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Abstract
Pediatric headache impacts up to 80% of children, many recurrently, by the time they are 15 years old. Preventing the progression of episodic to chronic headache results in less truancy, staying current with schoolwork and improves children's quality of life. Lifestyle choices can play an important role in headache treatment. Early effective treatment of episodic headache can prevent transformation into a chronic form. While details of a child's headache are critical for making a proper diagnosis; patient education is critical and effective rescue and preventive treatment strategies enable patients to focus on enjoying activities of daily living. Recognizing "red flags" that may suggest a serious underlying etiology is critical in the early stages of diagnosing and preparing to treat children with headaches. Finally directing patients to manage their headaches at home and when to proceed to an emergency department, urgent care or infusion unit can lower the economic burden of acute headache management.
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Affiliation(s)
- Debra M O'Donnell
- Pediatric Neurologist, Dayton Children's Hospital, Division of Neurology, OH, United States.
| | - Anastazia Agin
- Pediatrician and Headache Specialist, Dayton Children's Hospital, Division of Neurology, OH, United States
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2
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Abstract
PURPOSE OF REVIEW This article reviews the approach to a child or adolescent with headache, the criteria for common diagnoses, and the evidence base for treatments. RECENT FINDINGS The guidelines for acute and preventive treatment of migraine were updated in 2019. These guidelines summarize the available evidence and outline the questions that should be addressed in future research. The US Food and Drug Administration (FDA) approval of several new classes of drugs and devices to treat adult migraine in the past few years has resulted in ongoing or planned pediatric trials. SUMMARY Headache is a common symptom in children, and it is important to take a detailed history and perform a thorough physical examination to make the diagnosis. Nearly 1 in 10 children experience recurrent headaches due to migraine, which cause significant impairment in school performance and quality of life. The acute and preventive treatments that are currently available will help at least two-thirds of children with migraine, and several trials of new therapies offer hope for the future.
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Raieli V, D'Amico A, Piro E. Migraine in Children Under 7 Years of Age: a Review. Curr Pain Headache Rep 2020; 24:79. [PMID: 33326057 DOI: 10.1007/s11916-020-00912-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Despite the accumulation of a significant amount of data on pediatric headache, few studies have been conducted on its occurrence in children under 7 years of age. Within primary headaches in this age, migraine especially, turns out to be a disorder affecting up to 4% of the general population. An underestimate of its true prevalence can be due to lack of specific diagnostic markers, the frequent difficulty of describing pain in childhood, and the necessity of reliable parents' reports. Thus, migraine in children under 7 years of age represents an important challenge for clinicians. The objective of this manuscript is to provide a comprehensive review of epidemiologic, clinic, and therapeutic aspects of migraine in this age. RECENT FINDINGS Current literature data show that migraine has some differences, especially in clinical and therapeutic terms, in this age group compared to subsequent ages. Furthermore, some evidences showing that an early onset of migraine may play an unfavorable role in its natural history, suggest an early identification and management of migraine in younger children. Moreover, we highlight the role that factors of prenatal and perinatal development can play in the predisposition and anticipation of migraine onset. Finally, open questions related to the several undefined features of migraine in this age are reported. Migraine in this pediatric population is absolutely not rare, represents an importan clinical challenge and probably has a negative predictive role.
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Affiliation(s)
- Vincenzo Raieli
- Child Neuropsychiatry Unit- ISMEP -P.O. Cristina - ARNAS Civico, via dei Benedettini 1, Palermo, Italy.
| | - Antonina D'Amico
- Department for Health Promotion, Maternal Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro," Child Neuropsychiatry School, University Hospital "P. Giaccone", Via A. Giordano 3, 90127, Palermo, Italy
| | - Ettore Piro
- Department for Health Promotion, Maternal Infant Care, Internal Medicine and Medical Specialties "G. D'Alessandro," Neonatal Intensive Care Unit, University Hospital "P. Giaccone", Via A. Giordano 3, 90127, Palermo, Italy
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Marchese F, Rocchitelli L, Messina LM, Nardello R, Mangano GD, Vanadia F, Mangano S, Brighina F, Raieli V. Migraine in children under 6 years of age: A long-term follow-up study. Eur J Paediatr Neurol 2020; 27:67-71. [PMID: 32334992 DOI: 10.1016/j.ejpn.2020.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/23/2019] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Early starting of migraine seems predictive for less favorable outcome in later ages, however follow-up investigations are very few and all with short-term prospective period. We report here the longest follow-up study in a population of children presenting with migraine under the age of 6. METHODS We followed-up 74 children under 6 years of age, referred for headache to our department between 1997 and 2003. The study was carried out between October 2016 and March 2018. Headache diagnoses were made according to the IHS criteria. RESULTS 23/74 patients, 31% of the original cohort, were found at follow-up in a period ranging between 15 to 21 years after the first visit. Seven of them were headache free. The remaining 16 patients had migraine. In the migraine group, the localization of pain changed in 75% of the subjects, 11/16 (68.7%) had allodynia and 9/16 (56.25%) had cranial autonomic symptoms. CONCLUSIONS Our results suggest that the onset of migraine at very young age represents unfavorable prognostic factor for persistence of the disease at later ages. Some clinical features may change during clinical course, and the active persistence of the disorder may lead to an increase in allodynia.
