
comorbidity
COVID-19 and migraine

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Published Papers (10 papers)

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Editorial

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2 pages, 173 KiB

Open AccessEditorial

Pediatric Migraine: Diagnosis and Management

by Vincenzo Raieli and Vittorio Sciruicchio

J. Clin. Med. 2022, 11(24), 7252; https://doi.org/10.3390/jcm11247252 - 7 Dec 2022

Viewed by 1432

Abstract

The WHO recognizes migraine as one of the most disabling diseases [...] Full article

(This article belongs to the Special Issue Pediatric Migraine: Clinical Advances in Diagnosis and Treatment)

Research

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9 pages, 259 KiB

Open AccessArticle

Cardiovascular Risk Factors and Family History of Major Thrombotic Events in Children with Migraine: A 12-Year Retrospective Single-Centre Study

by Roberta Rossi, Stefania Benetti, Barbara Lauria, Giulia Grasso, Emanuele Castagno, Fulvio Ricceri, Claudia Bondone and Antonia Versace

J. Clin. Med. 2023, 12(7), 2582; https://doi.org/10.3390/jcm12072582 - 29 Mar 2023

Viewed by 1206

Abstract

Background: Migraine is one of the most frequent primary headaches in childhood. The role of thrombotic predisposition in its pathogenesis is debated. Our aim was to analyse the cardiovascular risk factors and family history of major thrombotic events in children with migraine. Methods: A retrospective, single-centre study was performed over 12 years. Our headache centre record database was screened for migraine with aura (MA) and migraine without aura (MO) on the basis of the ICHD-II (until 2013) and III criteria. A control group of otherwise healthy children was recruited. Descriptive and multivariate analyses are provided; significance was set at p < 0.05. Results: Migraine was diagnosed in 930 children (24.7% MA); 73.3% were 9–14 years old. Children with MA were older (p < 0.001). A family history of cerebral ischemic events at ≤50 years old was more commonly reported by children with MA than those with MO (p < 0.001) and those in the control group (p = 0.001). Children with MA showed a higher risk of a family history of cerebral ischemic events at ≤50 years old than children with MO (OR: 2.6) and those in the control group (OR: 3.1). When comparing the family history of DVT, we observed a significantly increased risk for MA vs. MO (OR: 2.9). Conclusion: A family history of cerebral ischemic events at ≤50 years old leads to an increased risk of MA. Further studies are needed to explore such an association. Full article

(This article belongs to the Special Issue Pediatric Migraine: Clinical Advances in Diagnosis and Treatment)

11 pages, 682 KiB

Open AccessArticle

Evolution of Pediatric Migraine Patients Admitted at an Emergency Department after a 10-Year Follow-Up

by Maria Laura Manzo, Federica Reina, Edvige Correnti, Francesca D’Aiuto, Daniela D’Agnano, Andrea Santangelo, Luigi Vetri, Giuseppe Santangelo, Laura Maniscalco, Gabriele Tripi, Vittorio Sciruicchio and Vincenzo Raieli

