The premonitory stage of migraine is an increasingly recognised area of interest within headache research. This phase has not been rigorously studied in children.
Cases of children seen within the Specialist Headache Service at Great Ormond Street Hospital for Children between 1999–2015 were randomly selected, if at least one premonitory symptom was recorded in the initial consultation clinic letter. The age at headache onset, family history of headache, headache diagnosis, presence of episodic syndromes which may be associated with headache, gestation at birth, mode of delivery and presence of premonitory symptoms occurring before or during headache were recorded.
Of the 100 patients (n=100), 65% were female. The age range of the patients was 18 months-15 years at the time of headache onset. The most common diagnosis was chronic migraine in 67%, followed by episodic migraine, New Daily Persistent Headache with migrainous features and hemiplegic migraine. A history of infantile colic was noted in 30% and was the most common episodic syndrome that may be associated with migraine. The most common premonitory symptoms recorded were fatigue, mood change and neck stiffness. The commonest number of reported premonitory symptoms was two.
Although this study cannot allude to the population prevalence of premonitory symptoms in the paediatric population, premonitory symptoms associated with migraine are reported in children as young as 18 months. The clinical phenotype is comparable to adults. Better documentation of this stage will aid parents and clinicians to understand the phenotype of attacks, better recognise migraine and thus initiate appropriate management.
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