Migraine in children and adolescents

This narrative review explores recent advances in the study of migraine with an emphasis on its complex polygenic aetiology, pathogenesis, clinical presentation, and the potential for new specific mechanism-based treatments in children and adolescents. The polygenic aetiology and complex pathogenesis of migraine make its clinical presentation subject to the influences of intrinsic physiological and psychological factors as well as extrinsic environmental and lifestyle factors. In addition to variation in the clinical presentation of migraine in children, several disorders, such as abdominal migraine, cyclical vomiting syndrome, benign paroxysmal vertigo, benign paroxysmal torticollis, and infantile colic, are considered under the wide umbrella of childhood migraine syndrome. Advances in the study of migraine pathophysiology have identified the important roles of several neurotransmitters and opened the way for the development of new specific medication to treat migraine episodes and for prevention. In the absence of reliable biomarkers, clinical assessment remains the backbone for the diagnosis and assessment of migraine. With better understanding of the complexity of migraine pathophysiology comes the realization that no single drug will solve all the problems of the disease for all patients.