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Affiliation(s)
- Francesca Marchese
- Child Neuropsychiatry Unit Department Pro.M.I.S.E. "G D'Alessandro", University of Palermo, Italy
| | - Luciana Rocchitelli
- Child Neuropsychiatry Unit Department Pro.M.I.S.E. "G D'Alessandro", University of Palermo, Italy
| | - Luca Maria Messina
- Child Neuropsychiatry Unit Department Pro.M.I.S.E. "G D'Alessandro", University of Palermo, Italy
| | - Rosaria Nardello
- Child Neuropsychiatry Unit Department Pro.M.I.S.E. "G D'Alessandro", University of Palermo, Italy
| | - Giuseppe Donato Mangano
- Child Neuropsychiatry Unit Department Pro.M.I.S.E. "G D'Alessandro", University of Palermo, Italy
| | - Francesca Vanadia
- Child Neuropsychiatry Dept., P.O. Di Cristina, ARNAS Civico Palermo, Italy
| | - Salvatore Mangano
- Child Neuropsychiatry Unit Department Pro.M.I.S.E. "G D'Alessandro", University of Palermo, Italy
| | - Filippo Brighina
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Italy
| | - Vincenzo Raieli
- Child Neuropsychiatry Dept., P.O. Di Cristina, ARNAS Civico Palermo, Italy.
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Gontard A, Overs C, Moritz A, Thomé‐Granz S, Hussong J. Incontinence and headache in preschool children. Neurourol Urodyn 2019; 38:2280-2287. [DOI: 10.1002/nau.24134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Alexander Gontard
- Department of Child and Adolescent PsychiatrySaarland University Hospital Homburg Germany
| | - Cornelia Overs
- Department of Child and Adolescent PsychiatrySaarland University Hospital Homburg Germany
| | | | | | - Justine Hussong
- Department of Child and Adolescent PsychiatrySaarland University Hospital Homburg Germany
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Albers L, Kries RV, Straube A, Heinen F, Landgraf MN, Obermeier V, Ruscheweyh R. Age- and sex-specific first health care use for migraine in 2016 in children and adolescents from prospectively collected health insurance data in Germany. Cephalalgia 2019; 39:1156-1163. [PMID: 30974953 DOI: 10.1177/0333102419844543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Migraine in children and adolescents is associated with significant disability and a high risk of persistence into adulthood. OBJECTIVE Data on migraine incidence in children and adolescents are few and relatively coarse. To tailor interventions starting shortly after disease onset, detailed information on age- and sex-specific incidence of migraine in children and adolescents is needed. METHODS We used health care data prospectively collected by the BARMER statutory health insurance, representing ∼11% of the German population. The incidence of migraine diagnoses (International Classification of Diseases (ICD)-10 code G43) in the year 2016 was assessed in subjects aged 0-19 years, who had been continuously insured with the BARMER between 2005 and 2016 or during their entire lifespan. RESULTS Data from ∼1.2 million children and adolescents were available. The incidence of migraine diagnoses steadily increased with age, reaching ∼1% per year around the age of 10 for both sexes, and 3.49% per year in females and 1.72% per year in males at the age of 19. Incidences in males and females were similar up to the age of 13 and higher in females from there on. The proportion of incident migraine diagnoses specified as "definite" versus "probable" migraine increased with age. CONCLUSION The present study provides a representative estimation of the first documented health care use for migraine in children and adolescents in Germany within 1-year age bins, separately for boys and girls. These data will be helpful for tailoring early healthcare interventions to reduce disability and prevent migraine chronification.
