Natural history of migraine in childhood

Epidemiological studies have shown that 3-7% of the paediatric population s uffer from migraine. Despite this high prevalence Little has been published about the natural history of migraine or of its prognosis. The objectives of this study were: (i) to outline the natural history of migraine in child hood; and (ii) to identify early predictors of an unfavourable clinical evo lution. A prospective, longitudinal, 10-year follow-up study was conducted of the clinical evolution of 181 paediatric patients with migraine. Data an alysis was performed by statistical significance and logistic regression te sts. In our study 24.3% of children with migraine had their onset before ag e 6 years and another 57% between 6 and 10 years of age. A positive family history of migraine was recorded in 77.5%. Eighty-eight percent of patients followed a favourable clinical course. The remaining 12% of patients had t o be placed on prophylactic treatment owing to the increasing of their head ache. Of all parameters investigated, the age of onset was the only statist ically significant predictor of an unfavourable clinical evolution. We conc lude: (i) most patients with migraine headache starting in childhood do not require prophylactic treatment; (ii) the earlier the disease begins the mo re likely is an unfavourable clinical course; (iii) genetic factors play an important role in the phenotypic expression of the disease; (iv) our study suggests the existence, at least, of two different populations among child hood migraine patients.