Irritable but well babies are difficult to manage for both the parents and the doctors - but is this a sign of things to come? This paper looks at the link between infantile colic and childhood migraine.
Association Between Childhood Migraine and History of Infantile Colic
JAMA. 2013;309(15):1607-1612. doi:10.1001/jama.2013.747.
The article is available here.
We recently had some discussions about the limited role of acid suppressive therapy in irritable babies on paed-form (you can join the forum here).
Here is more on irritable babies, this time looking at the association between infantile colic and migraine. An association that has been suspected for some time. Maternal migraine has previously been shown to be a risk factor for colic in their offspring.
The study does rely on parent recall but there are good attempts to control bias and a big control group. The odds ratios and confidence intervals are highly suggestive of a real association and a large effect.
There may be specific environmental or internal triggers that initiate the neuronal excitation known to occur in migraine and this may be happening in babies with colic too. These babies certainly seem be more sensitive to external and physiological stimuli than non-colicky babies.
Both colic and migraine show a close relationship with the sleep-wake cycle and typical/similar diurnal patterns. Babies that sleep well have less colic, but it may be that poor sleep is the cause of colic rather than the other way round. Interestingly breastfeed babies might have better sleep and less colic than because of melatonin in the breast milk (which is secreted in a circadian pattern).
If colic is an early manifestation of migraine, this may explain the consistent lack of efficacy of treatments directed at a gastrointestinal etiology as we discussed recently.
Importance Infantile colic is a common cause of inconsolable crying during the first months of life and has been thought to be a pain syndrome. Migraine is a common cause of headache pain in childhood. Whether there is an association between these 2 types of pain in unknown.
Objective To investigate a possible association between infantile colic and migraines in childhood.
Design, Setting, and Participants A case-control study of 208 consecutive children aged 6 to 18 years presenting to the emergency department and diagnosed as having migraines in 3 European tertiary care hospitals between April 2012 and June 2012. The control group was composed of 471 children in the same age range who visited the emergency department of each participating center for minor trauma during the same period. A structured questionnaire identified personal history of infantile colic for case and control participants, confirmed by health booklets. A second study of 120 children diagnosed with tension-type headaches was done to test the specificity of the association.
Main Outcomes and Measures Difference in the prevalence of infantile colic between children with and without a diagnosis of migraine.
Results Children with migraine were more likely to have experienced infantile colic than those without migraine (72.6% vs 26.5%; odds ratio [OR], 6.61 [95% CI, 4.38-10.00]; P < .001), either migraine without aura (n = 142; 73.9% vs 26.5%; OR, 7.01 [95% CI, 4.43-11.09]; P < .001), or migraine with aura (n = 66; 69.7% vs 26.5%; OR, 5.73 [95% CI, 3.07-10.73]; P < .001). This association was not found for children with tension-type headache (35% vs 26.5%; OR, 1.46 [95% CI, 0.92-2.32]; P = .10).
Conclusion and Relevance The presence of migraine in children and adolescents aged 6 to 18 years was associated with a history of infantile colic. Additional longitudinal studies are required.