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  • Perspective
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The childhood migraine syndrome

Nature Reviews Neurology volume 17, pages 449–458 (2021)Cite this article

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Abstract

Migraine is a complex genetic brain disorder with an intricate pathogenesis and polymorphous clinical presentations, particularly in children. In this Perspective, we describe the different phenotypes of migraine in children, including conditions that have been referred to in the International Classification of Headache Disorders as “syndromes that may be related to migraine’’. Evidence is presented for the integration of abdominal migraine, cyclical vomiting syndrome, benign paroxysmal vertigo, benign paroxysmal torticollis and infantile colic into the unified diagnosis of ‘childhood migraine syndrome’ on the basis of clinical and epidemiological characteristics, and shared inheritance. In our opinion, such integration will guide clinicians from specialities other than neurology to consider migraine in the assessment of children with these disorders, as well as stimulate research into the genetics, pathophysiology and clinical features of all disorders within the syndrome. A diagnosis of childhood migraine syndrome would also enable patients to benefit from inclusion in clinical trials of old and new migraine treatments, thus potentially increasing the number of treatment options available.

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Fig. 1: Prevalence of headache and migraine in schoolchildren.

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Author information

Authors and Affiliations

  1. Paediatric Neurosciences Unit, Royal Hospital for Children, Glasgow, UK

    Ishaq Abu-Arafeh

  2. Neurology and Pediatrics, University of California San Francisco, San Francisco, CA, USA

    Amy A. Gelfand

Authors
  1. Ishaq Abu-Arafeh
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  2. Amy A. Gelfand
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Contributions

I.A.-A. carried out the literature review, wrote the first draft, and edited and approved subsequent drafts. A.A.G. contributed to the literature review, added to the first draft, and edited and approved subsequent drafts.

Corresponding author

Correspondence to Ishaq Abu-Arafeh.

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Competing interests

I.A.-A. is the Chairman of the Child and Adolescent Standing Committee of the International Headache Society, is a Chief Investigator for two clinical trials sponsored by Eli-Lilly and a Principal Investigator for a clinical trial sponsored by Amgen. A.A.G. has received consulting fees from Biohaven, has received honoraria from JAMA Neurology and UpToDate, and receives grant support from Amgen and the Duke Clinical Research Institute. She receives a stipend from the American Headache Society for her role as Editor of Headache. The spouse of A.A.G. reports research support (to UCSF) from Genentech for a clinical trial, honoraria for editorial work from Dynamed Plus, and personal compensation for medical legal consulting.

Additional information

Informed consent

The authors affirm that human research participants provided informed consent for publication of the video in Supplementary Video 1.

Peer review information

Nature Reviews Neurology thanks V. Guidetti, F. Heinen, A. Verrotti and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Review criteria

In preparing this Perspective, literature searches of PubMed and Google Scholar were carried out to assess original research on components of the migraine syndrome. It was not the intention to perform a formal systematic review.

Supplementary information

Supplementary video 1

A child with a typical episode of benign paroxysmal torticollis.

Glossary

Biopsychosocial model

A model in which the interaction of biological, psychological and social factors influence the presentation of disease and response to treatment.

Cephalic cutaneous allodynia

An abnormal perception of normally innocuous sensory stimuli, such as combing of hair, as painful.

Macropsia

A visual hallucination in which objects looks larger than their real size.

Micropsia

A visual illusion in which objects looks smaller than their real size.

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Abu-Arafeh, I., Gelfand, A.A. The childhood migraine syndrome. Nat Rev Neurol 17, 449–458 (2021). https://doi.org/10.1038/s41582-021-00497-6

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