NEUROLOGY
Migraine
in Childhood A Review
P.
J. Congdon, MB, MRCP,
! HE
.
of arterial hyperemia.2 ~~te~, Eulenburg classified migraine into vasospastic and vasopariilytic ’types, and the vascular basis of migqaine has been further elucidated by the ~c~r~ ~~’ ~~~~‘~’ e~ ~~. ~ ‘ ~B.. &dquo;
.~
&dquo;
.
~~
.:
/’
’,’:.;;::
~’
&dquo; ~
Diagnosis, -~:’.&dquo;; .~&dquo;:,~. ~ ;,:,~ ~..B: ’J. ’~ &dquo;~.~’’’-&dquo; Migraine ~~ a a lini~~ ~~~~no~~ and inve,stigations are helpful only in excluding more ~.’ ~ s€.rmus.-c.o,:nditio.as.,~I.M~ migraine head- :~ ...:a’ch@s~’can ~ ~’!tOBf~s~:~Wtt&; other causes of ’’
severe cephaigia, but,e’,vents,at’.-, usaaiyc-arified when similar epis6d ~e~g occur after. symptom-free ~~.t~~~:~..~ child with rec’tiirent
headaches should,
:a;gcaemi:and;:.com’’ ::/f..ptetc’;Beu~l~gie~ with particular emphasis ori examining the fundi, -auscultating ’, Thig type is similar to the ’*’cluster&dquo; at-tacks seen in adults,, and is rarely seen in children,, ’’~ ~th~s~MMs~S~~bru~~ and ~h@’~.Mood~ -
; /
&dquo;
manifestations .include
paresthpsie, dizziness, and hemiplegia. 2-9.30 ,. -/ -~/ ~any authors comment on the high inc:~~ dence of gastrointestinal symptoms. Up to ;’: 98 per, cent experie,n,cenause,a and/or vonut- / B ing, and. motion sickness is not uncommon B’ in ; intervals,~’I A positive family ~ history.has been found in 44. ;t0!/ 90 per,c ent ~
~
This encompasses ~: number of well defined entities. Hemiplegic migraine may be familial, and is characterized by hemiplegia, hcmisensory loss, and speech disturbance if the dominant hemisphere is involved.’5 Opthalmoplegic migraine has been reported at 8 months,36 and is characterized by severe pain in the region of the affected eye followed by an’ ipsilateral third nerve palsy and rarely fourth and sixth’nerve palsies. The oculomotor signs may persist long after the. headache subsides.3&dquo; &dquo; does Rarely migraine present as an acute confusional state or be confused with psychiatric conditions.&dquo;’ Lee and Lance described 7 patients, 2 of whom ’were-children,’ whose, rnigraine presented with’’ confusion and ag’ ..’.’;’ ..&dquo; ..~ ’ ; :B:&dquo; gression.311 ..
are
/.~
migraine
~~~~~~~~~~ ~~~~~~_~~’
.~.’/~~.,~~;,~, /.
~~.’
~:’;/r.’
