It is well known that migraine is one of the most common and debilitating conditions that affect the quality of life of both late teenagers and adults. What is less appreciated, however, is that migraine seems to have the potential to express itself right from infancy.
However, as this expression does NOT involve headache as a symptom, migraine can masquerade as a range of seemingly unrelated problems in the infant and young child.
In the our previous post we explained the underlying neurological impairment that is common to all primary headache types – brainstem sensitisation due to decreased pain modulation. This is underpinned by a genetically impaired production of serotonin, dopamine and noradrenaline.
While we have always thought of migraine as an adult and adolescent condition, it is now thought that a group of migraine equivalents are in fact an early expression of the genes that will later manifest as the more classic migraine disorder.
There are now several known migraine equivalents, such as;
1. Infantile colic
2. Benign paroxysmal torticollis – wry neck
3. Benign paroxysmal vertigo/dizziness
4. Cyclical vomiting syndrome
5. Abdominal migraine – transitory abdominal pains
6. Aura without migraine
7. Acute confusional migraine – a mimic of seizure or concussion
8. Concentration problems – mimics ADHD
The genetic link is a key feature of these syndromes, and a family history of migraines is important to understand. We know that migraine sufferers are 2-3 more likely to have a colicky baby and abdominal migraine is more likely if the child has a parent with irritable bowel syndrome.
Interestingly, these children can often be misdiagnosed, but the key differential is that the nature of these symptoms is periodic, normally only lasting up to 4 hours, with the child showing no signs between episodes.