Deborah Brauser

June 11, 2017

BOSTON — Although past research has shown an association between maternal migraine and infants with colic, a new study suggests that migraine status in dads isn't a risk factor.

In the cross-sectional survey study of more than 1000 parents, the odds of having a colicky baby were 50% higher for mothers who reported having a history of migraine/probable migraine than their peers without migraine. The odds were more than twofold higher for moms who had at least 15 headache days during the previous month.

However, 29% of fathers with migraine/probable migraine, as defined by American Migraine Prevalence and Prevention (AMPP) study criteria, had offspring with colic vs 31% without migraine.

In a second presentation from the study, the parents perceived their colicky infants as having increased sensitivity to certain stimuli, especially loud noises and strong smells — a trait that is often associated with migraine.

Dr Amy Gelfand

Lead author Amy Gelfand, MD, director of pediatric headache at the University of California, San Francisco (UCSF), told Medscape Medical News the overall findings should speak to several specialties.

"For obstetricians, it's worth counseling pregnant women with a history of migraine that they are more likely to have a baby with colic — and to let them know that colic is a time-limited phenomenon that isn't their fault. It's perhaps part of the genetic package, with babies that are predisposed for fussiness."

In addition, research has shown a link between infant colic and increased risk for migraine in adolescents, she noted.

"So for primary-care pediatricians, if you're seeing a colicky baby with a family history of migraine, keep it in the back of your mind that these children may be coming back with headache or migraine at the age of 7 or 8 years old."

Dr Gelfand presented the results here at the American Headache Society (AHS) 2017 Annual Meeting.

Not Well Understood

Although it's been the subject of "decades of research," the etiology of infant colic is still not understood, write Dr Gelfand and colleagues. Yet understanding its underlying mechanisms "is important for guiding appropriate selection of therapeutic interventions."

A previous study by the investigators showed that maternal migraine was associated with infant colic in a group of 154 mothers and children. For the current research, they sought to replicate these earlier findings in a larger population. Also, they wanted to expand their focus to the effects of paternal migraine, which was underpowered in the first study.

Using social media ads, the researchers recruited parents in the United States who had infants between the ages of 4 and 8 weeks. Online surveys for the participants included questions about offspring crying patterns and their own medical history. Questions about a second parent could be answered on an "optional" basis.

Colic was defined as the baby crying for at least 3 hours per day for at least 3 days during the prior week.

Migraine status was determined by parental self-report, the parent reporting having received a physician diagnosis, and AMPP questions following International Classification of Headache Disorders (ICHD) criteria. These questions were also asked to determine migraine and/or probable migraine.

Between February and March 2017, 1010 of the surveys were completed — 829 of these by mothers (88.4% white, 4.5% black, 2.7% Asian).

Results showed that 230 infants had colic and 35% of the mothers who responded had AMPP criteria-based migraine. Regardless of how migraine was defined, it was significantly associated with infant colic, with odds ratios (ORs) ranging between 1.5 and 1.8.

Table 1. Association Between Maternal Migraine and Infant Colic
Infants with colic, when maternal migraine based on: Maternal Migraine (%) No Maternal Migraine (%) OR (95% CI*) P
Self-report 30.7 23.3 1.51 (1.1–2.0) .02
Self-report of physician diagnosis 31.6 22.5 1.61 (1.1–2.3) .02
AMPP/ICHD questions 33.4 21.6 1.8 (1.3–2.5) .0002
AMPP/ICHD questions for migraine/probable migraine 32.6 21.8 1.7 (1.3–2.4) .0006
*95% CI = confidence interval

Also, 52% of mothers with AMPP-defined migraine with 15 or more headache days in the past month had a baby with colic compared with 30% of those with fewer headache days (OR, 2.5; 95% CI, 1.2 – 5.2; P = .01). There were no significant differences between the mothers who had migraine with or without aura.

Only 17 of the fathers who provided data had migraine. No matter what definition of migraine was used, it was not significantly associated with colicky babies.

"It seems as if paternal migraine status is not a predictor of infant colic," said Dr Gelfand. On the other hand, "maternal migraine was again shown to be a predictor. By replicating earlier findings, it reinforces that it's a robust and real association."

The investigators then turned their focus toward environmental sensitivities in 895 of babies. Of these, 25.7% had colic.

"It's been my hypothesis for a period of time that babies who have colic are more sensitive to stimuli than babies who don't have colic and that that is potentially genetically mediated," said Dr Gelfand.

"It's thinking that babies with migraine genes are possibly 'wired up' to being more sensitive to stimuli when they're crying and even between crying periods," she added.

The online surveys asked whether any of five different stimuli bothered the babies and if so, how often, and whether any interventions helped to stop the crying. Responses were grouped into never/rarely and sometimes/often/always categories.

As shown in the table, there were only two factors where the babies with colic were significantly more sensitive than babies without colic.

Table 2. Link Between Infant Colic and Sensitivity to Particular Stimuli
Stimuli Type Colic (%) No Colic (%) P
Loud sounds 43.4 34.7 .02*
Strong smells 10.6 6.5 .04*
Bright lights 32.7 30.4 .51
Diaper changes/ tactile stimulation 66.4 65.8 .88
Vigorous rocking/bouncing 14.6 14.6 1.0
*Significant association

When switching the place of "sometimes" in the grouping (to never/rarely/sometimes/ vs often/always), only loud sounds remained significantly higher in the babies with vs without colic (14.6% vs 7.8%, P = .003).

"We were also wondering: how can we help the parents and babies with colic, as this is such a young age? Although one could consider pharmacologic therapy, you don't want to expose young babies to risks or side effects," noted Dr Galfand.

"So are there behavioral interventions that can help, based on things we know help children with migraine? And can we use those principles and apply them to these babies when they're in distress and crying incessantly?"

Although parents reported several behaviors that were settling to the colicky infants, these were equally beneficial for those without. Feeding was the number-one technique for both groups (95.1% vs 97.8%, respectively), followed by gentle rocking (94.2% vs 93.7%), shushing (81.7% vs 86.3%), and adding white noise (81.3% vs 78.5%).

Between 4 and 8 pm was the most commonly reported time for heaviest crying for both types of infants. Those with colic were more likely than those without colic to cry heavily from 8 pm to midnight (P = .0005) and midnight to 4 am (= .03).

"Powerful" Observations

Session comoderator Robert E Shapiro, MD, professor of neurological sciences at the Larner College of Medicine, University of Vermont, in Burlington, told Medscape Medical News that the identification of colic as the first manifestation of migraine "is a fundamental and powerfully important observation."

Dr Robert Shapiro

"This tells us that early experience and genetics may be very important," said Dr Shapiro, who was not involved with this research.

He noted that in the stimuli part of the study, "there weren't a huge number of distinctions between the ability to console babies who met the criteria for colic vs those who had other situations where they were inconsolable," he noted.

"But I think it's very early in this analysis of the phenotype of colic for us to conclude that there aren't distinctive differences behaviorally or in terms of the things that will help remedy colic or console babies. This is really a pilot study."

As to why some colicky babies with mothers who have migraine go on to develop migraines themselves and others don't, "these are all things that really need to be identified and investigated clearly."

Dr Gelfand and Dr Shapiro have disclosed no relevant financial relationships.

American Headache Society (AHS) 2017 Annual Meeting. Abstracts PF-86LB, presented June 9, 2017 and OR-03LB, presented June 10.

Follow Deborah Brauser on Twitter: @MedscapeDeb. For more Medscape Neurology news, join us on Facebook and Twitter.

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