Extended Phenotyping of Migraine in Children: A Cross-Sectional Study in a Specialist Children's Headache Clinic

Nazia Karsan; Prab Prabhakar; Peter J Goadsby

doi:10.1016/j.pediatrneurol.2024.03.026

Extended Phenotyping of Migraine in Children: A Cross-Sectional Study in a Specialist Children's Headache Clinic

Pediatr Neurol. 2024 Apr 3:156:33-40. doi: 10.1016/j.pediatrneurol.2024.03.026. Online ahead of print.

Authors

Nazia Karsan¹, Prab Prabhakar², Peter J Goadsby³

Affiliations

¹ Headache Group, NIHR King's Clinical Research Facility and SLaM Biomedical Research Centre, The Wolfson Sensory, Pain and Regeneration Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Neurology, Children's Headache Clinic, Great Ormond Street Hospital for Children, London, UK. Electronic address: nazia.karsan@kcl.ac.uk.
² Department of Neurology, Children's Headache Clinic, Great Ormond Street Hospital for Children, London, UK.
³ Headache Group, NIHR King's Clinical Research Facility and SLaM Biomedical Research Centre, The Wolfson Sensory, Pain and Regeneration Research Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Neurology, Children's Headache Clinic, Great Ormond Street Hospital for Children, London, UK; Department of Neurology, University of California, Los Angeles, CA.

PMID: 38718550
DOI: 10.1016/j.pediatrneurol.2024.03.026

Abstract

Background: The pediatric migraine phenotype may exhibit differences to adults, leading to diagnostic challenges. We aimed to perform a cross-sectional systematic study to characterize the extended phenotype of pediatric migraine.

Methods: New migraine patients presenting to the Children's Headache Clinic were included (n = 105). Data were collected via a detailed symptom questionnaire at the first clinical encounter and were analyzed using descriptive statistics, Cohen kappa (k), Spearman correlation (ρ), and Poisson and binomial logistic regression models within SPSS.

Results: Patients were 65% female and aged five to 17 years (median 14, interquartile range [IQR] 11 to 15), with a mean disease duration of 4.7 years (S.D. 2.8). Monthly headache frequency was 1 to 30 days (median 30, IQR 12 to 30). Attack duration varied between 2 and 168 hours (median 12, IQR 5 to 72). The majority (81%) experienced bilateral headache. Premonitory symptoms (PS) were reported by 93% (range 0 to 7; mood change and tiredness most commonly), cranial autonomic symptoms (CAS) by 58% (range 0 to 6; pallor and lacrimation most commonly), and premonitory CAS by 23%. Vertigo (53%) and allodynia (16%) were present. The laterality of headache and CAS showed agreement (k = 0.5, P < 0.001). For every year of disease duration, 1.07 times more PS were reported (95% confidence interval [CI] 1.03 to 1.12, P < 0.001). The number of CAS (odds ratio 2.13, 95% CI 1.2 to 3.8, P = 0.01) significantly predicted allodynia.

Conclusions: Children display a more enriched PS phenotype with disease chronicity. CAS and allodynia may be markers of central sensitization with shared neurobiological mechanisms in the absence of peripheral nociceptor activation.

Keywords: Adolescent; Allodynia; Children; Cranial autonomic symptoms; Migraine; Pediatric; Premonitory; Vertigo.