Original articleMigraine and Recurrent Epistaxis in Children
Introduction
Nosebleeds are quite common in children and are rarely life-threatening. The majority of nosebleeds are mild, self-limited, spontaneous, and recurrent [1], [2]. Nosebleeds often cause significant parental concerns and remain a challenging problem to patients and physicians alike. A study of 1218 schoolchildren ages 11–14 years found that 78 (6.5%) children had at least one nosebleed [3]. Another study found that an estimated 8% of children below age 20 years are habitual nose-bleeders with three or more nosebleeds per year [4]. Moreover, 70% of these habitual nose-bleeders have no apparent cause or trigger [4]. Schulman evaluated 34 children with recurrent nosebleeds with coagulation studies [5]. Half of the children with no other bleeding problem besides epistaxis had normal coagulation and bleeding studies. He emphasized that “the question of causation is the most difficult of all,” “several suggested factors such as upper respiratory infections, hypertrophic adenoids and tonsils, picking the nose, allergies, dry and overheated rooms,” “but I must say that by and large the pathogenesis is obscure” [5]. Similar conclusions of unknown etiology of most nosebleeds were reached in a study of 1724 pediatric and adult patients [6]. In our Pediatric Neurology Clinic, frequent complaints, or history, of nosebleeds in children being treated for migraine were observed. A computer-aided search of the medical literature identified brief case reports of the coexistence of migraine and epistaxis in adults [7], [8], [9], but we found no controlled studies. Given the high prevalence of migraine in childhood, which is 4–11% in children ages 7 to 11 years [10], one may expect migraine and nosebleeds to coexist by chance alone. Therefore, this study was conducted to reveal whether there is an association between recurrent epistaxis and migraine, and to explore whether recurrent epistaxis in children with migraine has similar or different characteristics to epistaxis in habitual nose-bleeders.
Section snippets
Methods
The study was undertaken of children with migraine, ages 6–11 years, who were examined consecutively for evaluation of recurrent headaches in the same Pediatric Neurology Clinic over a 3-year period from 1996 to1999. This age group of children was selected because they are more commonly affected by recurrent nosebleeds than infants or adolescents [2], [11]. Moreover, many children outgrow the problem of recurrent nosebleeds by adolescence [12]. Migraine was diagnosed using proposed pediatric
Results
There were 45 patients with migraine with a mean age of 8.84 years, and 23 were males. Control subjects consisted of 64 children with a mean age of 8.45 years; 38 were males. There was no statistical difference between patients and control subjects with respect to sex and age. The prevalence of recurrent epistaxis in patients with migraine was 16 (36%) of 45, as compared with 7 (11%) of 64 control subjects (odds ratio [OR] = 4.5; 95% confidence interval [CI] 1.6–12.1; P = 0.002). Spearman’s rho
Discussion
This study reveals that the prevalence of recurrent epistaxis is significantly higher in children with migraine than in control subjects. Recurrent epistaxis in childhood increased the odds of migraine more than fourfold. Moreover, epistaxis in children with migraine has similar characteristics to recurrent, idiopathic epistaxis as described in otolaryngology literature [1], [2], [4], [5], [12]. The similarities include onset in early childhood, high incidence in sleep, rarity of seeking
References (20)
Les épistaxis de l’enfant
Arch Pediatr
(1996)- et al.
Epidemiological investigation of the prevalence of von Willebrand’s disease
Blood
(1987) - et al.
Management of epistaxis in children
Int J Pediatr Otorhinolaryngol
(1991) - et al.
The periaqueductal grey matter modulates trigeminovascular inputA role in migraine?
Neuroscience
(2001) - et al.
Epistaxis
- et al.
Occurrence of epistaxis in habitual nose-bleeders and analysis of some etiological factors
ORL J Otorhinolaryngol Relat Spec
(1986) The significance of epistaxis in childhood
Pediatrics
(1959)Epistaxisa clinical study of 1724 patients
J Laryngol Otol
(1974)Cerebrocardiac form of migraine, clinical picture and treatment
Headache
(1967)- et al.
Letter to Editor. Nouvelles conceptions sur l’origine diencéphaliques des épistaxis et de la migraine
Rev Neurol (Paris)
(1968)
Cited by (13)
Physical–Mental Comorbidity of Pediatric Migraine in the Philadelphia Neurodevelopmental Cohort
2019, Journal of PediatricsMigraine and nosebleed in children case series and literature review
2015, European Journal of Paediatric NeurologyCitation Excerpt :The case series provides preliminary evidence for the occurrence of nosebleeds during migraine attacks among children and adolescents. Additionally, corroborating our findings, Jarjour et al.,7 Durán-Ferreras et al.,9 Adatia et al.,8 and Barros et al.,10 suggest that migraine could have a selective effect that is possibly restricted to the neurovascular structure of the nasal olfaction. The overlapping of the neuro-anatomy of the olfactory system and the areas involved in the pathogenesis of migraine might grant a consideration of migraine as one of the causes of nosebleed.
Physical comorbidity of migraine and other headaches in US adolescents
2012, Journal of PediatricsPrevalence of recurrent symptoms and their association with epilepsy and febrile seizure in school-aged children: A community-based survey in Iceland
2012, Epilepsy and BehaviorCitation Excerpt :Community-based study on recurrent symptoms in children and adolescents is mostly focused on recurrent abdominal pain [1,3,5], recurrent body pain [1,3] or recurrent dizzy spells [6,7]. Moreover, these recurrent symptoms are generally studied in association with migraine and associations have been found for recurrent abdominal pain, limb pain, motion sickness, and recurrent epistaxis [1,5,8]. The International Classification of Headache Disorders recognized cyclical vomiting, abdominal migraine and benign paroxysmal vertigo of childhood as migraine variants [2].
Recurrent Epistaxis: An Unusual Manifestation of Clinical Spectrum of Migraine -Case Series with Scoping Review of Literature
2023, Indian Journal of Otolaryngology and Head and Neck Surgery