All
forms of migraine, with the exception of cluster headache, occur in
childhood. Childhood migraine would also include the childhood periodic
syndromes that may be precursors to or associated with migraine (1.5 in the
IHS Classification). Some of the periodic syndromes were discussed earlier
under other varieties of migraine. The incidence of migraine in childhood
has been estimated at between 2% and 5.7%.191,192 It is
probable that most migrainous episodes actually begin early in childhood,192,193
but the diagnosis is not often made until the child is old enough to
describe the symptoms. Holguin and Fenichel194 reviewed the
characteristics of migraine in a group of 55 children. They stated that the
clinical picture of migraine in school‑age children is only more frequent in
the child, and abdominal symptoms are often more prominent.
The
visual symptoms experienced by children may be striking. Hachinski et al195
reviewed the symptomatology of 100 children with migraine. Seventy‑seven of
the 100 patients had transient visual impairment or binocular scotomas.
Total obscuration of vision was more common that hemianopia. Altitudinal or
quadrantic defects were unusual but did occur. Distortions of vision such as
micropsia and macropsia, inversion of vision, or alterations in the
perception of motion, and even elaborate hallucinations were experienced by
16 patients. Uniocular visual impairment occurred in 7 children.
A
particularly unusual type of migraine, with recurrent attacks of impairment
of time sense, body image, and visual analysis of the environment, has been
termed the 'Alice in Wonderland' syndrome. Golden196 reported 2
such children who retained a clear state of consciousness during recurrent
episodes. An excerpt from the description an 11‑year‑old girl is included:
As I started to go into Mommy's room I grabbed my door ‑‑ it felt about
one foot thick in my hand. As I went through the hall, it felt as if I was
going too fast. (Like you want to stop but energy is keening up inside of
you. You feel like you're going to burst and your eyes are going to pop out
‑ like you're going to explode.) Things were going too fast. I felt like my
hands were made of tiny twigs with a little mushy flesh on the
outside. I felt like I was holding things in my hands.
Migraine
may be triggered by head trauma in children197 and some of the
posttraumatic syndromes may be related to migraine. The suggestion has been
made that transient blindness following head injury in childhood198
may occur primarily in children with a history of migraine.199
Acute confusional states in juveniles may also represent migraine.156
The
treatment of childhood migraine is similar to that of adult migraine (see
Therapy) and is theoretically directed toward preventing vascular
dilatation.200 The prognosis in childhood migraine is thought to
be good,201 but a complete follow‑up study has not been reported.195