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Objective: To conduct a retrospective cross‐sectional multicenter study to validate the relationships between migraine‐associated symptoms. Background: Symptoms associated with headache—photophobia and phonophobia, nausea, and/or vomiting—are required criteria for migraine diagnosis based on the International Classification of Headache Disorders‐Third Edition (ICHD‐3). However, individuals with migraine report high rates of other symptoms (e.g., lightheadedness, difficulty thinking). We recently completed a single‐center study assessing the relationships between an expanded set of migraine‐associated symptoms. Methods: A pre‐registered cross‐sectional multicenter retrospective analysis was conducted on standardized questionnaire data of youth ages 6–17 years from two headache registries at pediatric tertiary care centers. Cluster Analysis of Migraine‐associated Symptoms (CAMS) was implemented to assess associations between 11 migraine‐associated symptoms. We explored differences between the two centers, and how CAMS was associated with demographics, including sex and age, and headache burden. Results: There were 10,721 participants who were 66.5% female and had a median (interquartile range) age of 13 (10–15) years. The first three CAMS dimensions accounted for 46.5% of the variance and were consistent across sites. The first dimension indicated those reporting any migraine‐associated symptoms were likely to report multiple. The second dimension separated symptoms into those included in ICHD‐3 migraine diagnostic criteria and non‐ICHD symptoms (e.g., lightheadedness, difficulty thinking). The third dimension separated sensory hypersensitivity and vestibular symptoms. An abundance of migraine‐associated symptoms correlated with greater headache severity (Spearman's ρ = 0.18, 95% confidence interval [CI] 0.17–0.20; small effect size) and disability (ρ = 0.26, 95% CI 0.25–0.28; small effect size). We also observed differences in associated symptoms across age and sex. Discussion: Associations between an expanded set of migraine‐associated symptoms are informative for headache burden and reveal intriguing changes across child development and sex. We were able to replicate findings across two centers, indicating that these symptom clusters are inherent to migraine. Plain Language Summary: The presence of symptoms such as light or sound sensitivity, nausea, and vomiting can help clinicians differentiate between migraine and other headache disorders, such as tension‐type headache. However, people with migraine commonly experience symptoms that are not part of migraine diagnostic criteria per the International Classification for Headache Disorders‐Third Edition criteria, including lightheadedness, vision changes, and vertigo. In this study, we found that by considering these other associated symptoms, we were able to better understand the burden of headache in children and adolescents; e.g., we found that having more associated symptoms was associated with more headache severity and greater headache impact in children and teenagers. [ABSTRACT FROM AUTHOR]

Objectives: We used Cluster Analysis of Migraine‐associated Symptoms (CAMS) to critically evaluate current International Classification of Headache Disorders‐Third Edition (ICHD‐3) migraine‐associated symptoms criteria. Background: Diagnostic criteria play a central role in guiding clinical trial inclusion, and therefore available treatments. Migraine and tension‐type headaches (TTH) are differentiated in ICHD‐3 by many headache characteristics, including associated symptoms. A diagnosis of probable migraine indicates some but not all features of migraine are met. Photophobia and phonophobia, or nausea and/or vomiting, are required to meet a diagnosis of migraine; however, CAMS—a model that describes associated symptoms across youth with headache—indicates that a broader range of symptoms contain information about migraine burden. Methods: In this multisite retrospective cross‐sectional study, we evaluated ICHD‐3 migraine criteria. Youth aged 6–17 years with migraine (including probable migraine) or TTH were included in the analysis. We used CAMS to evaluate the migraine‐associated symptom criterion. With CAMS as a guide, we evaluated how changes to the migraine‐associated symptom criterion altered who met the diagnosis of migraine. Results: Of the 9017 participants included in this study, 66.7% were female and had a median (interquartile range) age of 13 (10–15) years. Most participants had migraine or probable migraine (99.0%), and the remainder had TTH (1.0%). A sizable percentage (10.1%) of youth under the umbrella diagnosis of migraine were diagnosed with probable migraine because they did not meet migraine‐associated symptom criterion D; however, many in this group reported several non‐ICHD migraine‐associated symptoms. We explored alterations to criterion D based on CAMS. Allowing for photophobia or phonophobia re‐categorized 55.6% of youth as having migraine, though some only had one symptom. Including lightheadedness or lightheadedness and spinning re‐categorized 19.7% and 25.8% of youth with migraine, respectively, but all of those who were re‐categorized had at least two migraine‐associated symptoms. Conclusion: The ICHD‐3 captures the most prevalent migraine‐associated symptoms; however, many youths with probable migraine who do not meet full criteria due to insufficient associated symptoms nonetheless experience multiple non‐ICHD migraine‐associated symptoms. Changes to criterion D should be considered for the ICHD‐4. Plain Language Summary: For clinicians to make a diagnosis of migraine based on International Classification of Headache Disorders‐Third Edition (ICHD‐3) criteria, patients must have headache‐associated nausea, vomiting, or light and sound sensitivity (criterion D). However, migraine can also be associated with other symptoms like lightheadedness, difficulties with thinking, and vertigo. In this study of youth aged 6–17 years with migraine, probable migraine, or tension‐type headache, we looked at how altering the ICHD‐3 criterion D changed participants' diagnosis based on their symptoms; overall, our results suggest that the next version of ICHD should account for the fact that many youth who do not experience nausea, vomiting, or light and sound sensitivities still experience manyx other migraine associated symptoms. [ABSTRACT FROM AUTHOR]

