Migraine and headache in childhood and adolescence

In childhood and adolescence, migraine is the main, essential chronic heada che. This diagnosis is extensively underestimated and misdiagnosed in the p ediatric population. Lack of specific biologic marker and specific investig ation or brain imaging often reduces these clinical entities to a psycholog ic illness. Migraine is schematically a severe headache evolving by stereot yped crises associated with marked digestive symptoms (nausea and vomiting) ; throbbing pain, sensitivity to sound, light (and sometimes odors) are usu al 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 th e oral route is not available when nausea or vomiting occurs, the rectal or nasal routes then have to be used. Nonpharmacologic treatments (biofeedbac k and interventions combining progressive muscle relaxation) have been show n to have good efficacy. Daily prophylactic pharmacologic treatments are pr escribed in second line after failure of nonpharmacologic treatment.