355 Downloaded from cpj.sagepub.com at Yale University Library on July 6, 2015
pressure. Early morning headaches, especially if associated with vomiting, should alert the physician to the possibility of an underlying intracranial neoplasm; and this should be excluded before a diagnosis of migraine is made. Angiomas or arteriovenous malformations should be suspected when the headache is persistently unilateral, especially when there is accompanying focal epilepsy or motor signs in the contralateral limb. Computerized axial tomography is of value in the investigation of difficult cases, but arteriography is rarely necessary and potentially dangerous. Headache due to sinusitis occurs in children, but is usually associated with rhinorrhoea and tenderness over the maxillary antra. Headaches occurring as a result of psychiatric problems are not usually preceded by an aura, do not throb and are more diffuse. Tension headaches are unusual before puberty and do not occur when stress is removed, e.g., at weekends or after shool examinations. The relationship between epilepsy and migraine is complex. Epilepsy has a more abrupt onset and termination than migraine, with an alteration in conscious level as a major feature. While epilepsy appears to be more common in families with migraine, both can coexist. Temporal lobe epilepsy can be confused with &dquo;abdominal migraine,&dquo; but this has been overemphasized. Recurrent bouts of vomiting are rarely a feature of epilepsy. EEG abnormalities mainly due to focal stowing are more frequent in migraine sufferers. 39 There is some controversy over the significance of 14 and 6 cycles per second spikes in EEG records. This pattern is more common in children than adults, and more common in those with migraine than in controlS.39.40 ~a~~~~~~r~ as similar spiking may be seen in normal children, in those with psychiatric (~.~ behavior), in the ~,~~i~~~-~~rn~~~~, the of its presence is difficult to interpret. 41
Treatment The type of therapy employed will naturally the severity and frequency of mi-
depend on
graine attacks, and in children, these may be widely varied. Quite often, if the attacks are infrequent and not severe, all that is required is reassurance and an analgesic. However, if the attacks are more frequent, regular prophylactic drugs may be used. The child with infrequent but
severe
from
headaches may well benefit
Where headaches the ingestion of certain foodstuffs, the initial step should be their elimination from the diet.
are
regular positively related
treatment. to
Treatment of acute attack
mild analgesics may be tried, the effective form of treatment used to end an attack is ergotamine tartrate.1’ Numerous preparations are available which may be administered orally, sublingually, rectally, intramuscularly or by inhalation. Ergot is poorly absorbed via the gastrointestinal tract and a
Although
most
sublingual preparation ofergotamine {1 rn~) is often better. Dihydroergotamine has to be given in higher doses than ergotamine to end attack, but its weaker vasoconstrictive action allows it to be used on a long-term basis. 42 When caffeine is combined with ergot, there appears to be better absorption of the latter. 43 A combination of ergotamine and caffeine is marketed as cafergot and I tablet taken at onset of headache and repeated after 30 minutes is often successful. Ergot and its derivatives act by causing vasoconstriction due to stimulation of alpha receptors. They inhibit serotonin uptake by platelets and perhaps prevent the fall in plasma serotonin which may be responsible for extracranial vasoan
dilatation. 42 Preventatlve
therapy
Methysergide is a semisynthetic derivative of with no vasoconstrictive properties, its in an attack. However, it is a very powerful serotonin anand be used as a prophylactic agent.12 Its use in the population has been limited by the knowledge prolonged treatment may cause retroperitoneal fibrosis. 44 However, methysergide appears
356
Downloaded from cpj.sagepub.com at Yale University Library on July 6, 2015
Downloaded from cpj.sagepub.com at Yale University Library on July 6, 2015
reduce both the frequency and severity of attacks.32.4o It is best given in a discontinuous manner, i~., 5 out of 7 days, and treatment should be restricted to no more than 6 months.9 Clonidine. Zainis and Hannington first sugthat donidine-an imidazoline―may be useful in migraine as it diminishes the responsiveness of peripheral vessels to constrictor and dilator stimuli.45 Studies have shown it to be beneficial in adults46 but a controlled study in children showed it to be no better than placebo.41 One tablet (0.025 mg) given twice or three times a day seldom gives rise to serious side effects, but drowsiness and skin rashes may occur. Propranolol is a beta receptor blocking agent and has been shown with doses of 1 mg/kg three times a day to reduce both the severity and of attacks:~8 It may act by maintaining a certain level of vasoconstrictor tone and thus counteract the hypotonicity of extracranial arteries which is responsible for the headache.42 should not be given to children with asthma, diabetes or heart disease and should be withdrawn 24 hours before anesthesia. Ar~t~~~~~~l~c~~ts. Prophylactic treatment with both phenobarbital and dilantin in doses similar to that used when treating seizures has been used with conflicting results. Some have had beneficial results especially when the electroencephalogram results have been abnormal, while Others have found these drugs to be useful regardless of the EEG changes There are also reports where this form of therapy has been ineffective.9 to
However, about 20 per
how many children have a in later life.
