Machine generated keywords: child, premonitory, premonitory symptom, hour, child year, adolescent, pediatric, child adolescent, aura symptom, pediatric popula- tion, aura, phase, associate migraine, young child, young

Primary headaches during lifespan

DOI: https://doi.org/10.1186/s10194- 019- 0985- 0

Abstract-Summary Primary headaches, especially migraine, are cyclic disorders with a complex sequence of symptoms within every headache attack.

The clinical presentation of migraine shows an age-dependent change with a significantly shorter duration of the attacks and occurrence of different paroxysmal symptoms, such as vomiting, abdominal pain or vertigo, in childhood and, in con- trast, largely an absence of autonomic signs and a more often bilateral headache in the elderly.

The differences in the clinical presentation are in agreement with the idea that the connectivity of hypothalamic areas with different brainstem areas, especially the central parasympathetic areas, is important for the clinical manifestation of migraine, as well as, the change during lifespan.

Introduction Pain perception changes with age and is different in very young and very old patients.

In a systematic review of 12 studies, Tumi and others [98] found that in the elderly subjects (mean age: 62 years) the pressure pain thresholds were lower than in the younger subjects (mean age: 22 years). The heat pain thresholds did not differ. Another systematic review reports that the pain thresholds increase with age. Concerning gender differences in children, Boerner and others [99] stated that in the majority of studies there were no differences in the pain thresholds between girls and boys if the children were younger than 12 years.

3.2 Medical history

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Experimental data concerning pain perception in the trigeminal area in very

young children are missing.

Background In the same study, the 6-month prevalence in the 65–75-year-old group was about 3.5% for migraine and about 12.5% for tension-type headache, with females affected 2 to 1.5 times more often [100], and in a study from northern Italy the prevalence of migraine after the 75th year was 2.7% for males and 7.6% for females [101].

Concerning the severity of the primary headache patients over 70 years old with migraine, about 41% report on headache on 10–14 days per month [102, 103] and the average age of patients with chronic migraine is higher than that of patients with episodic migraine [104].

Aura symptoms with or without accompanying headache seem to occur more often in the elderly; in the group of 18–29-year-olds about 15.2% have auras com- pared to 41% of the patients aged 70 years and older [102, 105, 106].

The self-reported prevalence of tension-type headache in a Danish twin study was 86% (females slightly higher than males) and after the age of 39  years the prevalence declined for both sexes [107, 108].

Discussion One general feature, especially in migraine and less also in cluster headache, seems to be a decrease in autonomic symptoms during aging.

Such a study would help to answer the question of whether the change in the reactivity of the autonomic system during life could be a reason for the decline in the prevalence of the autonomic symptoms during ageing and also why migraine symptoms in very young children are not as typical as in adolescents.

It is unclear if this immature control of the cortical control of autonomic func- tions is somewhat related to the time of migraine onset as well as clinical symptoms in children.

The episodic syndromes in infancy, which often are precursor symptoms of a later migraine, would be best explained by a temporarily disturbed descending inhi- bition, especially, reduced inhibition of the vestibular system (benign paroxysmal vertigo), of the descending axial motor system (benign paroxysmal torticollis, spi- nal vestibular pathways), and of the area postrema (cyclic vomiting) or the vagal control of the intestinal tract (abdominal migraine).

Conclusions Headache symptoms change during lifespan, especially, in migraine.

In the elderly autonomic symptoms are less prominent and the headache becomes

more featureless.

Acknowledgement A machine generated summary based on the work of Straube, Andreas; Andreou, Anna. 2019 in The Journal of Headache and Pain.

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3 Diagnosis

Clinical features of visual migraine aura: a systematic review