One of the most insidious characteristics of Migraine disease is that it can strike people of any age, including very young children. Any parent, especially one who experiences Migraines, would tell you that they'd rather have the Migraine attack than watch their child suffer through one. Many parents express feelings of guilt for passing Migraine disease on to their children.

Migraine disease is a potentially disabling disease common in children and adolescents. Now, for children and adolescents with Migraine disease and for their families, there's potentially good news. A new study published in the journal Neurology suggests that their prognosis is excellent, that they may "grow out of" their Migraine or have less severe Migraines as they get older. However, these are the conclusions of one small study, the results of which raise some questions.
  

Study objective

To determine the long-term outcome of Migraine attacks in adolescents and to identify possible factors affecting their prognosis.
 

Study methods

Eighty children from a primary school in southern Italy were screened and assigned a Migraine diagnosis from the International Headache Society's International Classification of Headache Disorders (ICHD), 1st edition. These children, ages 11 to 14 years, were entered into a 10-year observational study. Some students with "unclassified headaches" were included in the study with a Migraine diagnosis.

Sixteen of the of 80 subjects who were evaluated and diagnosed in 1989 dropped out of the study at the first five-year follow up in 1994. In 1999, four subjects refused to continue participation and five could not be located. The remaining 55 participants were again evaluated for Migraine. Subjects were considered to be unaffected by Migraine if they had been Migraine-free for a period of 12 consecutive months.
  

Study results

Results were limited to the initial assessment and subsequent follow up evaluations of the 55 subjects who remained in the study at its completion in 1999. Of the 55 remaining subjects:

• 41.8% were still diagnosed with Migraine
• 38.2% had experienced remission (12 months Migraine-free)
• 20.0% "transformed to tension-type headache"
• Only subjects originally diagnosed Migraine without aura were still diagnosed with Migraine without aura after 10 years.
• Family history of Migraine significantly predicted the 10-year persistence of Migraine.
   

Study conclusions of the researchers

Migraine headaches in adolescents have a favorable long-term prognosis. Family history of Migraine predicted a poorer outcome, especially in subjects with Migraine without aura.

Further studies of adolescents, conducted on larger samples with the more sensitive criteria of the International Classification of Headache Disorders (2nd ed.) are warranted.

According to United Press International, Dr. Roberto Monastero, the primary researcher, commented, "This is great news for children and teens who are dealing with Migraine headache... Most of them will no longer have to deal with these disabling headaches by the time they are adults."
  

Questions and comments about this study

• This study, while a good beginning, is just that — a beginning. As the authors concluded, more studies with more participants and more detailed diagnostic criteria are in order.
• Is a 12-month Migraine-free period sufficient to think that these children and adolescents will have fewer or less severe Migraines as adults? Certainly, we see many adults who have infrequent Migraines and thus, although the are diagnosed with Migraine, would be considered to be in remission by the criteria of this study.
• It is unclear how one "transforms" from having Migraine, which is a genetic neurological disease, to having tension-type headaches. Perhaps this outcome is the result of subjects with "unclassifiable headache" were included in the study as Migraineurs.
• Dr. Monastero's statement that "Most of them will no longer have to deal with these disabling headaches by the time they are adults" seems out of proportion to the results of the study, especially in light of the above comments and questions.
• In all fairness, when this study began in 1989, less was know about Migraine disease. The ICHD was still in its first edition, which was far less detailed in breaking Migraine down into its various types. Were this study to be undertaken today, the selection and classification of the subjects would probably be more precise and lead to more more precise results with fewer questions.
   

Summary

This may be good news for adolescents and their families, but this small study is far from enough to say so with any certainty. Only with larger and better constructed studies will we actually be able to echo Dr. Monastero with any confidence.

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Resources:

Monastero, Roberto, MD, PhD; Camarda, Cecilia, MD; Pipia, Carmela, MD; Camarda, Rosolino, MD. "Prognosis of Migraine headaches in adolescents: A 10-year follow-up study." Neurology 2006;67;1353-1356. DOI: 10.1212/01.wnl.0000240131.69632.4f.

"Many teens with Migraines lose them later." United Press International. October 25, 2006.

Fact sheet. "Headache Disorders." World Health Organization. March, 2004.

Published October 31, 2006
© Teri Robert