migraine in childhood

Question 1

why might a child get familial migraines?

what other types of uncommon forms of migraine are there in children?

Answer 1

• calcium channel defect
• sporadic hemiplegic migraine
• basilar type migraine (vomiting with nystagmus and cerebellar signs)
• BPV of childhood

Question 2

what is the physiological basis behind migraines?

Answer 2

• imbalances in serotonin, drop in serotonin releases neuropeptides which irritate meninges

Question 3

what are the red flag symptoms in a child with migraines?

Answer 3

• a short history
• accelerated course (change over weeks/ days)
• headache suggesting raised ICP
• personality change, weakness, FND, seizures, fever
• young age
• known malignancy

Question 4

when would you do further investigations in a child with migraines?

Answer 4

• abnormal neuro exam
• history of trauma
• history of seizures
• unexplained change in headache pattern

Question 5

What is the management of migraines?

prophylaxis?

Answer 5

• Analgesia (NSAIDs and paracetamol)
• anti emetics (prochlorperazine and metoclopramide)
• serotonin antagonists (sumatriptan)
• pizotifen
• beta blockers
• Na blockers (valproate/ topiramate)