We are grateful the manuscript.
of mi-
to
Mrs. Annetta Kitcher for
preparing
References 1. Alverez WC: Was there sick headache in 3000 B.C.? Gastroenterology 6:524, 1945 2. Bille B: Migraine in school children. Acta Paediatr Scand 51 (Suppl):136, 1962 3. Wolff HG: Headaches and Other Head Pain. New York, University Press, 1963 4. Glaser J: Migraine in pediatric practice. Am J Dis Child 88:92, 1954 5. Ryan RE: Headache, Diagnosis and Treatment. St. Louis, C. V. Mosby, 1954 6. Vahlquist B, Hackzell G: Migraine of early onset. A study of thirty-one cases in which the disease first appeared between one and four years of age. Acta Paediatr Scand 38:622, 1949 7. Burke EC, Peters GA: Migraine in childhood: a preliminary report. Am J Dis Child 92:330, 1956 8. Selby G, Lance JW: Observations on 500 cases of migraine and allied vascular headache. J Neurol Neurosurg Psychiatry 23:23, 1960 9. Holguin J, Fenichel G: Migraine. J Pediatr 70:290, 1967 10. Trued S: Migraine in childhood. J Am Med Wom Assoc. 29:78, 1974 11. O’Brien MD: The relationship between aura symptoms and cerebral blood flow changes in the pro-
drome of
12.
13.
14.
16.
Childhood migraine to have a good
―~.g-.,
17.
siderably or f:ee from headaciies over an observation period of 9 to 14 years.49 found that 35 to 50 per cent of children in his survey were symptom over a 4 to 6 year period.2 The majority of children experience fewer attacks as they grow older, and in ny, migraine disappears completely.1°
recurrence
Acknowledgment
15.
Henrichs Keith found 80 per of childre; either con-
of adults had
graine
.
Prognosis
cent
migraine before the age of 10 years. It is, however, not completely clear from the literature
18.
19.
migraine. Headache 11:90, 1971 Paulson OB: Regional blood flow in internal carotid distribution during migraine attack. Br Med J 3:569, 1969 Elkind AH, Freedman AP, Grossman J: Cutaneous blood flow in vascular headaches of the migraine type. Neurology 14:24, 1964 O’Brien MD: Cerebral blood flow changes in the prodrome of migraine. Headache 10:139, 1971 Bradshaw P, Parsons M: Hemiplegic migraine, a clinical study. QJ Med 34:65, 1965 Hungerford GD, du Barlay GH, Zilkha KJ: Computerised axial tomography in patients with severe migraine: a preliminary report. J Neurol Neurosurg Psychiatry 39:990, 1976 Curran DA, Hinterberger H, Lance JW: Total plasma serotonin, 5 hydroxy-indolacetic acid and p-hydroxy-m-methoxymandelic acid excretion in normal and migrainous subjects. Brain 88:997,1965 Kangasniemi P, Sonninen V, Rinne UK: Excretion of free and conjugated 5-HIAA and VMA in urine and concentration of 5-HIAA and HVA in CSF during migraine attacks and free intervals. Headache12:62, 1972 Anthony M, Hinterberger H, Lance JW: The posSkinhøj E,
358 Downloaded from cpj.sagepub.com at Yale University Library on July 6, 2015
sible
20.
relationship of serotonin to the migraine syndrome. Res Clin Stud Headache 2:29, 1969 Lance JW, Anthony M, Gonski A: Serotonin, the carotid body, and cranial vessels in migraine.
Arch neurology 16:553, 1967 21. Kangasniemi P, Riekkinen P, Rinnie UK: Kallikrein—like esterase and peptidase activities in CSF during migraine attacks and free intervals. Headache 12:66, 1972 22. Siculeri F: Mast cells and their active substances: their role in the pathogenesis of migraine. Headache 3:86, 1963 23. Fanchamps A: The role of humoral mediators in migraine headache. Can J Neurol Sci 1:189, 1974 24. Curtis-Brown R: A protein poison theory. Br Med
J 1:156, 1925 25. 26.
