Researchers Evaluate 10-Year Outcomes of Pediatric Patients With Migraine, TTH

Most pediatric patients with migraine or tension-type headache (TTH) will experience a favorable outcome over 10 years, although those presenting with TTH will have twice the chance of complete headache resolution, according to study findings published in Life.

Prevalence of migraine among children in preschool is around 3%, while by early school years it can increase to 11% and is as high as 23% among high schoolers, researchers explained.

Although several studies have investigated remission rates of pediatric migraineurs, long-term prognosis of TTH in pediatric patients has not been thoroughly studied. To address this knowledge gap, researchers conducted a cohort study aimed at evaluating outcomes 10 years after the first clinic visit for children and adolescents with migraine vs TTH.

Investigators collected data from individuals who visited a pediatric neurology clinic in Israel between 2007 and 2008. During phone interviews, information regarding patients’ medical history, headache history, and other factors was collected.

Of the 147 children seen during that time window, researchers conducted follow-up interviews with 120 patients. A total of 59 fulfilled migraine criteria at their first visit, while 61 had TTH. For migraineurs, a mean time of 9.3 years elapsed since initial diagnosis compared with 9.2 years among those with TTH.

Analyses revealed:

• For the migraine patients, headaches improved in 48 (81.4%) and worsened in 4 (6.8%)
• Regarding diagnosis at follow-up, 59% still had migraine, 17% had TTH, and 23% were headache-free
• Aura and photophobia were significantly associated with persistence of a migraine diagnosis
• For the TTH patients, headaches improved in 49 (81.7%) and worsened in 9 (15%)
• Regarding diagnosis at follow-up, 36.7% still had TTH, 18.3% had migraine, and 45% were headache-free
• Of the patients with TTH, 36.7% retained their initial diagnosis compared to 59.3% among the migraine patients
• 16–18% of patients diagnosed with migraine or TTH during childhood will see their diagnosis changed within 10 years

“Our findings show that among pediatric-onset migraine patients, 81% improved in regard to the existence and frequency of headache episodes over an average period of 9.3 years, with 24% enjoying complete remission,” authors wrote. “However, 76% still reported suffering headache episodes, with 60% still meeting migraine criteria and 16% now fulfilling the criteria for TTH.”

In the current study, family history was not associated with persistence of headache diagnosis, although photophobia and migraine with aura both were. No gender differences were found in headache prognosis.

Shifts in the diagnosis of pediatric headache patients over time could be due to incorrect initial diagnoses or hormonal changes during puberty. Although prevalence of migraine is similar among boys and girls before puberty, it is higher in females post-puberty.

“Neurogenic inflammatory molecules, including calcitonin gene-related peptide (CGRP) and substance-P (SP), play a major role in migraine pathogenesis, and they are affected by the release of the female sex hormones, estrogen, and progesterone,” authors explained.

As findings are based off a relatively small sample size from a single clinic, results may not be generalizable to the wider public.

Reference

Genizi J, Hendler-Sade A, Segal I, Bamberger E, Srugo I, Kerem NC. Outcomes of migraine and tension-type headache in children and adolescents. Life (Basel). Published online July 13, 2021. doi:10.3390/life11070684