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Affiliation(s)
- Lucia Albers
- 1 Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, Ludwig Maximilians University, Munich, Germany
| | - Rüdiger von Kries
- 1 Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, Ludwig Maximilians University, Munich, Germany
| | - Andreas Straube
- 2 Department of Neurology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Florian Heinen
- 3 Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mirjam N Landgraf
- 3 Department of Paediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Viola Obermeier
- 1 Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, Ludwig Maximilians University, Munich, Germany
| | - Ruth Ruscheweyh
- 2 Department of Neurology, Ludwig-Maximilians-University Munich, Munich, Germany
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Abstract
Primary headaches are one of the most prevalent neurological disorders and can occur during a wide range of lifespan. Primary headaches, especially migraine, are cyclic disorders with a complex sequence of symptoms within every headache attack. There is no systematic review of whether these symptoms changes during lifespan. Indeed, the clinical presentation of migraine shows an age-dependent change with a significantly shorter duration of the attacks and occurrence of different paroxysmal symptoms, such as vomiting, abdominal pain or vertigo, in childhood and, in contrast, largely an absence of autonomic signs and a more often bilateral headache in the elderly. The age-dependent differences in the clinical presentation are less distinct in cluster headache and, especially, in tension-type headache. The differences in the clinical presentation are in agreement with the idea that the connectivity of hypothalamic areas with different brainstem areas, especially the central parasympathetic areas, is important for the clinical manifestation of migraine, as well as, the change during lifespan.
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Affiliation(s)
- Andreas Straube
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-University, 81377, Munich, Germany.
| | - Anna Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,The Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Aspinall N, D'Urso A, Ambegaonkar G. Fifteen minute consultation: an approach to the child with chronic headaches. Arch Dis Child Educ Pract Ed 2018; 103:177-183. [PMID: 29222182 DOI: 10.1136/archdischild-2016-312529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 10/17/2017] [Accepted: 11/13/2017] [Indexed: 11/03/2022]
Abstract
Children with chronic headache are a common referral to paediatric outpatients. This article suggests an approach to the assessment and management of chronic headaches, offering practical strategies for management as there is limited literature in paediatrics for this.
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Affiliation(s)
- Nichola Aspinall
- Paediatric Neurodisability, Royal College of Paediatrics and Child Health, Leeds, UK
| | - Anita D'Urso
- Department of Paediatrics, Bedford Hospitals NHS Trust, Bedford, UK
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Sangermani R, Boncimino A. How to treat children with headache. Neurol Sci 2018; 39:107-108. [DOI: 10.1007/s10072-018-3375-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Özge A, Faedda N, Abu-Arafeh I, Gelfand AA, Goadsby PJ, Cuvellier JC, Valeriani M, Sergeev A, Barlow K, Uludüz D, Yalın OÖ, Lipton RB, Rapoport A, Guidetti V. Experts' opinion about the primary headache diagnostic criteria of the ICHD-3rd edition beta in children and adolescents. J Headache Pain 2017; 18:109. [PMID: 29285570 PMCID: PMC5745373 DOI: 10.1186/s10194-017-0818-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/06/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The 2013 International Classification of Headache Disorders-3 (ICHD-3) was published in a beta version to allow the clinicians to confirm the validity of the criteria or to suggest improvements based on field studies. The aim of this work was to review the Primary Headache Disorders Section of ICHD-3 beta data on children and adolescents (age 0-18 years), and to suggest changes, additions, and amendments. METHODS Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the literature available on pediatric headache, they made observations and proposed suggestions for the primary headache disorders section of ICHD-3 beta data on children and adolescents. RESULTS Some headache disorders in children have specific features which are different from those seen in adults and which should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psycho-social basis in children and adolescents making primary headache disorders in children distinct from those in adults. CONCLUSIONS Several recommendations are presented in order to make ICHD-3 more appropriate for use with children.
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Affiliation(s)
- Aynur Özge
- Department of Neurology, Mersin University Medical Faculty, Mersin, Turkey
| | - Noemi Faedda
- Phd program in Behavioural Neuroscience, Department of Paediatrics and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Amy A. Gelfand
- UCSF Headache Center and UCSF Benioff Children’s Hospital, Pediatric Brain Center 2330 Post St 6th Floor San Francisco, Campus Box 1675, San Francisco, CA 94115 USA
| | - Peter James Goadsby
- NIHR-Wellcome Trust King’s Clinical Research Facility, King’s College London, London, England
| | - Jean Christophe Cuvellier
- Division of Paediatric Neurology, Department of Paediatrics, Lille Faculty of Medicine and Children’s Hospital, Lille, France
| | - Massimiliano Valeriani
- Division of Neurology, Ospedale Pediatrico Bambino Gesù, Piazza Sant’Onofrio 4, 00165 Rome, Italy
- Center for Sensory-Motor Interaction Aalborg University, Aalborg, Denmark
| | - Alexey Sergeev
- Department of Neurology and Clinical Neurophysiology, University Headache Clinic, Moscow State Medical University, Moscow, Russia
| | - Karen Barlow
- Faculty of Medicine, University of Calgary, Alberta Children’s Hospital, C4-335, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8 Canada
| | - Derya Uludüz
- Cerrahpaşa Medical Faculty, Department of Neurology, İstanbul University, Kocamustafapaşa, İstanbul, Turkey
| | - Osman Özgür Yalın
- İstanbul Research and Education Hospital, Kocamustafapaşa, İstanbul, Turkey
| | - Richard B. Lipton
- Department of Neurology Montefiore Headache Center, Albert Einstein College of Medicine, Louis and Dora Rousso Building, 1165 Morris Park Avenue, Room 332, Bronx, NY 10461 USA
| | - Alan Rapoport
- The David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Vincenzo Guidetti
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, Sapienza University, Rome, Italy
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Sleep Disorders in Childhood Neurological Diseases. CHILDREN-BASEL 2017; 4:children4100084. [PMID: 28937639 PMCID: PMC5664014 DOI: 10.3390/children4100084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 01/02/2023]
Abstract
Sleep problems are frequently addressed as a primary or secondary concern during the visit to the pediatric neurology clinic. Sleep disorders can mimic other neurologic diseases (e.g., epilepsy and movement disorders), and this adds challenges to the diagnostic process. Sleep disorders can significantly affect the quality of life and functionality of children in general and those with comorbid neurological diseases in particular. Understanding the pathophysiology of sleep disorders, recognizing the implications of sleep disorder in children with neurologic diseases and behavioral difficulties, and early intervention continue to evolve resulting in better neurocognitive outcomes.