Classification of Headache. JAMA 179:717, 1962 AL: Migraine and migrainous variants in pediatric patients. Pediatr Clin North Am 23: 461, 1976 31. Vahlquist B: Migraine in children. Int Arch Allergy
Prensky
Appl Immunol 7:348, 1955 Friedman AP: The migraine syndrome. Acad Med 44:45, 1968
Bull NY
33. Bickerstaff ER: Basilar artery migraine. Lancet
1:
15, 1961 34. Golden GS, French JM: Basilar artery migraine in young children. Pediatrics 56:722, 1975
Migraine stupor. Headache JW, Kagawn
specific
583, 1959 40. Whitehouse D,
Pappas JA, Escala PH, Livingston S: Electroencephalographic changes in children with migraine. N EnglJ Med 276:23, 1967
DR: Controlled studies of incidence and
and 14 per second positive spiking. Electroencephalogr Clin Neurophysiol 15:
significance of 6 161,1963 42. 43. 44.
Fanchamps
A:
Pharmacodynamic principles
of
anti-migraine therapy. Headache 15:79, 1975 Fanchamps A: Sandoz—fifty years involvement in migraine therapy. Triangle 15:103, 1976 Graham. JR, Suby HI, Le Compte PR, Sadowsky NL:
Fibrotic disorders associated with methysergide for headache. N Engl J Med 274:359,
therapy 1966 45. Zaimis E,
Hanington
E: A
possible pharmacological
approach to migraine. Lancet 2:298, 1969 46. Shafar J, Tallett ER, Knowlson PA: Evaluation of clonidine in
prophylaxis
of
migraine. Lancet
1:
403, 1972 47. Sillanpaa M: Clonidine prophylaxis in childhood migraine and other vascular headache. Headache 17:28, 1977 48. Ludvigsson J: Propranolol used in prophylaxis of migraine in children. Acta Neurologica Scand
50:109, 1974
49. Henrichs WL, Keith HM:
~’’~~’’-&dquo;B
~~ ~. ’
~,―
N: A
correlate of convulsive electroencephalographic equivalent disorders in children. J Pediatr 55:
Mellinger JF, Rook ED: Familial hemiplegic migraine. Mayo Clin Proc 50:307, 1975
35. Gliston G,
early onset of Dis Child 107:
1970
38. Lee CH, Lance JW: 17:32, 1977 39. Kellaway P, Crawley
41. Metcalf
Child Neurol 10:794, 1974 29. Ad Hoc Committee on Classification of Headache.
32.
ophthaimoplegic 628, 1964
migraine. Am J
37. Gascon G, Barlow C: Juvenile migraine, presenting as an acute confusional state. Pediatrics 45: 628,
Ungen AH, Ungen L: Migraine is an allergic disease. J Allergy Clin Immunol 23:429, 1952 Speen F: Allergy and migraine: a clinical study.
Headache 11:63, 1971 27. Hanington E: Preliminary report of tyramine headache. Br Med J 2:550, 1967 28. Forsythe WI, Redmond A: Two controlled trials of tyramine in children with migraine. Dev Med
30.
36. Van Pelt W, Andermann F: On the
a
Announcement
Migraine
in childhood:
followup report. Mayo Clin Proc 40:593,
.’.~/’
1965
~&dquo;
’3~~.~
~
;
eighth annual meeting of the Child Neurology Society will be held in. ~~~~r~~r, ~rw ~~~~~hir~, on ~~pt~r~s~~~ ~,~- ~ ~, ~. ~’7~. The meeting is open to all physicians. Registration information and abstract forms’may be obtained from ~~~~~~d ~l’~ur~~c~g~ Scr~~~ty:l~~ti~~a~ ~3~~a~~, ~crx 486 Mayo, 420 Delaware Street ~,~.~ .~~~a~~~~c~~i~, l~~ 5~~~~~.
