This periodic disorder is characterised by paroxysmal headache, often unilateral, and is characteristically throbbing. It is often accompanied by unpleasant gastrointestinal disturbance such as nausea, vomiting and abdominal pain and by visual disturbance. The visual disturbances include:
• Negative phenomena such as: hemianopia (loss of half the visual field) scotoma (small areas of visual loss).
• Positive phenomena such as: fortification spectra (seeing zigzag lines).
Rarely, there are unilateral sensory or motor symptoms.
Episodes usually last for a few hours, during which time children often prefer to lie down in a quiet, dark place. Sleep often relieves the bout.
Migraine is classified as:
• without aura (formerly called common migraine), affecting approximately 90%
• with aura (formerly called classical migraine) - the headache is preceded by an aura (visual, sensory or motor); this type affects approximately 10% (the aura may occur without a headache)
• complicated - associated with neurological phenomena such as ophthalmoplegia, hemiparesis, paraesthesiae or hemidysaesthesia (altered sensation down one side of the body). It occurs in 1-2% and, rarely, results in permanent neurological deficit. Hemiparetic migraine is linked to a calcium channel defect, often dominantly inherited. Vertebrobasilar migraine gives rise to signs of posterior circulation compromise, such as nystagmus and associated vomiting and dizziness.
Symptoms of tension-type headache and migraine often overlap. They are probably part of the same pathophysiological continuum; there is increasing evidence that both symptom groups result from channelopathies with vascular phenomena being secondary events. Headaches are common in first- and second-degree relatives of children with recurrent headaches. Some cases of cyclical (recurrent) vomiting and recurrent abdominal pain in young children are thought to be due to abdominal migraine. Stress at home or school may trigger headaches and make them more difficult to cope with, although for many, winding down is a trigger. A food diary helps to identify any food triggers, often cheese, chocolate, and caffeine, although they may vary with time. In girls, headaches can be related to menses and the oral contraceptive pill.
Causes of headache
Causes of recurrent headache
Tension-type headache
Migraine
• without aura
• with aura
• complicated
Raised intracranial pressure and space-occupying lesions
Other causes:
• sinusitis - may cause facial pain, elicited by percussion
• temporomandibular joint discomfort - from dental malocclusion, worse on chewing
• medication - side-effect
• refractive errors - rare cause, but check vision
• head trauma
• solvent, drug and alcohol abuse
• hypertension - uncommon cause, usually with encephalopathy - but blood pressure should always be checked
• benign intracranial hypertension, i.e. no space-occupying lesion or CSF obstruction. Characteristically in overweight adult females but occurs in children.
Causes of acute headache
• Febrile illness
• Migraine
• Stress
• Acute sinusitis
• Meningitis/encephalitis
• Head injury
• Subarachnoid or intracerebral haemorrhage
• Benign intracranial hypertension
• Medications, alcohol, solvent or drug abuse
• Other triggers: ice-cream, from reflex neuralgia
