Migraine and headache in childhood and adolescence

In childhood and adolescence, migraine is the main, essential chronic headache. This diagnosis is extensively underestimated and misdiagnosed in the pediatric population. Lack of specific biologic marker and specific investigation or brain imaging often reduces these clinical entities to a psychologic illness. Migraine is schematically a severe headache evolving by stereotyped crises associated with marked digestive symptoms (nausea and vomiting); throbbing pain, sensitivity to sound, light (and sometimes odors) are usual symptoms; the attack is sometimes preceded by a visual or sensory aura. Attack treatments must be given at the early beginning of the crisis. If the oral route is not available when nausea or vomiting occurs, the rectal or nasal routes then have to be used. Nonpharmacologic treatments (biofeedback and interventions combining progressive muscle relaxation) have been shown to have good efficacy. Daily prophylactic pharmacologic treatments are prescribed in second line after failure of nonpharmacologic treatment.