359 Downloaded from cpj.sagepub.com at Yale University Library on July 6, 2015
Migraine
in Childhood A Review
P.
J. Congdon, MB, MRCP,
! HE
.
of arterial hyperemia.2 ~~te~, Eulenburg classified migraine into vasospastic and vasopariilytic ’types, and the vascular basis of migqaine has been further elucidated by the ~c~r~ ~~’ ~~~~‘~’ e~ ~~. ~ ‘ ~B.. &dquo;
.~
&dquo;
.
~~
.:
/’
’,’:.;;::
~’
&dquo; ~
Diagnosis, -~:’.&dquo;; .~&dquo;:,~. ~ ;,:,~ ~..B: ’J. ’~ &dquo;~.~’’’-&dquo; Migraine ~~ a a lini~~ ~~~~no~~ and inve,stigations are helpful only in excluding more ~.’ ~ s€.rmus.-c.o,:nditio.as.,~I.M~ migraine head- :~ ...:a’ch@s~’can ~ ~’!tOBf~s~:~Wtt&; other causes of ’’
severe cephaigia, but,e’,vents,at’.-, usaaiyc-arified when similar epis6d ~e~g occur after. symptom-free ~~.t~~~:~..~ child with rec’tiirent
headaches should,
:a;gcaemi:and;:.com’’ ::/f..ptetc’;Beu~l~gie~ with particular emphasis ori examining the fundi, -auscultating ’, Thig type is similar to the ’*’cluster&dquo; at-tacks seen in adults,, and is rarely seen in children,, ’’~ ~th~s~MMs~S~~bru~~ and ~h@’~.Mood~ -
; /
&dquo;
manifestations .include
paresthpsie, dizziness, and hemiplegia. 2-9.30 ,. -/ -~/ ~any authors comment on the high inc:~~ dence of gastrointestinal symptoms. Up to ;’: 98 per, cent experie,n,cenause,a and/or vonut- / B ing, and. motion sickness is not uncommon B’ in ; intervals,~’I A positive family ~ history.has been found in 44. ;t0!/ 90 per,c ent ~
~
This encompasses ~: number of well defined entities. Hemiplegic migraine may be familial, and is characterized by hemiplegia, hcmisensory loss, and speech disturbance if the dominant hemisphere is involved.’5 Opthalmoplegic migraine has been reported at 8 months,36 and is characterized by severe pain in the region of the affected eye followed by an’ ipsilateral third nerve palsy and rarely fourth and sixth’nerve palsies. The oculomotor signs may persist long after the. headache subsides.3&dquo; &dquo; does Rarely migraine present as an acute confusional state or be confused with psychiatric conditions.&dquo;’ Lee and Lance described 7 patients, 2 of whom ’were-children,’ whose, rnigraine presented with’’ confusion and ag’ ..’.’;’ ..&dquo; ..~ ’ ; :B:&dquo; gression.311 ..
are
/.~
migraine
~~~~~~~~~~ ~~~~~~_~~’
.~.’/~~.,~~;,~, /.
~~.’
~:’;/r.’
