Are Colicky Infants Telling Us Their Mother’s Past … And Their Own Future?
Paroxysmal fussing in infancy, sometimes called colic, describes a healthy and well-fed infant who experiences bouts of irritability, fussing, or crying that last for a total of more than 3 hours a day and that occur on more than 3 days in any week for more than 3 weeks.1 Ever since Wessel and colleagues set forth these criteria for colic in their 1954 article,1 little has been accomplished toward determining what causes these episodes.
Recently, a group of researchers has hypothesized about a possible association between maternal migraine and infant colic; likewise, other researchers have explored the possibility that infantile colic is a precursor to chronic migraine and other pain syndromes in adolescents.
In a cross-sectional study published in 2012, Gelfand, Thomas, and Goalsby2 showed that maternal migraines were associated with an increased risk of infantile colic. They surveyed 154 mother-infant pairs who were being seen for well-child visits at general pediatrics clinics affiliated with the University of California San Francisco. The infants’ age ranged from 2 to 12 weeks, with the mean age of 8 weeks. Data were collected about parental reports of colic (using the Wessel criteria described above) and maternal migraine.
All told, 22 (14%) of the 154 infants had colic. Infants whose mother had a history of migraine were 2.6 times more likely to have colic than were infants with no maternal history of migraines. While no direct causality was identified in this study, it did suggest that infant colic might be a childhood periodic syndrome that is a migraine precursor. The authors do note that one of the study’s main limitations was that the marker of migraine genetics used for infants was maternal history of migraines rather than the development of migraines in the children themselves.
Building on this study, Romanello and colleagues3 in 2013 found an association between infant colic and the likelihood of developing childhood migraines with and without aura. In this case-controlled study, children with migraines were more likely to have experienced infantile colic than were children without migraines. A total of 208 patients aged 6 to 18 years who presented to the emergency department (ED) at any of 3 European tertiary care hospitals were evaluated and diagnosed with migraine by a pediatric neurologist. A control group comprised 471 age-matched patients who visited the same hospitals during the same period for minor trauma, but not headache. The authors also carried out a second study of 120 children with a diagnosis of tension-type headaches to test the specificity of the association between migraine and colic.
The children’s parents completed a structured questionnaire to ascertain the patient’s history and family history of infantile colic, as defined by Wessel’s criteria. The authors then cross-referenced this information using each child’s national health booklet, which contains their medical information from birth to adulthood and was identified as a reliable source, since only a physician can update it.
Of the children who received a migraine diagnosis during the ED visit, 72.6% reported a history of infantile colic. The prevalence of colic was 69.7% among the children who had migraine with aura, while the prevalence was 73.9% in the migraine without aura group. By comparison, the prevalence of colic among children in the tension-type headache group was 35.0% and in the control group was 26.5%.
Migraine headaches and infantile colic may have a link, since maternal migraine has been found to be associated with an increased risk of infantile colic,2 and the presence of migraine in children and adolescents has been found to be associated with a history of infantile colic.3 More research is needed to tease out the causality and mechanisms of action of this association, but the research does offer some insight into infantile colic. This may allow us to open the door to understanding colic in infancy and equip families with better strategies to address it.
Chalanda Jones, MD, is a pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.
Charles A. Pohl, MD—Series Editor, is professor of pediatrics and senior associate dean of student affairs and career counseling at Jefferson College in Philadelphia, Pennsylvania.
1. Wessel MA, Cobb JC, Jackson EB, Harris GS Jr, Detwiler AC. Paroxysmal fussing in infancy, sometimes called colic. Pediatrics. 1954;14(5):421-435.
2. Gelfand AA, Thomas KC, Goadsby PJ. Before the headache: infant colic as an early life expression of migraine. Neurology. 2012;79(13):1392-1396.
3. Romanello S, Spiri D, Marcuzzi E, et al. Association between childhood migraine and history of infantile colic. JAMA. 2013;309(15):1607-1612.