Migraine and chronic headache in children.

In childhood and adolescence, migraine is the main essential chronic headac he. This diagnosis is extensively underestimated and misdiagnosed in pediat ric population. Lacks of specific biologic marker, specific investigation o r brain imaging reduce these clinical entities too often to a psychological illness. Migraine is a severe headache evolving by stereotyped crises asso ciated with marked digestive symptoms (nausea and vomiting); throbbing pain , sensitivity to sound, light are usual symptoms; the attack is sometimes p receded by a visual or sensory aura. During attacks, pain intensity is seve re, most of children must lie down. Abdominal pain is frequently associated rest brings relief and sleep ends often the attack The prevalence of the m igraine varies between 5p.100 and 10p.100 in childhood. At childhood, heada che duration is quite often shorter than in adult population, it is more of ten frontal, bilateral (2/3 of cases) that one-sided. Migraine is a disabli ng illness: children with migraine lost more school days in a school year, than a matched control group. Migraine episodes are frequently triggered by several factors: emotional stress (school pressure, vexation, excitement u pset), hypoglycemia, lack of sleep or excess (week end migraine), sensorial stimulation (loud noise, bright light, strong odor, heat or cold...), symp athetic stimulation (sport, physical exercise). Attack treatments must be g iven at the early beginning of the crisis; oral dose of ibuprofen (10mg/kg) is recommended. If the oral route in not available when nausea or vomiting occurs, the rectal or nasal routes have then to be used. Non pharmacologic al treatments (biofeedback and interventions combining progressive muscle r elaxation) have shown to have good efficacy as prophylactic measure. Daily prophylactic pharmacological treatments are prescribed in second line after failure of non-pharmacological treatment.