J. Clin. Med. 2023, 12(7), 2475; https://doi.org/10.3390/jcm12072475 - 24 Mar 2023

Cited by 1 | Viewed by 1896

Abstract

Background: Despite its high prevalence, the clinical course of pediatric migraine has not been fully understood, and previous studies present conflicting results. We present here the findings of a 10-year follow-up study involving children with severe migraine pain admitted to our emergency department. Furthermore, all studies were carried out on selected outpatient clinical case studies. Our aim was to evaluate a population of migraine children admitted to an emergency department because of increased severity or frequency of pain or even because of very anxious parents concerning their child’s headache in order to describe their long-term outcomes, whether it differed from that of outpatient populations and to identify possible predictors of prognosis. Methods: We recruited 80 subjects with migraine headaches (mean age 8 years with a range of 4–14 years, 50% females), attending the baseline examination of a population admitted for a headache to the Emergency Department in the first half year of 2012. Of the 80 subjects, 48 (60%) were eligible for follow-up in 2022. We included in our study only patients diagnosed with migraine, according to the diagnostic criteria of the International Classification of Headache Disorders. All were contacted by telephone, and a semi-structured questionnaire was provided to them by email. The association between several possible prognostic factors (gender, familiar neurologic disorders, prenatal and perinatal disorders, social activities, sleep disorders, etc.) and the long-term persistence of migraine headaches were explored using logistic regression analysis. Results: Of 48 subjects with migraine headaches at baseline, 31 (65%) had persistent migraine, and 17 (35%) experienced remission. The preliminary results showed that the presence of neurologic disorders in parents (p < 0.01—odds ratio 9.34 (2.53–41.64) and sleep disorders (p < 0.01—odds ratio 13.18 (2.25–252.74) significantly predicted the 10-year persistence of migraine headaches, while the other considered predictors were found not to influence prognosis. Conclusions: To our knowledge, this was the first study conducted on a selected pediatric population upon admission to the emergency room. Our study suggests that a population of pediatric migraine selected for admission to the emergency department also shows a favorable long-term prognosis, like the studies conducted in the outpatient sample. Familial neurological comorbidity and sleep disorders were unfavorable factors for predicting good outcomes. Full article

(This article belongs to the Special Issue Pediatric Migraine: Clinical Advances in Diagnosis and Treatment)

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10 pages, 1563 KiB

Open AccessArticle

Real Life Data on OnabotulinumtoxinA for Treatment of Chronic Migraine in Pediatric Age

by Laura Papetti, Ilaria Frattale, Fabiana Ursitti, Giorgia Sforza, Gabriele Monte, Michela Ada Noris Ferilli, Samuela Tarantino, Martina Proietti Checchi and Massimiliano Valeriani

J. Clin. Med. 2023, 12(5), 1802; https://doi.org/10.3390/jcm12051802 - 23 Feb 2023

Cited by 4 | Viewed by 1953

Abstract

Background: The use of OnabotulinumtoxinA (OBT-A) for the treatment of chronic migraine (CM) in adults represents a therapy with the greatest efficacy and safety data. However, we have little evidence on the use of OBT-A in children or adolescents. The present study aims to describe the experience with OBT-A in the treatment of CM in adolescents in an Italian third-level headache center. Methods: The analysis included all patients under the age of 18 treated with OBT-A for CM at the Bambino Gesù Children’s Hospital. All patients received OBT-A following the PREEMPT protocol. Subjects were classified as good responders if a greater than 50% reduction in the monthly frequency of attacks was observed, partial responders if the reduction was between 30 and 50%, and non-responders if it was <30%. Results: The treated population consisted of 37 females and 9 males with a mean age of 14.7 years. Before starting OBT-A, 58.7% of the subjects had attempted prophylactic therapy with other drugs. From OBT-A initiation to the last clinical observation, the mean duration of follow-up was 17.6 ± 13.7 SD (range: 1–48) months. The number of OBT-A injections were 3.4 ± 3 SD. Sixty eight percent of the subjects responded to treatment within the first three administrations of OBT-A. Proceeding with the number of administrations, a progressive improvement in frequency was further observed. Conclusions: The use of OBT-A in pediatric age can have benefits in terms of reduction in the frequency and intensity of headache episodes. Furthermore, treatment with OBT-A has an excellent safety profile. These data support the use of OBT-A in the treatment of childhood migraine. Full article

(This article belongs to the Special Issue Pediatric Migraine: Clinical Advances in Diagnosis and Treatment)

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Review

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15 pages, 486 KiB

Open AccessReview

Non-Pharmacological Treatments in Paediatric Migraine

by Valentina Baglioni, Fabiola Bozza, Annachiara Beatrice, Noemi Cameli, Elisa Maria Colacino Cinnante, Giuliana Lentini, Noemi Faedda, Giulia Natalucci and Vincenzo Guidetti

