TRAUMA TRIGGERED MIGRAINE (TTM) IN CHILDREN AND ADOLESCENTS (C/A)

Objectives: To review the clinical features, evaluation, pathophysiology treatment, and prognosis of TTM.

Methods: A review of 680 consecutive C/A with HA was undertaken. 11 patients experienced migraine following head trauma. 7 patients with similar history evaluated prior to 2001 were included. A literature review from 1968–2005 revealed 78 patients.

Results: The M/F ratio was 73:22 average age was 11 (1–18 years). 43% of TTM occurred in males 13–18 years, and 37% in males under age 12. All had mild head trauma, 13 had LOC, none exceeded 10 seconds. 87% had symptoms within 30 minutes and 8% within 30–60 minutes. 26% had a history of migraine and 67% had a family history of migraine. HA 88%, disorientation/confusion 80%, emesis 53%, and visual disturbances 47%. Symptoms lasted on average of 10 hours. 40% had recurrent attacks. Imaging in 47 patients was normal. EEG showed unilateral or bilateral slowing in 17/18 patients. No data on treatment was collatable.

Conclusion: Migraine can follow trauma. Most frequently in male children and adolescents playing contact sports. The majority had mild-moderate trauma, did not lose consciousness and developed typical migrainous symptoms within 30 minutes. A personal and/or family history of migraine is common. In addition to HA, vomiting, confusion and visual disturbances were noted. Symptoms cleared in 10 hours. Many had recurrent attacks. Trauma can initiate spreading depression resulting in migrainous symptoms and slowing on EEG. It is important to differentiate this disorder from concussion and intracranial hemorrhage. Prevention utilizing a helmet is appropriate. Imaging may not be needed if the presentation is typical. Pretreating patients with NSAIDS may help. No data is available regarding prophylactic medications. Further study of this not uncommon entity is warranted.