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Eidlitz-Markus T, Haimi-Cohen Y, Zeharia A. Vomiting and migraine-related clinical parameters in pediatric migraine. Headache 2017; 57:899-907. [DOI: 10.1111/head.13109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/04/2017] [Accepted: 02/04/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Tal Eidlitz-Markus
- Pediatric Headache Clinic; Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva; and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Yishai Haimi-Cohen
- Pediatric Headache Clinic; Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva; and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Avraham Zeharia
- Pediatric Headache Clinic; Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva; and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
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Raieli V, Pitino R, Giordano G, Spitalieri C, Consolo F, Puma D, Santangelo G, Vanadia F, D'Amelio M. Migraine in a pediatric population: a clinical study in children younger than 7 years of age. Dev Med Child Neurol 2015; 57:585-8. [PMID: 25586426 DOI: 10.1111/dmcn.12679] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 01/17/2023]
Abstract
AIM Migraines in children younger than 7 years of age have received limited attention in the published literature. The aim of this study is to describe the characteristics of migraine phenotypes in children younger than 7 years, and to compare them with migraines in children older than 7 years of age. METHOD We reviewed all standard clinical files, collected over 4 years, related to children with a diagnosis of primary headache. We included all children younger than 7 years diagnosed with migraine in our study. RESULTS A total of 374 children (188 males, 186 females) were affected by migraine with/without aura: 40 of these patients (10.7%; 20 males, 20 females; mean age 5y 7mo, SD 1y 2mo) where younger than 7 years old. The frequencies of the main migraine features in the younger age group were similar to those of children older than 7 years, with the exception of a shorter duration of migraine and reduced frequency of attacks. INTERPRETATION In children younger than 7 years of age, the clinical phenotype of migraine is similar to that seen in older children. We propose that there is a general genetic migraine susceptibility that, in the presence of activating environmental factors, may induce typical attacks of migraine in individuals already predisposed to migraine attacks. Therefore, different modules induce different clinical features within the different age groups, but there is no difference in the frequencies of clinical phenotypes between the two age groups.
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Affiliation(s)
- Vincenzo Raieli
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Renata Pitino
- Child Neuropsychiatry School, University of Palermo, Palermo, Italy
| | | | | | - Flavia Consolo
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Domenico Puma
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Giuseppe Santangelo
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Francesca Vanadia
- Child Neuropsychiatry Unit, Di Cristina Hospital ARNAS Civico, Palermo, Italy
| | - Marco D'Amelio
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
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14
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Abstract
The interaction between sleep and headache or migraine is powerful and an elevated comorbidity between these 2 disorders has been reported in either adults or children. This comobidity is linked to common neurophysiological and neuroanatomical substrates that are genetically based strongly. The first reports on this relationship were related to the prevalence of parasomnias and sleep-disordered breathing in headache but recent research has expanded the comorbidity to several other sleep disorders, such as restless legs syndrome, periodic limb movements during sleep, and narcolepsy. The assessment of children with headache should always include an accurate anamnesis for the presence of sleep problems either in the child or in the relatives; no correct approach for treating children and adolescents is possible without an integrated method of evaluation and management.
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Affiliation(s)
- Claudia Dosi
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Mariagrazia Figura
- Department of Clinical and Experimental Medicine University of Messina, Messina, Italy; Oasi Research Insitute IRCCS, Troina, Italy
| | | | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy.
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