355 Downloaded from cpj.sagepub.com at Yale University Library on July 6, 2015
pressure. Early morning headaches, especially if associated with vomiting, should alert the physician to the possibility of an underlying intracranial neoplasm; and this should be excluded before a diagnosis of migraine is made. Angiomas or arteriovenous malformations should be suspected when the headache is persistently unilateral, especially when there is accompanying focal epilepsy or motor signs in the contralateral limb. Computerized axial tomography is of value in the investigation of difficult cases, but arteriography is rarely necessary and potentially dangerous. Headache due to sinusitis occurs in children, but is usually associated with rhinorrhoea and tenderness over the maxillary antra. Headaches occurring as a result of psychiatric problems are not usually preceded by an aura, do not throb and are more diffuse. Tension headaches are unusual before puberty and do not occur when stress is removed, e.g., at weekends or after shool examinations. The relationship between epilepsy and migraine is complex. Epilepsy has a more abrupt onset and termination than migraine, with an alteration in conscious level as a major feature. While epilepsy appears to be more common in families with migraine, both can coexist. Temporal lobe epilepsy can be confused with &dquo;abdominal migraine,&dquo; but this has been overemphasized. Recurrent bouts of vomiting are rarely a feature of epilepsy. EEG abnormalities mainly due to focal stowing are more frequent in migraine sufferers. 39 There is some controversy over the significance of 14 and 6 cycles per second spikes in EEG records. This pattern is more common in children than adults, and more common in those with migraine than in controlS.39.40 ~a~~~~~~r~ as similar spiking may be seen in normal children, in those with psychiatric (~.~ behavior), in the ~,~~i~~~-~~rn~~~~, the of its presence is difficult to interpret. 41
Treatment The type of therapy employed will naturally the severity and frequency of mi-
depend on
graine attacks, and in children, these may be widely varied. Quite often, if the attacks are infrequent and not severe, all that is required is reassurance and an analgesic. However, if the attacks are more frequent, regular prophylactic drugs may be used. The child with infrequent but
severe
from
headaches may well benefit
Where headaches the ingestion of certain foodstuffs, the initial step should be their elimination from the diet.
are
regular positively related
treatment. to
Treatment of acute attack
mild analgesics may be tried, the effective form of treatment used to end an attack is ergotamine tartrate.1’ Numerous preparations are available which may be administered orally, sublingually, rectally, intramuscularly or by inhalation. Ergot is poorly absorbed via the gastrointestinal tract and a
Although
most
sublingual preparation ofergotamine {1 rn~) is often better. Dihydroergotamine has to be given in higher doses than ergotamine to end attack, but its weaker vasoconstrictive action allows it to be used on a long-term basis. 42 When caffeine is combined with ergot, there appears to be better absorption of the latter. 43 A combination of ergotamine and caffeine is marketed as cafergot and I tablet taken at onset of headache and repeated after 30 minutes is often successful. Ergot and its derivatives act by causing vasoconstriction due to stimulation of alpha receptors. They inhibit serotonin uptake by platelets and perhaps prevent the fall in plasma serotonin which may be responsible for extracranial vasoan
dilatation. 42 Preventatlve
therapy
Methysergide is a semisynthetic derivative of with no vasoconstrictive properties, its in an attack. However, it is a very powerful serotonin anand be used as a prophylactic agent.12 Its use in the population has been limited by the knowledge prolonged treatment may cause retroperitoneal fibrosis. 44 However, methysergide appears
356
Downloaded from cpj.sagepub.com at Yale University Library on July 6, 2015
Downloaded from cpj.sagepub.com at Yale University Library on July 6, 2015
reduce both the frequency and severity of attacks.32.4o It is best given in a discontinuous manner, i~., 5 out of 7 days, and treatment should be restricted to no more than 6 months.9 Clonidine. Zainis and Hannington first sugthat donidine-an imidazoline―may be useful in migraine as it diminishes the responsiveness of peripheral vessels to constrictor and dilator stimuli.45 Studies have shown it to be beneficial in adults46 but a controlled study in children showed it to be no better than placebo.41 One tablet (0.025 mg) given twice or three times a day seldom gives rise to serious side effects, but drowsiness and skin rashes may occur. Propranolol is a beta receptor blocking agent and has been shown with doses of 1 mg/kg three times a day to reduce both the severity and of attacks:~8 It may act by maintaining a certain level of vasoconstrictor tone and thus counteract the hypotonicity of extracranial arteries which is responsible for the headache.42 should not be given to children with asthma, diabetes or heart disease and should be withdrawn 24 hours before anesthesia. Ar~t~~~~~~l~c~~ts. Prophylactic treatment with both phenobarbital and dilantin in doses similar to that used when treating seizures has been used with conflicting results. Some have had beneficial results especially when the electroencephalogram results have been abnormal, while Others have found these drugs to be useful regardless of the EEG changes There are also reports where this form of therapy has been ineffective.9 to
However, about 20 per
how many children have a in later life.
