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

Most pediatric patients with migraines or tension headaches (TTH) will experience a beneficial outcome for 10 years, although those who present with TTH are twice as likely to have complete headache relief, according to research results published in Life.

The prevalence of migraine in kindergarten children is about 3%, while it can increase to 11% in the early school years and is even 23% among high school students, researchers explained.

While several studies have examined the remission rates of pediatric migraineurs, the 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 migraines versus TTH.

Researchers collected data from individuals who attended a pediatric neurology clinic in Israel between 2007 and 2008. During telephone interviews, information was collected about the patient’s medical history, headache history, and other factors.

Of the 147 children seen in that time window, researchers conducted follow-up interviews with 120 patients. A total of 59 met the migraine criteria at their first visit, while 61 had TTH. For migraineurs, an average time of 9.3 years has passed since initial diagnosis, compared to 9.2 years in those with TTH.

Analyzes revealed:

For the migraine patients, the headaches improved in 48 (81.4%) and worsened in 4 (6.8%) In terms of diagnosis at follow-up, 59% still had migraines, 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%) As for diagnosis at follow-up, 36.7% still had still TTH, 18.3% had migraines and 45% had headache-free Of the patients with TTH, 36.7% maintained their initial diagnosis, compared to 59.3% of the migraine patients.16-18% of the patients who received TTH during the were diagnosed with migraine or TTH in childhood will see their diagnosis change within 10 years

“Our findings show that in pediatric migraineurs, 81% improved in the existence and frequency of headache episodes over a mean period of 9.3 years, with 24% enjoying complete remission,” the authors wrote. “However, 76% still reported experiencing headache attacks, with 60% still meeting the migraine criteria and 16% now meeting the criteria for TTH.”

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

Shifts in the diagnosis of pediatric headache patients over time may be due to incorrect initial diagnoses or hormonal changes during puberty. While the prevalence of migraine is equal in prepubescent boys and girls, it is higher in postpubertal women.

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

Since the findings are based on a relatively small sample size from a single clinic, the results may not be generalizable to the general public.

Reference

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

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