the  footnote in the international classification of headache disorders , second edition ( ichd-2 )   for migraine without aura ( 1.1 ) recognized some differences between pediatric and adult migraine . it only briefly mentioned the differentiating feature in migraine pain location :  migraine headache is commonly bilateral in young children ; an adult pattern of unilateral pain usually emerges in late adolescence or early adult life and  migraine headache is usually fronto - temporal. ichd-2 also comments on the rarity of occipital headache in children and calls for diagnostic caution to exclude structural lesions ; however , no study had ever made a head to head comparison between migraine pain location both at onset and during established headache between children and adults . comments related to location of migraine headache in children have been made by wober - bingol et al . more recently , the present authors reported their experience on migraine pain location at onset and during established headaches in a group of 200 children living in the eastern indian state of west bengal . in the present report the data from the aforementioned study would be compared with those obtained from a similar study in relation to migraine pain location at onset and during established headaches in 800 adult patients which was carried out simultaneously with the study in children . the reported studies were carried out between september 2003 and december 2005 at the neurology out - patient department of a large general teaching hospital ( 550 beds ) in the city of calcutta in the eastern part of india . in the pediatric study , a total of 262 subjects ( age 715  years ) diagnosed with migraine ( ichd-2 criteria - location excluded ) and having at least two attacks of acute migraine per month during the preceding 6  months of recruitment and who were not on any form of prophylactic medication were assessed through a semistructured questionnaire . the first consecutive 200 subjects giving consistent ( or near consistent ) responses to questions relating to pain location , both at onset and during established phase of headaches , were included for analysis . a total of 1,172 adult patients ( > 15  years of age ) with migraine ( ichd-2 criteria- location excluded ) were originally recruited and studied with a similar headache questionnaire in three stages as described in case of children . at first visit , each patient was evaluated by one of the three participating consultants ( authors ) to confirm diagnosis of migraine , identification of subtype and arranging of relevant investigations to exclude secondary headaches as and when needed ( imaging done in 162 patients and positive in only two patients ) . during the second visit , 1  week ( on average ) later , each patient was evaluated through a semi - structured questionnaire by a trainee physician specifically assessing the site of location of onset pain and its subsequent location during established attacks in the majority ( > 50% ) of headache spells in the preceding 6  months . patients were asked to put their hands at the sites of onset pain , show with their hands the subsequent spread of the pain ( if possible ) and finally the location of the pain during the established phase of the headache . description of terms used for anatomical sites of location :  1.oculareye/orbit2.frontalunilateralone side of foreheadbifrontal  whole of forehead3.temporalunilateral/bilateral temple region4.hemicranialunilateral temporal and parietal regions ; may involve ipsilateral frontal / orbital regions and occasionally ipsilateral occipital area5.vertex/centralcenter of cranium6.occipitalback of head above hairline  generally both sided7.cervicalback of neck below hairline  generally both sided8.holocranialwhole forehead , both temporal and parietal as well as central cranial area and occipital region it may be noted that , while noting the location of pain , especially pain at onset , the area mostly affected was taken into account . for example , pain involving one side of forehead but extending a little into the temple region , had been designated as frontal onset and similarly vice versa . indeed , this may be somewhat artificial but this had been necessary for making the final analysis a little simplified but still meaningful . during a third visit , usually a month later , each patient was asked the same question relating to the location of pain by one of the authors ( consultants ) and compared to the responses in the interview by the trainees . in subjects in whom some discrepancies had been noted between the two responses the patients were offered the first responses and given the choice . patients ( n  =  102 ) giving grossly discrepant and vague responses ( not really of localizing value ) were excluded from the study . also excluded were patients who failed to turn up for the second or third stage of interview even after reminder ( n  =  88 ) . all response sheets were carefully evaluated by the corresponding author and only the first 800 subjects giving consistent ( or near consistent ) responses to questions relating to pain localization both at onset and during established phase of headache were included for analysis . table  1 is a composite table showing migraine