What is the prognosis of migraine in children?

Updated: Aug 15, 2019
  • Author: William C Robertson, Jr, MD; Chief Editor: Amy Kao, MD  more...
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Although migraine has long been considered a benign and self-limited condition, it can significantly impact the patient's life. The pain is often intense, and often the patient cannot concentrate or function effectively during or immediately after episodes. An estimated 65-80% of children with migraine attacks interrupt their normal activities because of the symptoms. Among 970,000 self-reported migraineurs aged 6-18 years, 329,000 school days were lost per month.

The burden of migraine may cause emotional changes such as anxiety or sadness. One study found a higher frequency of suicidal ideation in adolescents with migraine. [10]

The course and severity of migraine may be influenced by a variety of factors, including stress, depression, sleep deprivation, overuse of analgesics, and hormonal fluctuation. Appropriate diagnosis and treatment of migraine can significantly improve quality of life.

In one of the few longitudinal studies of migraine patients, Bille observed 73 children with migraine for 40 years. During puberty or young adulthood, 62% of the children were migraine free for at least 2 years; approximately 33% of these children regained regular attacks after an average of 6 migraine-free years, and a surprising 60% of the original 73 children still had migraine attacks after 30 years. In 30 years, 22% of the children never had a migraine-free year. [9]

At age 50 years, more than half the migraine group still had migraine attacks. A recall bias was found; several subjects in midlife (41%) could not remember that they experienced aura symptoms. Of those who became parents, 52% had at least 1 child in their present or previous families who developed recurrent headache, probably migrainous.

Another study assessed the 5-year follow-up outcome and possible prognostic factors of migraine subtypes with onset in childhood or adolescence. A total of 343 patients meeting the International Classification of Headache Disorders (ICHD)-II criteria for migraine without aura (MO), migraine with aura (MA), or both MO+MA (ie, 1.1, 1.2) were contacted by phone and underwent structured follow-up headache interviews. Of the original sample patients, 22.7% were headache-free at follow-up, 14.1% had a transformed headache diagnosis (tension-type headache: 8.2%, chronic daily headache: 5.8%), and 63.3% still had migraine fulfilling the criteria for ICHD-II 1.1. or 1.2, but those who were still migraineurs at follow-up were older at baseline (respectively 12.93, 9.99, and 11.02 years for MO, MA and MO+MA,P= .0005). The probability of having the same migraine subtype diagnosis at baseline and at 5-year follow-up was 55.2%, 95.1%, and 31.1% for ICHD-II 1.1, 1.2, and both 1.1 and 1.2, respectively. [11]

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