Allison Shelley

February 27, 2012

February 27, 2012 — Mothers with migraine are more than twice as likely as those without to have an infant with colic, researchers report.

"Infants that inherit migraine genes may be more sensitive to normal stimuli and express that sensitivity as colicky crying," lead investigator Amy Gelfand, MD, a child neurologist at the University of California, San Francisco, told Medscape Medical News.

Dr. Amy Gelfand

"This association, if it proves to be robust in future studies, could help mothers prepare for the possibility of having a colicky infant," she explained, "and give them some comfort and understanding as to why their baby is crying so much. It also may have implications for how we manage colic. For example, perhaps these babies would benefit from decreased stimulation, such as turning down loud music or avoiding bright lights when they are crying."

Dr. Gelfand will present the findings at the American Academy of Neurology (AAN) 64th Annual Meeting, which takes place in New Orleans, Louisiana, in April.

In this cross-sectional study, investigators looked at 154 mothers and their infants. Excessive crying in an otherwise healthy infant was reported by parents based on questions developed by the researchers using standard criteria for colic.

Mothers were surveyed at their infants' 2-month-old well-child visit — the age when infant colic is most likely. The researchers identified colic by parental report using modified Wessel's colic criteria. They obtained migraine history by means of physician diagnosis or a positive screen on the Identity Migraine Questionnaire.

Investigators used a Chi-squared test to compare differences between groups. They found that maternal migraine is associated with a more than 2-fold increased risk for infant colic (Table 1).

Table 1. Mothers and Infants With Colic (n = 154)

Infants Maternal Migraine (%) No Maternal Migraine (%) Prevalence Ratio P
With colic 28.6 11.1 2.6 .02

The researchers report that mothers with migraine accurately perceived their infants' colic compared with women without headaches.

Data on paternal history of migraine were available for most of the infants, and interestingly, fathers with migraine were also more likely to have an infant with colic (Table 2).

Table 2. Fathers and Infants With Colic (n = 93)

Infants Paternal Migraine (%) No Paternal Migraine (%) Prevalence Ratio P
With colic 22.2 9.5 2.3 .24

"Since migraine is a highly genetic disorder, our study suggests that infant colic may be an early sign that a child may be predisposed toward migraine headache later in life," Dr. Gelfand said.

"This may be helpful in more accurately identifying children who have childhood periodic syndromes by asking about a history of infant colic," she added. "This study helps to advance our understanding about the different expressions of migraine across a person's lifetime."

Asked by Medscape Medical News to comment on the findings, Joel Saper, MD, a spokesperson for the AAN, said he agrees. "Migraine is a manifestation of something that very likely begins early in life. This is a very interesting piece of science that correlates with something we've suspected for some time — that colic could be part of the migraine spectrum with the body overreacting to normal stimuli." Dr. Saper is the founder of the Michigan Headache and Neurological Institute in Ann Arbor.

Two previous retrospective studies found that children with migraine were more likely to have colic as infants. The authors suggest these studies may have been affected by recall bias because parents were being asked about colic several years after their children were infants.

"This motivated us to try to collect the information about colic when it was actually happening," Dr. Gelfand explained. "This is why we surveyed mothers when they were bringing their infants in for the 2-month well-baby check."

It would also be helpful to have more complete family histories, for example, to have migraine data on both parents for all infants, she said, "and ideally, also information about migraine history in the baby's grandparents. This is hard to do, as usually all 4 grandparents are not present at the 2-month well-baby check."

This was a preliminary study, Dr. Gelfand pointed out, "and we were trying to keep our survey short so that exhausted parents could complete it, so we did not collect data on other epidemiologic variables that may interact in a potential relationship between migraine and colic." She cites parental depression or family stress as examples.

"Critics might note that we did not have an external way of validating that the infants were colicky, as we were going by parental report," Dr. Gelfand said. "However, parental report is a common way for determining colic in research. In addition, physician diagnosis of colic is to a great extent itself dependent on what parents report in the office."

Moving forward, the researchers intend to have parents keep crying diaries so they will have a more objective measure.

"Migraine is a lifelong illness," Dr. Saper said. "And we now have evidence that it starts early in life, much earlier than we knew."

The investigators have disclosed no relevant financial relationships.

American Academy of Neurology (AAN) 64th Annual Meeting. Abstract 113. April 21 - 28, 2012. First results released February 20, 2012.

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