Objective: To provide healthcare professionals guidance on youth at risk for prolonged recovery and post‐traumatic headache (PTH), and on pharmacologic and non‐pharmacologic management of PTH due to concussion and mild traumatic brain injury. Background: Headache is the most common persistent post‐concussive symptom affecting 8% of youth for >3 months after concussion. Over the past decade, many studies have explored the treatment of PTH in youth, but there are no established guidelines. Methods: This white paper is based on a synthesis of an updated systematic review of the literature on treatment of PTH and a narrative review of the literature on risk factors for prolonged recovery and health disparities. Results were interpreted by a group of expert providers in PTH in children and adolescents through collaboration of the PTH and pediatric special interest groups of the American Headache Society. Results: Factors that consistently were associated with prolonged recovery from concussion and persistent PTH included female sex, a high number of acute symptoms, and adolescent age. Social determinants of health also likely play an important role in PTH and deserve consideration in the clinical and research settings. A total of 33 studies met the criteria for inclusion in the systematic review of PTH treatment in youth, although most were retrospective and of fair‐to‐poor quality. Treatment strategies included acute and preventive pharmacologic management, procedures, neuro‐modulatory devices, physical therapy, physical activity, and behavioral health support. A collaborative care approach that includes a thoughtful combination of these management strategies is likely most effective. Conclusions: This white paper provides a roadmap for tailoring the treatment of PTH based on factors influencing prolonged headache, the timing of therapies, and therapies with the most evidence for treating PTH in youth. We also highlight research needed for developing more definitive guidelines on PTH management in youth. Plain Language Summary: Post‐traumatic headache (PTH) following concussion is a common and potentially disabling condition impacting youth, yet there are no standards for treatment. This article reviews current evidence and identifies knowledge gaps to guide future research. Based on the limited available evidence and expert opinion, we offer a roadmap for the treatment of PTH in children. [ABSTRACT FROM AUTHOR]

