The Pediatric Trochlear Migraine: Diagnostic and Therapeutic Implications

Abstract

Trochlear Migraine has been recently described as the concurrence of strictly unilateral migraine and ipsilateral trochleodynia with relief of migraine after successful treatment of trochleodynia. This disorder has been interpreted as "cluster-tic syndrome" or "seizure-triggered migraine". Trochlear Migraine is unrecognized and rarely described in childhood. The aim of this study is to review the few cases of Trochlear Migraine reported in the literature in addition to the cases observed in our clinical experience. In particular, our cases showed recurrent attacks of severe and pulsating headache associated with nausea, vomiting, phonophobia, photophobia, and strict trochlear localization of pain. They often presented with alternating side attacks. Therefore, we suggest that the term "Trochlear Migraine" should be reserved for clinical migraine attacks strictly localized in the trochlear region, and we assume that the excessive increase in descriptions of new primary headache syndromes, according to the International Classification of Headache Disorders, can be probably be ascribed to the common physiopathological mechanisms characterizing these forms of migraine.

Keywords: children; international headache classification; migraine; pediatric headaches; primary trochlear headache; trochlear region.

Figure 1

Pain localization pictured by child n.1 of 12-year-old.

Figure 2

Pain localization pictured by child n. 4 of 11-year-old. dolore pulsazione—throbbing pain; zona mal di testa—headache area; espansione dolore—pain expansion; dolore occhio—eye pain; intensita—intensity.