Favorable outcome of early treatment of new onset child and adolescent migraine-implications for disease modification

• Published in: Journal of headache and pain Vol. 10; no. 4; pp. 227 - 233
• Main Authors: Charles, James A., Peterlin, B. L., Rapoport, Alan M., Linder, Steven L., Kabbouche, Marielle A., Sheftell, Fred D.
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.08.2009; Springer; Springer Nature B.V
• Subjects: Adolescent; Age of Onset; Aging - physiology; Analgesics - therapeutic use; Biological and medical sciences; Brain Stem - pathology; Brain Stem - physiopathology; Child; Children & youth; Clinical outcomes; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Disease Progression; Early Diagnosis; Humans; Internal Medicine; Medical sciences; Medical treatment; Medicine; Medicine & Public Health; Migraine; Migraine Disorders - drug therapy; Migraine Disorders - physiopathology; Migraine Disorders - prevention & control; Neurology; Pain Medicine; Review; Review Article; Risk Factors; Treatment Outcome; Trigeminal Nerve - physiopathology; Vascular diseases and vascular malformations of the nervous system; Disease modification; Child; Migraine; Adolescent; Human; Headache; Modification; Nervous system diseases; Prognosis; Cardiovascular disease; Cerebral disorder; Vascular disease; Pain; Treatment; Central nervous system disease; Neurological disorder; Cerebrovascular disease
• ISSN: 1129-2369; 1129-2377
• DOI: 10.1007/s10194-009-0133-3

There is evidence that the prevalence of migraine in children and adolescents may be increasing. Current theories of migraine pathophysiology in adults suggest activation of central cortical and brainstem pathways in conjunction with the peripheral trigeminovascular system, which ultimately results in release of neuropeptides, facilitation of central pain pathways, neurogenic inflammation surrounding peripheral vessels, and vasodilatation. Although several risk factors for frequent episodic, chronic, and refractory migraine have been identified, the causes of migraine progression are not known. Migraine pathophysiology has not been fully evaluated in children. In this review, we will first discuss the evidence that early therapeutic interventions in the child or adolescent new onset migraineur, may halt or limit progression and disability. We will then review the evidence suggesting that many adults with chronic or refractory migraine developed their migraine as children or adolescents and may not have been treated adequately with migraine-specific therapy. Finally, we will show that early, appropriate and optimal treatment of migraine during childhood and adolescence may result in disease modification and prevent progression of this disease.