Martina Šutovská
Migraine is chronic paroxysmal disease characterized by throbbing and episodic headache often associated with autonomic symptoms. It affects approximately 3,5 to 5 % of children of school age; prevalence rises to 20 % in adolescence. International Headache Society classifies migraine in childhood between primary headaches and distinguishes migraine without aura, migraine with aura and so-called migraine variants. Childhood migraine has a typical clinical course, character of headache, frequency of attacks, symptoms that matches a typical range of nosological units, and also requires specific treatment. The basis of a migraine attack is a complex interaction of vasoconstriction and subsequent vasodilatation in connection with the release of neurotransmitters and their effects on ion channel function. Opinions and theories of pathogenesis have evolved in relation to the discovery of new knowledge. The genetic aspects come to the fore in recent years. Identification of mutations in voltage-dependent and ligand-dependent channels in various paroxysmal neurologic disorders has opened the possibility to include the migraine to group of neurological channelopathies. The treatment of migraine in childhood is complex. It consists of lifestyle modifications, elimination of trigger factors and medication. Pharmacotherapy is aimed on elimination of acute pain as well as the prevention of migraine. Acute nonspecific (analgesic) and specific treatment (triptans) is intended to suppress an ongoing migraine attack. The aim of prophylaxis, which is essential for 30 % of patients, either to prevent migraine attacks or reduce the frequency and intensity of repeated migraine attacks. An antihistamine cyproheptadine and antiepileptics are drugs of choice in children. Individual well-chosen therapy, which ideally combines pharmacological and non-pharmacological methods, leads to substantial improvements in quality of life for paediatric patients.