Background: New daily persistent headache (NDPH) is a challenging and understudied primary headache disorder with no known effective treatment. Although the International Classification of Headache Disorders criteria require that the new onset continuous headache be present for at least three months before diagnosing NDPH, the biologic basis for when a new, continuous headache starts to behave as NDPH is unknown, and some pediatric headache experts consider that the minimum duration criterion could be shorter. Methods: In this retrospective study, we reviewed the intake questionnaires and medical records of 5–17 year-olds seen in neurology clinic for headache at the Children's Hospital of Philadelphia. Those with a new onset continuous headache of at least one month in duration were eligible. The patient's self-report and clinician's description both had to indicate that the headache was new, of abrupt onset, and continuous to be included, although patients were allowed to have a prior history of infrequent headaches. We compared headache outcomes at last follow-up and at one year after continuous headache onset between those who had a continuous headache duration of 1 to <3 months ("new onset headache", or NOH) at first visit vs. those with ≥3 months (NDPH). We used multivariate regression modeling to examine for predictors of headache outcomes. Results: Of 472 patient records reviewed, 172 met the inclusion criteria for analysis. Of these, 84 had a headache duration of 1 to <3 months in duration and 88 had a duration of ≥3 months. Those with shorter duration continuous headache were younger (median (interquartile range) 13.5 (11.1–15.7) vs. 15.1 (12.3–16.5) years, and less likely to have previously received a prescription preventive for the continuous headache (n = 14 (17%) vs. 26 (30%), p = 0.046), but were otherwise similar to those with NDPH in terms of baseline clinical and demographic variables. Sixty-five (74%) of those with NDPH and 60 (71%) with NOH had follow-up data. At last clinic follow-up, 41/65 (63%) with NDPH and 43/60 (72%) with NOH had experienced any headache benefit (p = 0.307), although 39/65 (60%) with NDPH and 29/60 (48%) with NOH still had continuous headache (p = 0.191). Headache duration was not associated with outcomes in multivariate regression modeling. Conclusions: Headache outcomes of children and adolescents with new onset continuous headache, whether of 1 to <3 months (NOH) or ≥3 months in duration (NDPH) are suboptimal. More research is needed to improve treatment outcomes for this patient population. [ABSTRACT FROM AUTHOR]

Objective: To equip clinicians with recommendations specific to concerns related to the novel coronavirus disease 2019 (COVID‐19), which impact the physical, emotional, and social health of youth with headache disorders. Background: COVID‐19 has affected societies on a global scale including children and youth with chronic headache disorders. Many concerns are predicted to arise in the 2020–2021 school year, whether classes are conducted in‐person or virtually. Methods: Clinical impressions were combined with a review of the literature, although limited due to the recent nature of this issue. Results: We describe recommendations to support caregivers and youth as they face changes expected with the return to school in the fall of 2020. Conclusion: Although there are significant concerns for caregivers and youth with migraine given the context of changes related to the pandemic, there are many recommendations that can help minimize exacerbations of the physical, emotional, and social health of youth with chronic migraine. [ABSTRACT FROM AUTHOR]

The author comments on a study by R. Chauhan and colleagues, published in the issue, on the benefit of physical activity interventions on recovery in youth with concussion. Topics discussed include importance of having effective management strategies for promoting recovery and return to typical function after concussion, a challenge faced by researchers studying concussion recovery, and approaches that yielded the greatest improvement.

The retinal ganglion cells (RGCs) receive different combinations of L, M, and S cone inputs and give rise to one achromatic and two chromatic postreceptoral channels. The goal of the current study was to determine temporal sensitivity across the three postreceptoral channels in subcortical and cortical regions involved in human vision. We measured functional magnetic resonance imaging (fMRI) responses at 7 T from three participants (two males, one female) viewing a high-contrast, flickering, spatially uniform wide field (∼140°). Stimulus flicker frequency varied logarithmically between 2 and 64 Hz and targeted the L + M + S, L - M, and S - (L + M) cone combinations. These measurements were used to create temporal sensitivity functions of the primary visual cortex (V1) across eccentricity and spatially averaged responses from the lateral geniculate nucleus (LGN), and the V2/V3, hV4, and V3A/B regions. fMRI responses reflected the known properties of the visual system, including higher peak temporal sensitivity to achromatic versus chromatic stimuli and low-pass filtering between the LGN and V1. Peak temporal sensitivity increased across levels of the cortical visual hierarchy. Unexpectedly, peak temporal sensitivity varied little across eccentricity within area V1. Measures of adaptation and distributed pattern activity revealed a subtle influence of 64 Hz achromatic flicker in area V1, despite this stimulus evoking only a minimal overall response. The comparison of measured cortical responses to a model of the integrated retinal output to our stimuli demonstrates that extensive filtering and amplification are applied to postretinal signals., Competing Interests: The authors declare no competing financial interests., (Copyright © 2024 the authors.)