Comment: Cranial autonomic symptoms typify migraine in children and adolescents.

Lipton RB.

Abstract

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.)