pain location at onset and during established headaches ( vis -  - vis onset location ) in children ( n  =  200 ) and adults ( n  =  800 ) in > 50% of headache spells.table  1location of migraine pain at onset and subsequent evolution during established headaches in children and adults . ( in > 50% occasions)location of onset painpain location during established headacheschildren ( n  =  200)adults ( n  =  800)a . bilateral / holocranial4 ( 36.4%)*30 ( 17.0% ) * p  <  0.001  2 . bilateral / holocranial2 ( 40%)20 ( 15.6% )  side lockednone*105 ( 31.72% ) * p  <  0.001b . bilateral / central66 ( 33%)258 ( 32.25% )  1 . bilateral ocular18 ( 27.3%)36 ( 13.96%)a . remained same11 ( 61.1%)25 ( 69.4%)b . holocranial70 ( 35%)*nil * p  <  0.001 *  important differences between children and adults . chi square test applied location of migraine pain at onset and subsequent evolution during established headaches in children and adults . chi square test applied observations made in the pediatric study of 200 patients had already been detailed . migraine in children and adolescents in the study appears to be a slightly male - dominant disease . this might have been contributed by referrel pattern.migraine with aura ( ma ) is rare in indian patients and migraine in children and adolescents is no exception.only 20.5% of children had unilateral onset of pain during acute migraine attacks . of these ( n  =  41 ) , most ( 60.9% ) had unilateral frontal location ; ocular pain occurred in 26.8% and temple pain in only 12.2% . in no subjects had onset pain been side locked.pain was bilateral in 33% of subjects ( n  =  66 ) . bifrontal pain at onset was found to be most common ( 56.1% ) and was less commonly found in both eyes ( 27.3% ) and bitemporally ( 16.6% ) . none had onset pain localizing in the vertex region.holocranial location of pain at onset was common , occurring in 35% ( n  =  70 ) of subjects.onset pain localizing at the occipito - cervical region was found in 11.5% ( n  =  23 ) of subjects , and was mostly bilateral.in 31.7% of subjects with unilateral ocular , frontal and temporal location of pain at onset , pain remained at the same site during established headaches.only 19.5% ( n  =  8) of subjects with unilateral ocular , frontal and temporal location of pain at onset subsequently developed ipsilateral hemicranial headache.in contrast 48.8% of subjects with unilateral location of pain at onset , subsequently developed bilateral or holocranial headaches.in 42.4% of subjects with bilateral ( both eyes , bifrontal and bitemporal ) location of pain at onset , pain remained at the same sites during established headache spells , but in the majority ( 57.8% ) , during established attacks pain had been holocranial.all subjects with holocranial location of pain at onset ( n  =  70 ) continued to experience pain at the same location , but of varying intensity.of the small number of subjects with occipito - cervical location of pain at onset ( n  =  23 ) , most ( n  =  17 ; 73.9% ) subsequently had holocranial pain and in 26.1% ( n  =  6 ) pain remained localized at the same site . none developed hemicranial headaches.in all , during the established migraine headache phases , only 10.5% ( n  =  21 ) of all subjects ( n  =  200 ) had experienced strictly unilateral pain . the vast majority experienced bilateral or holocranial headaches ( n  =  173 , 86.5% ) during established migraine . a minority of subjects ( n  =  6 , 3% ) experienced only occipito - cervical pain during established migraine attacks . migraine in children and adolescents in the study appears to be a slightly male - dominant disease . migraine with aura ( ma ) is rare in indian patients and migraine in children and adolescents is no exception . of these ( n  =  41 ) , most ( 60.9% ) had unilateral frontal location ; ocular pain occurred in 26.8% and temple pain in only 12.2% . in no subjects had onset pain been side locked . bifrontal pain at onset was found to be most common ( 56.1% ) and was less commonly found in both eyes ( 27.3% ) and bitemporally ( 16.6% ) . none had onset pain localizing in the vertex region . holocranial location of pain at onset was common , occurring in 35% ( n  =  70 ) of subjects . onset pain localizing at the occipito - cervical region was found in 11.5% ( n  =  23 ) of subjects , and was mostly bilateral . in 31.7% of subjects with unilateral ocular , frontal and temporal location of pain at onset , pain remained at the same site during established headaches . n  =  8) of subjects with unilateral ocular , frontal and temporal location of pain at onset subsequently developed ipsilateral hemicranial headache . in contrast 48.8% of subjects with unilateral location of pain at onset , subsequently developed bilateral or holocranial headaches . in 42.4% of subjects with bilateral ( both eyes , bifrontal and bitemporal ) location of pain at onset , pain remained at the same sites during established headache spells , but in the majority ( 57.8% ) , during established attacks pain had been holocranial . all subjects with holocranial location of pain at onset ( n  =  70 ) continued to experience pain at the same location , but of varying intensity . of the small number of subjects with occipito - cervical location of pain