Premonitory Symptoms of Migraine in Childhood and Adolescence

DOI: https://doi.org/10.1007/s11916- 017- 0631- y

Abstract-Summary Premonitory symptoms in migraine; symptoms occurring before the onset of migraine pain or aura, are an increasingly recognised area of interest within head- ache research.

This review discusses the wide presentation of premonitory symptoms in migraine in children and adolescents, and the importance of understanding how these early symptoms are mediated in order to ensure that targeted abortive thera- pies are developed in the future.

A previous clinic-based questionnaire study in 103 children found a prevalence of premonitory symptoms in paediatric migraine of 67%, with a mean number of reported symptoms of two.

A recent study found that in a clinic population of 100 children or adolescents with a migraine diagnosis who were preselected as having at least one premonitory symptom associated with their attacks, two or more premonitory symptoms were reported by 85% of patients.

3.2 Medical history

491

Although the population prevalence of premonitory symptoms in migraine within the paediatric population, or their ability to predict accurately the onset of an impending headache cannot be deduced from the retrospective studies performed to date, premonitory symptoms occur in children as young as 18 months old.

Extended: Where possible, functional brain imaging studies both in adults and in the slightly older paediatric population, with larger patient numbers, would further help understanding of the differences between paediatric and adult migraine and help design future therapeutics research and clinical trials.

Introduction This review will summarise our understanding to date of this early phase of a migraine attack, both from adult and paediatric studies, with the aim to increase understanding about the presence of these symptoms in children and adolescents and to enhance further interest in performing studies into these symptoms and their neurobiological basis.

Cuvellier and others performed a clinic-based study in 103 patients in 2009 and found 67% of patients retrospectively reported at least one premonitory symptom in association with migraine [142].

Yawning is a partially dopamine-mediated symptom [143, 144] and has been consistently commonly reported in adult studies of premonitory symptoms in migraine, suggesting that dopamine may be a neurotransmitter involved early in a migraine attack.

Of the 100 children in our study 30% reported yawning as a premonitory symp-

tom [145].

It has been noted from the adult literature that these symptoms can start before the onset of pain; and neck stiffness was one of the most common premonitory symptoms noted in our paediatric study [145].

Conclusions We have outlined in this review what we know so far about premonitory symptoms, how we can translate these findings into the paediatric population, where there is a paucity of studies into the premonitory phase of migraine, and have suggested areas for further work.

This is an interesting and exciting time for migraine research, with the discovery of drug agents targeted against specific mechanisms, such as those for calcitonin gene-related peptide (CGRP) [146] and the serotonin 5-HT1F receptor [147], which are now in late phase clinical trials.

Clinical drug trials are limited in children but expanding the understanding of symptoms experienced, areas of brain involved, possible neurochemical systems at play and potential drug targets and pharmaceutical development is likely to have a substantial long-term impact on paediatric practice.

Acknowledgement A machine generated summary based on the work of Karsan, N.; Prabhakar, P.; Goadsby, P. J. 2017 in Current Pain and Headache Reports.

492

3 Diagnosis

Are some patient-perceived migraine triggers simply early manifestations of the attack?