J. Clin. Med. 2024, 13(5), 1278; https://doi.org/10.3390/jcm13051278 - 23 Feb 2024

Cited by 4 | Viewed by 3108

Abstract

Psychological, social, and biological aspects contribute synergistically to the maintenance and chronicity of pain in primary headaches. An integrated intervention seems to be the most appropriate in the management of these conditions, taking advantage not only of pharmacological strategies, but also of different approaches according to the global assessment and patient necessities. In this perspective, non-pharmacological treatments are becoming increasingly used to overcome these issues also in paediatric migraine treatment. Particularly, nutraceuticals, non-invasive neuromodulation, and behavioural approaches are well tolerated and of potential interest. This paper aims to present the main approaches reported in the literature in the management of migraine in children and adolescents presenting an up-to-date review of the current literature. We therefore performed a narrative presentation for each of these three categories: nutraceuticals (riboflavin; magnesium; melatonin; vitamin D; coenzyme Q10; and polyunsaturated fatty acid); non-invasive neuromodulation (trigeminal nerve stimulator; non-invasive vagal nerve stimulation; transcranial magnetic stimulation; and remote electrical neuromodulation), and behavioural therapies (biofeedback; cognitive behavioural therapy; and mindfulness-based therapy). These approaches are increasingly seen as a valid treatment option in primary headache management also in paediatrics, avoiding medication overuse and drug treatment contraindications. Full article

(This article belongs to the Special Issue Pediatric Migraine: Clinical Advances in Diagnosis and Treatment)

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19 pages, 374 KiB

Open AccessReview

Hemiplegic Migraine in Children and Adolescents

by Ilaria Bonemazzi, Francesco Brunello, Jacopo Norberto Pin, Mattia Pecoraro, Stefano Sartori, Margherita Nosadini and Irene Toldo

J. Clin. Med. 2023, 12(11), 3783; https://doi.org/10.3390/jcm12113783 - 31 May 2023

Cited by 6 | Viewed by 3063

Abstract

Background: Only a few studies have focused on hemiplegic migraine (HM) in children despite its early age of onset. The aim of this review is to describe the peculiar characteristics of pediatric HM. Methods: This is a narrative review based on 14 studies on pediatric HM selected from 262 papers. Results: Different from HM in adults, pediatric HM affects both genders equally. Early transient neurological symptoms (prolonged aphasia during a febrile episode, isolated seizures, transient hemiparesis, and prolonged clumsiness after minor head trauma) can precede HM long before its onset. The prevalence of non-motor auras among children is lower than it is in adults. Pediatric sporadic HM patients have longer and more severe attacks compared to familial cases, especially during the initial years after disease onset, while familial HM cases tend to have the disease for longer. During follow-up, the frequency, intensity, and duration of HM attacks often decrease. The outcome is favorable in most patients; however, neurological conditions and comorbidities can be associated. Conclusion: Further studies are needed to better define the clinical phenotype and the natural history of pediatric HM and to refine genotype–phenotype correlations in order to improve the knowledge on HM physiopathology, diagnosis, and outcome. Full article

(This article belongs to the Special Issue Pediatric Migraine: Clinical Advances in Diagnosis and Treatment)

21 pages, 425 KiB

Open AccessReview

Migraine, Allergy, and Histamine: Is There a Link?

by Alessandro Ferretti, Mattia Gatto, Margherita Velardi, Giovanni Di Nardo, Thomas Foiadelli, Gianluca Terrin, Manuela Cecili, Umberto Raucci, Massimiliano Valeriani and Pasquale Parisi

J. Clin. Med. 2023, 12(10), 3566; https://doi.org/10.3390/jcm12103566 - 19 May 2023

Cited by 7 | Viewed by 4687

Abstract

The relationship between migraines and allergies is controversial. Though they are epidemiologically linked, the underlying pathophysiological connection between them remains unclear. Migraines and allergic disorders have various underlying genetic and biological causes. As per the literature, these conditions are epidemiologically linked, and some common pathophysiological pathways have been hypothesized. The histaminergic system may be the clue to understanding the correlation among these diseases. As a neurotransmitter in the central nervous system with a vasodilatory effect, histamine has a well-documented influence on the allergic response and could be involved in the pathophysiology of migraines. Histamine may influence hypothalamic activity, which may play a major role in migraines or may simply influence their severity. In both cases, antihistamine drugs could prove useful. This review examines whether the histaminergic system, particularly H3 and H4 receptors, may provide a mechanistic link between the pathophysiology of migraines and allergic disorders, two common and debilitating conditions. Identifying their connection could help identify novel therapeutic strategies. Full article

(This article belongs to the Special Issue Pediatric Migraine: Clinical Advances in Diagnosis and Treatment)

