Migraine pain location at onset and during established headaches in children and adolescents: a clinic-based study from eastern India.

Literature documenting the location of pain at onset of migraine attacks and during established headaches in children and adolescents is sparse. Through a prospective study (2003-2005) of 200 children with migraine (ICHD-2: 1.1 and 1.2.1), we set out to document (i) the site of onset of pain and (ii) the location of pain during established attacks (on >50% of occasions) through semistructured interviews of patients and parents. Of the 200 children, the male:female ratio was 118 : 82 (1 : 0.69), the age range was 7-15 years (mean 11.8 years) and the duration of migraine 6 months to 4 years (mean 1.6 years). Ninety-three percent of subjects were ethnic Bengalis from the eastern Indian state of West Bengal, capital city Calcutta. Migraine types were: 1.1, 197 (98.5%); 1.2.1, three (1.5%). Location of pain at onset: 20.5% of subjects had unilateral onset; of these, 26.8% had eye pain, 65.9% frontal and 12.3% temporal pain. Thirty-three percent had bilateral location of pain, mostly bifrontal or ocular. None had vertex onset pain. However, in 35% of subjects, pain was holocranial at onset. Only 11.5% experienced pain in the occipito-cervical region at onset. Location of established headaches: in 53.7% of subjects with unilateral onset, headaches subsequently became holocranial. Hemicranial headaches occurred in only 19.5%. Of bilateral onset pains, 57.8% also became holocranial subsequently. In all, 73.5% of children ultimately experienced holocranial headaches. This study documents pain location at onset and during established headaches in children with migraine largely from a specific ethnic group.