at onset ( n  =  23 ) , most ( n  =  17 ; 73.9% ) subsequently had holocranial pain and in 26.1% ( n  =  6 ) pain remained localized at the same site . none developed hemicranial headaches . in all , during the established migraine headache phases , only 10.5% ( n  =  21 ) of all subjects ( n  =  200 ) had experienced strictly unilateral pain . the vast majority experienced bilateral or holocranial headaches ( n  =  173 , 86.5% ) during established migraine . a minority of subjects ( n  =  6 , 3% ) experienced only occipito - cervical pain during established migraine attacks . the results in the adult study ( as depicted in table  1 ) may be summarized as follows : demographic features include : n  =  800 ; m : f 1:4.56 ; age 1642  years ( mean 26  years ) ; duration 118  years(mean 6.8  years ) ; migraine without aura 668 ( 83.5% ) ; migraine with typical aura 18 ( 2.25% ) ; probable migraine 114 ( 14.25% ) . migraine with aura appears to be uncommon in indian subjects in the present study.exactly 41.38% of subjects had unilateral onset of migraine headache of which little over one - half ( 53.17% ) had ocular location of pain at onset and little over one - third ( 38.67% ) had location of pain at onset in the temple region . in about one - third of subjects with unilateral onset , pain had been side locked.bilateral/central ( vertex ) location of pain at onset was experienced by 32.25% of subjects . majority ( 51.16% ) of them had bitemporal pulsating pain to start with followed by 27.91% experiencing onset pain at the vertex region.exactly 26.38% of subjects noted a cervico - occipital location of pain at onset , of which 14.63% had predominantly occipital region onset and 11.75% had predominantly cervical region onset of pain . as in many cases , it had been difficult to clearly distinguish between cervical or occipital location of onset pain ; these two areas had been grouped togetherin 47.4% of subjects with unilateral ocular , frontal and temporal location of pain at onset , pain remained at the same site during established headaches.approximately one - third of subjects with location of pain at onset in unilateral ocular , frontal and temporal regions subsequently developed ipsilateral hemicranial pain during established spells of migraine headaches.only 19.6% of subjects with unilateral location of pain at onset developed bilateral or holocranial headaches during established phase of the migraine attack.in 56.98% of subjects with bilateral or vertex location of pain at onset ( n  =  258 ) , pain remained at the same site during established migraine attacks . about 70% of subjects with bitemporal onset of throbbing pain , continued to experience pain at the same site but in about 30% pain subsequently became holocranial . over half ( 56.9% ) of subjects having onset pain at vertex region , experienced holocranial headaches subsequently.in 41.23% of subjects with cervico - occipital location of pain at onset subsequently experienced holocranial headaches . about a quarter of subjects subsequently developed hemicranial headaches.in all , although during established migraine attacks 40.5% of subjects experienced strictly unilateral pain , only 20.88% had truly hemicranial headaches . demographic features include : n  =  800 ; m : f 1:4.56 ; age 1642  years ( mean 26  years ) ; duration 118  years(mean 6.8  years ) ; migraine without aura 668 ( 83.5% ) ; migraine with typical aura 18 ( 2.25% ) ; probable migraine 114 ( 14.25% ) . exactly 41.38% of subjects had unilateral onset of migraine headache of which little over one - half ( 53.17% ) had ocular location of pain at onset and little over one - third ( 38.67% ) had location of pain at onset in the temple region . in about one - third of subjects with unilateral onset bilateral / central ( vertex ) location of pain at onset was experienced by 32.25% of subjects . majority ( 51.16% ) of them had bitemporal pulsating pain to start with followed by 27.91% experiencing onset pain at the vertex region . exactly 26.38% of subjects noted a cervico - occipital location of pain at onset , of which 14.63% had predominantly occipital region onset and 11.75% had predominantly cervical region onset of pain . as in many cases , it had been difficult to clearly distinguish between cervical or occipital location of onset pain ; these two areas had been grouped together in 47.4% of subjects with unilateral ocular , frontal and temporal location of pain at onset , pain remained at the same site during established headaches . approximately one - third of subjects with location of pain at onset in unilateral ocular , frontal and temporal regions subsequently developed ipsilateral hemicranial pain during established spells of migraine headaches . only 19.6% of subjects with unilateral location of pain at onset developed bilateral or holocranial headaches during established phase of the migraine attack . in 56.98% of subjects with bilateral or vertex location of pain at onset ( n  =  258 ) , pain remained at the same site during established migraine attacks . about 70% of subjects with bitemporal onset of throbbing pain , continued to experience pain at the same site but in about 30% pain subsequently became holocranial . over half ( 56.9% ) of subjects having onset