Falling asleep as a means of ending migraine attack was studied in 133 4-16
-year-old children in out-patient settings. Children registered 999 migrain
e attacks in headache diaries using a visual analogue scale (VAS) in 409 at
tacks and a five-face scale in 590 attacks. The distribution of maximal pai
n intensity was similar on both scales; on VAS 88% assigned grades between
63 and 100, and on the face scale 93% assigned grades of 4 or 5. Children f
ell asleep during 33% of the attacks (n = 329), in 64% of these within the
first hour (n = 209). Of the children, 68% (n = 91) had fallen asleep at le
ast once during an attack. Falling asleep was more common in children under
8 years of age than in older children. In those under 8 years, 62% (95% co
nfidence interval (CI) 49-75%) of attacks were resolved by sleep, in those
aged 8-12 years 34% (26-41%), and in children > 12 years 24% (15-33%) (ANOV
A, P < 0.0001). Pain was relieved without sleep in 43% (n = 431) of attacks
, in 38% of these (n = 383) within the first 4 h. The data on migraine reso
lution were missing for 24% (n = 239) of the attacks, most often because th
e attack exceeded the 5-h observation period. This study confirms that migr
aine attacks in children are extremely painful and often resolve during an
interval of sleep in children under 8 years of age.