11 pages, 328 KiB

Open AccessReview

Visual Disturbances Spectrum in Pediatric Migraine

by Ilaria Frattale, Laura Papetti, Fabiana Ursitti, Giorgia Sforza, Gabriele Monte, Alessandra Voci, Martina Proietti Checchi, Luigi Mazzone and Massimiliano Valeriani

J. Clin. Med. 2023, 12(8), 2780; https://doi.org/10.3390/jcm12082780 - 8 Apr 2023

Cited by 1 | Viewed by 3269

Abstract

Migraine is a complex neurological disorder with partially unknown pathophysiological mechanisms. The prevalence in childhood ranges from 7.7% to 17.8%, thus representing the most frequent primary headache. In half of the cases, migraine is accompanied or preceded by various neurological disturbances, among which the visual aura is the best known. In literature, other conditions, such as Alice in Wonderland Syndrome and Visual Snow syndrome, are characterized by visual manifestations and are often associated with migraine. The aim of this narrative review is to describe the spectrum of visual disturbances in pediatric migraine and their pathophysiological mechanisms. Full article

(This article belongs to the Special Issue Pediatric Migraine: Clinical Advances in Diagnosis and Treatment)

10 pages, 225 KiB

Open AccessReview

Headache and Psychological Comorbidities: An Appraisal of the Evidence

by Ishaq Abu-Arafeh

J. Clin. Med. 2023, 12(7), 2683; https://doi.org/10.3390/jcm12072683 - 4 Apr 2023

Cited by 8 | Viewed by 2058

Abstract

Background: It has been observed that there is a higher-than-expected risk of anxiety and depression in children with chronic headache and also an increased risk for the persistence of headache in patients with anxiety and depression. Objectives: This review aims to identify and assess the relationships between primary headache disorders and comorbid emotional and psychological disorders. Methods: A targeted review of the literature was carried out. Results: The associations between the disorders are more pronounced in clinic patients, who may represent the severe end of the headache spectrum, but less clear in patients who were identified in population-based studies and who may represent the “average” child with headache or the “average” child with psychological disorders. Conclusions: Understanding this bidirectional association of comorbid disorders is of great importance to offering a holistic biopsychosocial approach to the management of headache disorders in children and adolescents and in addressing the risks for and the co-existence of psychological comorbidities. Full article

(This article belongs to the Special Issue Pediatric Migraine: Clinical Advances in Diagnosis and Treatment)

Other

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11 pages, 1674 KiB

Open AccessBrief Report

Clinical Correlates of Osmophobia in Primary Headaches: An Observational Study in Child Cohorts

by Vittorio Sciruicchio, Daniela D’Agnano, Livio Clemente, Alessandra Rutigliano, Anna Laporta and Marina de Tommaso

J. Clin. Med. 2023, 12(8), 2939; https://doi.org/10.3390/jcm12082939 - 18 Apr 2023

Cited by 2 | Viewed by 1529

Abstract

Primary headaches, especially migraines, have a significant impact on physical and mental health, as well as on the scholarly performance and quality of life of children and adolescents. Osmophobia could be a potential diagnostic marker of migraine diagnosis and disability. This multicenter observational cross-sectional study included 645 children, aged 8–15, with a diagnosis of primary headaches. We took into consideration the duration, intensity and frequency of headaches, pericranial tenderness, allodynia and osmophobia. In a subgroup of migraine children, we evaluated the migraine-related disability, Psychiatric Self-Administration Scales for Youths and Adolescents, and the Child Version of the Pain Catastrophizing Scale. Osmophobia was found to be present in 28.8% of individuals with primary headaches, with children suffering from migraines having the highest prevalence (35%). Migraine patients with osmophobia also showed a more severe clinical picture, with enhanced disability, anxiety, depression, pain catastrophizing, and allodynia symptoms (F Roy square 10.47 p < 0.001). The presence of osmophobia could help in identifying a clinical migraine phenotype coherent with an abnormal bio-behavioral allostatic model that is worthy of prospective observations and careful therapeutic management. Full article

(This article belongs to the Special Issue Pediatric Migraine: Clinical Advances in Diagnosis and Treatment)

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