Headache Medicine, v.3, n.4, p.198-235, Oct./Nov./Dec. 2012 220

INTRODUCTION

Migraine and probable migraine in childhood has

prevalence rates that range between 3.76% and 17.1%

in Brazil.

(1)

Children with migraine have attention deficits,

and experience negative consequences with regard to

school performance as well as familial and social

relationships.

(2-3)

A possible role for the neurotransmitters was

suggested, as was a close link between migraine and visual

attention deficits.

(3)

In continuation of our line of research,

(3)

we herein aimed to evaluate the visual attention

performance of children undergoing migraine prophylaxis

in comparison with children with untreated migraine and

a healthy control group.

METHODS

Eighty-two children were enrolled and divided into

three groups: untreated migraine (n = 30), migraine

prophylaxis (n = 22), and control (n = 30). Participants

in the untreated migraine group had been newly admitted

to the outpatient childhood headache service at the

Division of Investigation and Treatment of Headaches

(DITH) of the Federal University of São Paulo; all were

diagnosed with migraine with (n = 5) or without aura

(n = 25) according to the International Headache Society

criteria (ICDH-II, 2004).

(4)

They were aged 8-12 years

(mean age, 10.8 ± 1.5 years); 15 were boys. On

average, they experienced 5.8 ± 3.2 days of headache

per month, confirmed by a 30-day headache diary, without

previous or current use of migraine prophylaxis. However,

all children were free of pain and migraine symptoms in

the two days preceding the assessment.

Participants in the migraine prophylaxis group were

regular patients at DITH; all were diagnosed with migraine

with (n = 6) or without aura (n = 16). They were aged

8-12 years (mean age, 10.8 ± 1.5 years); 10 were

boys. They had experienced an average of 6.3 ± 2.0

days of headache per month prior to treatment.

Prophylactic treatment started 3-6 months before

evaluation, and children were free of pain and migraine

symptoms in the two months preceding the assessment.

Eight of them were taking sodium valproate (500-1000

mg/day), six of them propranolol (40-80 mg/day), five

amitriptyline (25-50 mg/day), and three flunarizine (5 mg-

10 mg/day). All of these prophylactic drugs have been

shown to be well tolerated and efficient in the treatment

of migraine in this age group. The control group

comprised children without headache aged 9.9 ± 1.3

years; 16 were boys. Children were selected through

questionnaires completed by parents in two public

schools in the city of São Paulo.

All children were subjected to medical and

psychological evaluations. They were also evaluated using

the Weschler Intelligence Scale for Children, 3

edition

(WISC-III) which was applied by a DITH psychologist.

Exclusion criteria were as follows: any other concomitant

systemic illness; abnormalities revealed on neurological

examination; intelligence quotient (IQ) less than 80;

psychiatric disturbances; learning disabilities; history of

epilepsy; head trauma or use of other drugs acting on the

central nervous system, including alcohol consumption,

smoking, and illicit drugs abuse; prior use of migraine

prophylaxis (in the untreated migraine group) and a history

of episodes of primary headache (in the control group).

Each child was subjected to the following visual

attention tests, between July 2010 and January 2012

under the direction of a DITH psychologist: Trail Making

Tests (TMT) parts A and B), the Letter – Cancellation Test

and the Test of Visual Attention 3

edition, a computerized

test, standardized for the Brazilian population.

SHORT COMMUNICATIONS

Visual attention in children with migraine: the

importance of prophylaxis

Thaís Rodrigues Villa, Andréa Regina Correa Moutran, Alberto Alain Gabbai, Deusvenir de Souza Carvalho

Division of Investigation and Treatment of Headaches (DITH), Department of Neurology and Neurosurgery

Federal University of São Paulo – Unifesp, São Paulo,SP, Brazil

Villa TR, Moutran AR, Gabbai AA, Carvalho DS. Visual attention in children with migraine:

the importance of prophylaxis. Headache Medicine. 2012;3(4):215-7

221 Headache Medicine, v.3, n.4, p.198-235, Oct./Nov./Dec. 2012

All children were students of public schools in São

Paulo city and had similar socio economic backgrounds.

None of them had a prior history of frequent school

absences. Informed consent was obtained from the

parents, and the study was approved by our Local

Research Ethics Committee. For statistical analysis, the

Student t-test and Mann-Whitney test were used. The

significance level was set at p < 0.05.

RESULTS

Children with untreated migraine performed

significantly worse in TMT parts A and B (p < 0.001) and

had a greater number of action errors in tasks 1 (p = 0.032)

and 2 (p = 0.015) of the Visual Attention Test when

compared with control group (Table 1). Children with

untreated migraine performed significantly worse in TMT

part B (p = 0.004) and had a greater number of

omission errors in task 1 (p = 0.019) of the Visual

Attention Test when compared to the migraine prophylaxis

group (Table 2). The migraine prophylaxis and control

group showed similar results. The only variable that was

significantly different between these two groups was the

reaction time in task 1 of the Visual Attention Test (p =

0.038) (Table 3).

DISCUSSION

Children with untreated migraine performed

significantly worse in all tests applied in comparison to

control children or children undergoing migraine

prophylaxis. Nonetheless, the performance in attention

tasks was within the normal range in all groups.

Compared to the other groups, the untreated migraine

group presented deficits in selective and alternate

attention.

In this study, we were unable to evaluate

differences between prophylactic treatments due to

small number of children taking each type of

medication. However, clinical observation revealed no

performance differences between children taking

different prophylactic drugs. Importantly, all the children

who underwent migraine prophylaxis experienced an

improvement in their symptoms, regardless of the drug

being administered.

Attention is the capacity to respond to significant

stimuli, irrespective of other stimuli. This is an important

SHORT COMMUNICATIONS

Headache Medicine, v.3, n.4, p.198-235, Oct./Nov./Dec. 2012 222

cognitive function, highly dependent on a set of

anatomical structures such as the brain stem, the cerebral

cortex, and the limbic system, as well as on a combination

of neurotransmitters, chiefly noradrenaline and

dopamine.

(5)

Disturbances of these neurotransmitters can cause

attention deficits. In addition, they play a role in the

physiopathology of migraine, including pain and other

symptoms in the crisis and intercrisis periods.

(6-8)

With an effective prophylactic treatment, it is possible

that the equilibrium of neurotransmitters is re-established,

consequently restoring attention. This hypothesis being

proposed, could attention deficit be considered a migraine

symptom in some patients? Further large-scale studies are

needed to address this question. It is necessary to

investigate cognitive dysfunction in children with migraine,

and to administer effective prophylactic treatment when

indicated.

SHORT COMMUNICATIONS

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