We are grateful the manuscript.
of mi-
to
Mrs. Annetta Kitcher for
preparing
References 1. Alverez WC: Was there sick headache in 3000 B.C.? Gastroenterology 6:524, 1945 2. Bille B: Migraine in school children. Acta Paediatr Scand 51 (Suppl):136, 1962 3. Wolff HG: Headaches and Other Head Pain. New York, University Press, 1963 4. Glaser J: Migraine in pediatric practice. Am J Dis Child 88:92, 1954 5. Ryan RE: Headache, Diagnosis and Treatment. St. Louis, C. V. Mosby, 1954 6. Vahlquist B, Hackzell G: Migraine of early onset. A study of thirty-one cases in which the disease first appeared between one and four years of age. Acta Paediatr Scand 38:622, 1949 7. Burke EC, Peters GA: Migraine in childhood: a preliminary report. Am J Dis Child 92:330, 1956 8. Selby G, Lance JW: Observations on 500 cases of migraine and allied vascular headache. J Neurol Neurosurg Psychiatry 23:23, 1960 9. Holguin J, Fenichel G: Migraine. J Pediatr 70:290, 1967 10. Trued S: Migraine in childhood. J Am Med Wom Assoc. 29:78, 1974 11. O’Brien MD: The relationship between aura symptoms and cerebral blood flow changes in the pro-
drome of
12.
13.
14.
16.
Childhood migraine to have a good
―~.g-.,
17.
siderably or f:ee from headaciies over an observation period of 9 to 14 years.49 found that 35 to 50 per cent of children in his survey were symptom over a 4 to 6 year period.2 The majority of children experience fewer attacks as they grow older, and in ny, migraine disappears completely.1°
recurrence
Acknowledgment
15.
Henrichs Keith found 80 per of childre; either con-
of adults had
graine
.
Prognosis
cent
migraine before the age of 10 years. It is, however, not completely clear from the literature
18.
19.
migraine. Headache 11:90, 1971 Paulson OB: Regional blood flow in internal carotid distribution during migraine attack. Br Med J 3:569, 1969 Elkind AH, Freedman AP, Grossman J: Cutaneous blood flow in vascular headaches of the migraine type. Neurology 14:24, 1964 O’Brien MD: Cerebral blood flow changes in the prodrome of migraine. Headache 10:139, 1971 Bradshaw P, Parsons M: Hemiplegic migraine, a clinical study. QJ Med 34:65, 1965 Hungerford GD, du Barlay GH, Zilkha KJ: Computerised axial tomography in patients with severe migraine: a preliminary report. J Neurol Neurosurg Psychiatry 39:990, 1976 Curran DA, Hinterberger H, Lance JW: Total plasma serotonin, 5 hydroxy-indolacetic acid and p-hydroxy-m-methoxymandelic acid excretion in normal and migrainous subjects. Brain 88:997,1965 Kangasniemi P, Sonninen V, Rinne UK: Excretion of free and conjugated 5-HIAA and VMA in urine and concentration of 5-HIAA and HVA in CSF during migraine attacks and free intervals. Headache12:62, 1972 Anthony M, Hinterberger H, Lance JW: The posSkinhøj E,
358 Downloaded from cpj.sagepub.com at Yale University Library on July 6, 2015
sible
20.
relationship of serotonin to the migraine syndrome. Res Clin Stud Headache 2:29, 1969 Lance JW, Anthony M, Gonski A: Serotonin, the carotid body, and cranial vessels in migraine.
Arch neurology 16:553, 1967 21. Kangasniemi P, Riekkinen P, Rinnie UK: Kallikrein—like esterase and peptidase activities in CSF during migraine attacks and free intervals. Headache 12:66, 1972 22. Siculeri F: Mast cells and their active substances: their role in the pathogenesis of migraine. Headache 3:86, 1963 23. Fanchamps A: The role of humoral mediators in migraine headache. Can J Neurol Sci 1:189, 1974 24. Curtis-Brown R: A protein poison theory. Br Med
J 1:156, 1925 25. 26.
