Premonitory Symptoms of Migraine in Childhood and Adolescence

Abstract

Purpose of ReviewPremonitory 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.Recent FindingsA 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.SummaryAlthough 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.

Developmental innervation of cranial dura mater and migraine headache: A narrative literature review

“…These symptoms can be broadly divided into three categories: (1) hypersensitivities (photophobia, phonophobia, osmophobia, and allodynia); (2) changes in mood and arousal (low mood, fatigue, yawning, elation, irritability, poor memory, and concentration difficulty); and (3) homeostatic alterations (frequency of micturition, change in bowel habit, thirst, and cravings). These premonitory symptoms are largely consistent between children and adults with minor nuances 26 . For instance, there is a mild predilection in children to experience fatigue, mood changes, and neck stiffness 27 .…”

“… Date were compiled using references 1, 4, 26–31, and 41. …”

“…These premonitory symptoms are largely consistent between children and adults with minor nuances. 26 For instance, there is a mild predilection in children to experience fatigue, mood changes, and neck stiffness. 27 Similarly, autonomic features, such as facial swelling, flushing, and sweating, have been less frequently reported in adults.…”

“…27 Similarly, autonomic features, such as facial swelling, flushing, and sweating, have been less frequently reported in adults. 26 The headache phase generally tends to present as throbbing or pulsating in quality. Although all age groups will experience this phase, presentations may vary by age.…”

Migraine Pathophysiology in Children and Adolescents: A Review of the Literature

“…11–15 Face changes were the most reported pediatric prodromal symptoms in the study by Cuvellier et al, 30 while Jacobs et al 32 did not gather data on face changes and Karsan et al 31 chose to exclude all prodromal symptoms that could be interpreted as being caused by cranial autonomic features, including facial swelling, flushing, or sweating. However, Karsan et al 34 write in a later review that it would be sensible going forward to inquire into cranial autonomic symptoms presenting as prodromal symptoms in children, as pallor (7%), hypersalivation (2%), and feeling hot (3%) all were reported as prodromal symptoms in their paper. 31 Thus, it is possible that facial changes may be a part of a subset of autonomically regulated prodromal symptoms.…”