Abstract text (incl. figure legends and references)

Question

We set out to perform prospective extended phenotyping of children presenting to a tertiary headache service.

Methods

Consecutive new migraineurs presenting to the Children"s Headache Clinic at Great Ormond Street Hospital for Children between 6th January- 6th September 2022 were included (n=51). A detailed headache history was taken at the first consultation by a trained headache physician. A questionnaire was used to ensure complete symptomatic capture. Data were tabulated and analysed (IBM SPSS v 28). Descriptive statistics, Chi-square and Pearson correlation analyses were used. Significance was assessed at P < 0.05.

Results

Patients were 69% female and aged 8-16 years (mean 13, SD 2), with mean disease duration 5 years (SD 3). Baseline monthly headache frequency was 1-30 days (median 30, IQR 10-30). Chronic migraine was the most common diagnosis (61%). Aura was present in 45%. At least one infantile migraine marker was present in 71%; the most common were travel sickness (45%) and colic (41%). At least one premonitory symptom (PS) was reported by 94%, at least one cranial autonomic symptom (CAS) by 71% and premonitory CAS by 18%. Vertigo, allodynia and neck stiffness were also reported. The most common perceived triggers were stress (43%), concentration (22%) and bright lights (22%). CAS and headache lateralities co-associated (ꭓ2 15, P=0.005). There was a positive correlation between disease duration and the number of PS reported (Pearson correlation coefficient 0.3, P=0.026). There was a negative correlation between gestational age at birth and number of PS reported (Pearson correlation coefficient -0.4, P=0.009).

Conclusion

The extended paediatric migraine phenotype includes several non-canonical migraine symptoms. Similarly to in adults, CAS can occur prior to headache and tend to lateralise with headache. There may be an association of PS with disease chronicity and a suggestion that prematurity is associated with more PS.