Classification of Headache. JAMA 179:717, 1962 AL: Migraine and migrainous variants in pediatric patients. Pediatr Clin North Am 23: 461, 1976 31. Vahlquist B: Migraine in children. Int Arch Allergy
Prensky
Appl Immunol 7:348, 1955 Friedman AP: The migraine syndrome. Acad Med 44:45, 1968
Bull NY
33. Bickerstaff ER: Basilar artery migraine. Lancet
1:
15, 1961 34. Golden GS, French JM: Basilar artery migraine in young children. Pediatrics 56:722, 1975
Migraine stupor. Headache JW, Kagawn
specific
583, 1959 40. Whitehouse D,
Pappas JA, Escala PH, Livingston S: Electroencephalographic changes in children with migraine. N EnglJ Med 276:23, 1967
DR: Controlled studies of incidence and
and 14 per second positive spiking. Electroencephalogr Clin Neurophysiol 15:
significance of 6 161,1963 42. 43. 44.
Fanchamps
A:
Pharmacodynamic principles
of
anti-migraine therapy. Headache 15:79, 1975 Fanchamps A: Sandoz—fifty years involvement in migraine therapy. Triangle 15:103, 1976 Graham. JR, Suby HI, Le Compte PR, Sadowsky NL:
Fibrotic disorders associated with methysergide for headache. N Engl J Med 274:359,
therapy 1966 45. Zaimis E,
Hanington
E: A
possible pharmacological
approach to migraine. Lancet 2:298, 1969 46. Shafar J, Tallett ER, Knowlson PA: Evaluation of clonidine in
prophylaxis
of
migraine. Lancet
1:
403, 1972 47. Sillanpaa M: Clonidine prophylaxis in childhood migraine and other vascular headache. Headache 17:28, 1977 48. Ludvigsson J: Propranolol used in prophylaxis of migraine in children. Acta Neurologica Scand
50:109, 1974
49. Henrichs WL, Keith HM:
~’’~~’’-&dquo;B
~~ ~. ’
~,―
N: A
correlate of convulsive electroencephalographic equivalent disorders in children. J Pediatr 55:
Mellinger JF, Rook ED: Familial hemiplegic migraine. Mayo Clin Proc 50:307, 1975
35. Gliston G,
early onset of Dis Child 107:
1970
38. Lee CH, Lance JW: 17:32, 1977 39. Kellaway P, Crawley
41. Metcalf
Child Neurol 10:794, 1974 29. Ad Hoc Committee on Classification of Headache.
32.
ophthaimoplegic 628, 1964
migraine. Am J
37. Gascon G, Barlow C: Juvenile migraine, presenting as an acute confusional state. Pediatrics 45: 628,
Ungen AH, Ungen L: Migraine is an allergic disease. J Allergy Clin Immunol 23:429, 1952 Speen F: Allergy and migraine: a clinical study.
Headache 11:63, 1971 27. Hanington E: Preliminary report of tyramine headache. Br Med J 2:550, 1967 28. Forsythe WI, Redmond A: Two controlled trials of tyramine in children with migraine. Dev Med
30.
36. Van Pelt W, Andermann F: On the
a
Announcement
Migraine
in childhood:
followup report. Mayo Clin Proc 40:593,
.’.~/’
1965
~&dquo;
’3~~.~
~
;
eighth annual meeting of the Child Neurology Society will be held in. ~~~~r~~r, ~rw ~~~~~hir~, on ~~pt~r~s~~~ ~,~- ~ ~, ~. ~’7~. The meeting is open to all physicians. Registration information and abstract forms’may be obtained from ~~~~~~d ~l’~ur~~c~g~ Scr~~~ty:l~~ti~~a~ ~3~~a~~, ~crx 486 Mayo, 420 Delaware Street ~,~.~ .~~~a~~~~c~~i~, l~~ 5~~~~~.
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