Migraine in children and adolescents. Diagnostic and therapeutic approach enhanced psychological problems

Between 2% and 10% of children preset the so-called "functional" pains, for which a "cause" is not found. However, the lack of evidence for organic cause does not mean in itself that problem is exclusively "psychological". Psychological factors interact with this biological basis, even though we do not know how (triggers, shared background, or both?). IHS in 2004 presents a new classification for headache disorders, cranial neuralgias and facial pain, which includes criteria of the diagnosis of migraine in children. Authors pay attention on the differences in the migraine clinical diagnostic criteria in children in relation to the adults. Evolution of migraine symptoms during the childhood depend generally on the maturity of dopaminergic and serotoninergic systems. The diagnosis of migraine bases on history, examination and observation of the child during and after attacks. Some psychological features are more frequent in children with migraine. Psychogenic attacks triggering factors are the most frequent in children and psychotherapy is most effective as the prophylactic therapy. In the last period there are a few studies concerning the role of antiepileptics in the treatment of migraine. The new double blinded studies are needed to establish the indications and effectiveness of the prophylactic treatment in migraine in children.