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Assessing headache disorders in children and adolescents is complicated by the broad range of diagnostic possibilities, by the variation and incomplete characterization of phenotypic expression, by clinical differences between children and adults, and by the need to rely on proxy informants for a headache history. The ocular and nasal symptoms associated with pediatric headache are often thought to reflect either trigeminal autonomic cephalgias (TACs, e.g., cluster headache) or sinus disease. We know that ocular and nasal features, along with other cranial autonomic symptoms (CAS), also occur with migraine in the majority of adults.1 These features are not unexpected because trigeminally mediated pain activates an autonomic reflex, giving rise to CAS.2
Footnotes
Disclosure: R.B. Lipton receives research support from the NIH [PO1 AG03949 (Program Director), RO1AG025119 (Investigator), RO1AG022374-06A2 (Investigator), RO1AG034119 (Investigator), RO1AG12101 (Investigator), K23AG030857 (Mentor), K23NS05140901A1 (Mentor), and K23NS47256 (Mentor)], the National Headache Foundation, and the Migraine Research Fund; has reviewed for the NIA and National Institute of Neurological Disorders and Stroke; holds stock options in eNeura Therapeutics; and serves as consultant, advisory board member, or has received honoraria from Allergan, American Headache Society, Autonomic Technologies, Boehringer-Ingelheim Pharmaceuticals, Boston Scientific, Bristol Myers Squibb, Cognimed, Colucid, Eli Lilly, ENDO, eNeura Therapeutics, GlaxoSmithKline, Merck, Novartis, NuPathe, Pfizer, and Vedanta. Go to Neurology.org for full disclosures.
- © 2013 American Academy of Neurology
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