Redefining Migraine without Aura in Children A 7-Year Study Based on ICHD 2

Objective: To document short duration (less than one hour) activity affected headaches in children without migraine diagnostic-associated features of nausea, vomiting, phonophobia and photophobia and thus to redefine current( ICHD 2 and 3 BETA) paediatric migraine diagnostic criteria. Background: Studies show that migraine in children are of shorter duration and when they present without associated features like nausea, vomiting, phonophobia or photophobia, diagnosis can be a real challenge as they miss two current migraine diagnostic criteria/group 14 is applied (headache unspecified / not elsewhere classified). This study is to document such short duration headaches in children without migraine diagnostic-associated features. Methods: 7 year prospective cohort study conducted on 1432 children, 5 to 15 years old with the following inclusion criteria: 1) Recurrent short duration throbbing/non throbbing headaches (unilateral/bilateral / unilateral spreading bilaterally) 2) Activity affected (motionless/lie down/sleep off), 3) No nausea, vomiting, phonophobia or photophobia, 4) Common/well known/local migraine triggers in this region of India precipitating them. 5) One family member suffering from ICHD 2 1.1 (migraine without auras)/1.2 (migraine with auras)/ 1.6 (probable migraines). 6) No other significant headache-related history and normal physical, neurological and neuro ocular examinations. Results: Duration of head pain: 5 minutes to 45 minutes. Common regional /well known migraine triggers: sun exposure, bus travel, missing meals, strenuous physical exercises and sleep disturbances. Family history: 83% (1188) mothers, 11% fathers (158) and 6% (86) siblings suffering from ICHD2, 1.1 (migraine without auras)/1.2 (migraine with auras)/1.6 (probable migraines). Conclusion: A new definition of paediatric migraine based on above findings will be extremely helpful for any clinician in a busy practice. Recurrent activity-affected headaches precipitated by known or regional migraine triggers and one family member suffering from migraine origin pain (1.1, 1.2, 1.6) in the absence of another disorder, should lead one to consider the diagnosis of migraine without aura in children. Keywords: Paediatric migraine