title: Reconsideration of the diagnosis and treatment of childhood migraine: A practical review of clinical experiences.
abstract: OBJECTIVE
  To provide insight into the wide spectrum of migraine during childhood to establish practical and comprehensive treatment strategies.
  
  
  BACKGROUND
  Although recent studies have confirmed the effect of anti-migraine agents in childhood headaches fulfilling the criteria of migraine without aura, there have been no studies regarding the efficacy of these drugs in childhood migraine without aura not filling the diagnostic criteria.
  
  
  METHODS
  In total, 154 patients with a clinical diagnosis of migraine, with onset of repetitive headaches at the age of ⩽15years, were retrospectively included from clinics in seven tertiary medical centers.
  
  
  RESULTS
  Patients' diagnoses included migraine with aura (n=49), migraine without aura (n=65), clinical migraine without aura not fulfilling International Classification of Headache Disorders-3 beta criteria (suspected migraine without aura; n=38), and hemiplegic migraine (n=2). Abortive medicine was effective in 74 of 97 patients, and preventive medicine was effective in 61 of 84 patients. Drugs with high efficacy were acetaminophen and ibuprofen for abortive therapy and cyproheptadine, amitriptyline, and propranolol for preventive therapy. Psychosocial problems were less common, and abnormalities on electroencephalography were more common in the suspected migraine without aura group. Otherwise, clinical features and drug responsibility were comparable among the migraine with aura, migraine without aura, and suspected migraine without aura groups. Retrospectively, experts clinically diagnosed childhood migraine without aura when the headache met at least one of the three criteria B, C, and D in International Classification of Headache Disorders-3 beta in addition to A and E. Abortive and preventive medication including paroxetine (n=2) benefited 10 and 15 of the 33 patients with daily headache, respectively. Psychotherapy/counseling (n=4), treatment for orthostatic dysregulation (n=4), and elimination of stressors (n=3) markedly alleviated headache in this group.
  
  
  CONCLUSIONS
  Our results indicated that those with suspected migraine without aura not filling International Classification of Headache Disorders diagnostic criteria should be included in the treatment for migraine. Treatment should also be targeted to comorbid developmental disorders, orthostatic dysregulation, and psychosocial problems in patients with refractory daily headaches.
authors.affiliation: Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan. Electronic address: saitoyo@med.tottori-u.ac.jp.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Saito
authors.affiliation: Department of Pediatrics, Tokyo Medical University, Shinjuku, Tokyo, Japan.
authors.forename: Gaku
authors.initials: G
authors.lastname: Yamanaka
authors.affiliation: Department of Pediatrics, Shiga Medical Center for Children, Moriyama, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Shimomura
authors.affiliation: Department of Pediatric Neurology, National Hospital Organization, Utano National Hospital, Kyoto, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Shiraishi
authors.affiliation: Department of Pediatrics, Tokyo Metropolitan Health and Medical Treatment Corporation Toshima Hospital, Tokyo, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Nakazawa
authors.affiliation: Division of Pediatrics, Shimane Prefectural Central Hospital, Izumo, Japan.
authors.forename: Fumihide
authors.initials: F
authors.lastname: Kato
authors.affiliation: Department of Child Neurology, National Center of Neurology and Psychiatry, Kodaira, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Shimizu-Motohashi
authors.affiliation: Department of Child Neurology, National Center of Neurology and Psychiatry, Kodaira, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sasaki
authors.affiliation: Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Maegaki
mesh_terms: D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D002648:Child; D002658:Developmental Disabilities / Q000188:drug therapy / Q000209:etiology; D004569:Electroencephalography; D006261:Headache / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008881:Migraine Disorders / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D018712:Analgesics, Non-Narcotic
keywords: Autism spectrum disorders; Childhood; Migraine; Orthostatic dysregulation; Pervasive developmental disorder