Headaches in children are common, with around 70% of school children experiencing at least one per year and 25% more frequently.¹ They are a cause of considerable morbidity, with school absence and academic underachievement common sequelae in older children. Studies from developed countries indicate that migraine is the most common diagnosis among children with headache who present to a medical practitioner. This article focuses on the diagnosis, epidemiology, differential diagnosis, and management of migraine, and includes a review of the evidence base for currently used treatment.

DIAGNOSIS AND CLASSIFICATION

In 1988 the International Headache Society (IHS) published complex diagnostic criteria for classifying headaches in general.² For young children these criteria were too restrictive, and a recently published revision includes an extensive classification of migraine headache (table 1) as well as more developmentally sensitive criteria for use in children (table 2).³

Diagnostic criteria for children are broader than those for adults, and allow for a broader range of duration and a broader localisation of the pain. In essence, migraine can be defined as a recurrent headache that occurs with or without aura and lasts 1–72 hours. It is usually unilateral, of moderate or severe intensity, pulsating in quality and aggravated by routine physical activity. Nausea, vomiting, phonophobia, and photophobia are common accompanying symptoms (table 2).

EPIDEMIOLOGY AND AETIOLOGY

Migraine affects 3–10% of children,^1,4–6 a figure which equates to 50/1000 school age children in the UK and an estimated 7.8 million children in the European Union.⁷ The mean age at onset is 7.2 years for boys and 10.9 years for girls, with 20% of children experiencing their first attack before the age of 5 years.^8,9 The symptom based definition precludes diagnosis in …