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  • Cranial autonomic symptoms common in pediatric migraine

    By Michael Vaphiades, DO
    Neuro-Ophthalmology/Orbit

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    This cross-sectional study of pediatric migraineurs found that the presence of cranial autonomic symptoms appears to be the rule rather than the exception, with approximately two-thirds of these patients having at least one of these symptoms.

    They note that the presence of cranial autonomic symptoms often leads to misdiagnosis of sinus headache in adult migraineurs. A previous study found that nearly 40 percent of pediatric migraineurs were initially mislabeled as having sinus headache. They say that misdiagnosing pediatric patients with migraine as having sinus headaches could lead to inappropriate and unnecessary treatments, as well as delay in appropriate migraine therapy.

    The current study included all pediatric and adolescent patients with migraine evaluated by a single investigator at four sites during a two-year period. While the compilation of the study’s data was performed after the fact, the data was collected prospectively, as the practice systematically seeks information on cranial autonomic symptoms at the initial visit in these patients.

    The authors found that of 125 pediatric migraineurs, 62 percent had at least one cranial autonomic symptom. These included aural fullness, conjunctival injection, lacrimation, rhinorrhea, eyelid edema, facial sweating or flushing, ptosis, sense of grit in the eye and/or nasal congestion. The majority had more than one cranial autonomic symptom and the symptoms tended to be bilateral. These findings are in line with previous studies in adults.

    In caring for young children with migraine, they say that clinicians must be cognizant of the potential need to infer some of these symptoms from behavior. For example, a young child who is pulling on an ear during a migraine could be experiencing a sense of aural fullness.

    They conclude that a greater awareness of the anatomy and physiology of the trigeminal-autonomic reflex and its potential for activation in any trigeminal pain state may save many children suffering and numerous parents angst.