Pediatric migraine with aura in an Italian case series

The aim of the present study was to describe the characteristics of migraine with aura (MwA) in a case series of patients with headache onset before 12 years of age. We considered all consecutive patients referred to the Parma Headache Centre between 1975 and 2015 affected by MwA, diagnosed by our team of trained neurologists; the cases were subsequently reviewed applying the ICHD3-beta criteria. We then identified those cases with headache age-of-onset < 12 years (i.e., "pediatric" cases), which were compared to all remaining cases. We identified 283 cases with pediatric onset (87 males and 196 females). The male-to-female ratio was 1:2.3 in both "pediatric" and "non-pediatric" cases. The time lag between MwA onset and our first evaluation was significantly higher among the pediatric cases (18.7 +/- 13.3 vs 10.4 +/- 10.4 years). In both groups of patients, visual aura was the most common type of aura, followed by sensory and speech disturbances; however, these two latter aura symptoms were significantly more common among pediatric cases. In this group of patients, aura without headache was significantly less frequent (1.8 vs 5.3%); furthermore, headache had migraine characteristics in a higher proportion of cases (90.1 vs 82.6%). A family history of MwA was significantly more frequent among cases with pediatric onset (31.1 vs 16.9%). Males but not females with pediatric MwA had more frequently a comorbid migraine without aura (27.6 vs 16.8%). Among cases with pediatric onset, we did not find any significant differences between males and females. In conclusion, in our very large case series of MwA, patients with headache onset before 12 years of age seem to have a specific clinical phenotype, without significant gender differences.