pain at vertex region , experienced holocranial headaches subsequently . in 41.23% of subjects with cervico - occipital location of pain at onset subsequently experienced holocranial headaches . about a quarter of subjects subsequently developed hemicranial headaches . in all , although during established migraine attacks 40.5% of subjects experienced strictly unilateral pain , only 20.88% had truly hemicranial headaches . migraine in children and adolescents in the study appears to be a slightly male - dominant disease . this might have been contributed by referrel pattern.migraine with aura ( ma ) is rare in indian patients and migraine in children and adolescents is no exception.only 20.5% of children had unilateral onset of pain during acute migraine attacks . of these ( n  =  41 ) , most ( 60.9% ) had unilateral frontal location ; ocular pain occurred in 26.8% and temple pain in only 12.2% . in no subjects had onset pain been side locked.pain was bilateral in 33% of subjects ( n  =  66 ) . bifrontal pain at onset was found to be most common ( 56.1% ) and was less commonly found in both eyes ( 27.3% ) and bitemporally ( 16.6% ) . none had onset pain localizing in the vertex region.holocranial location of pain at onset was common , occurring in 35% ( n  =  70 ) of subjects.onset pain localizing at the occipito - cervical region was found in 11.5% ( n  =  23 ) of subjects , and was mostly bilateral.in 31.7% of subjects with unilateral ocular , frontal and temporal location of pain at onset , pain remained at the same site during established headaches.only 19.5% ( n  =  8) of subjects with unilateral ocular , frontal and temporal location of pain at onset subsequently developed ipsilateral hemicranial headache.in contrast 48.8% of subjects with unilateral location of pain at onset , subsequently developed bilateral or holocranial headaches.in 42.4% of subjects with bilateral ( both eyes , bifrontal and bitemporal ) location of pain at onset , pain remained at the same sites during established headache spells , but in the majority ( 57.8% ) , during established attacks pain had been holocranial.all subjects with holocranial location of pain at onset ( n  =  70 ) continued to experience pain at the same location , but of varying intensity.of the small number of subjects with occipito - cervical location of pain at onset ( n  =  23 ) , most ( n  =  17 ; 73.9% ) subsequently had holocranial pain and in 26.1% ( n  =  6 ) pain remained localized at the same site . none developed hemicranial headaches.in all , during the established migraine headache phases , only 10.5% ( n  =  21 ) of all subjects ( n  =  200 ) had experienced strictly unilateral pain . the vast majority experienced bilateral or holocranial headaches ( n  =  173 , 86.5% ) during established migraine . a minority of subjects ( n  =  6 , 3% ) experienced only occipito - cervical pain during established migraine attacks . migraine in children and adolescents in the study appears to be a slightly male - dominant disease . migraine with aura ( ma ) is rare in indian patients and migraine in children and adolescents is no exception . of these ( n  =  41 ) , most ( 60.9% ) had unilateral frontal location ; ocular pain occurred in 26.8% and temple pain in only 12.2% . in no subjects had onset pain been side locked . bifrontal pain at onset was found to be most common ( 56.1% ) and was less commonly found in both eyes ( 27.3% ) and bitemporally ( 16.6% ) . holocranial location of pain at onset was common , occurring in 35% ( n  =  70 ) of subjects . onset pain localizing at the occipito - cervical region was found in 11.5% ( n  =  23 ) of subjects , and was mostly bilateral . in 31.7% of subjects with unilateral ocular , frontal and temporal location of pain at onset n  =  8) of subjects with unilateral ocular , frontal and temporal location of pain at onset subsequently developed ipsilateral hemicranial headache . in contrast 48.8% of subjects with unilateral location of pain at onset , subsequently developed bilateral or holocranial headaches . in 42.4% of subjects with bilateral ( both eyes , bifrontal and bitemporal ) location of pain at onset , pain remained at the same sites during established headache spells , but in the majority ( 57.8% ) , during established attacks pain had been holocranial . all subjects with holocranial location of pain at onset ( n  =  70 ) continued to experience pain at the same location , but of varying intensity . of the small number of subjects with occipito - cervical location of pain at onset ( n  =  23 ) , most ( n  =  17 ; 73.9% ) subsequently had holocranial pain and in 26.1% ( n  =  6 ) pain remained localized at the same site . none developed hemicranial headaches . in all , during the established migraine headache phases , only 10.5% ( n  =  21 ) of all subjects ( the vast majority experienced bilateral or holocranial headaches ( n  =  173 , 86.5% ) during established migraine . a minority of subjects ( n  =  6 , 3% ) experienced only occipito - cervical pain during established migraine attacks . the results in the adult study ( as depicted in table  1 ) may be summarized as follows : demographic features include : n  =  800 ; m : f 1:4.56 ; age 1642  years ( mean 26  years ) ; duration 118  years(mean 6.8  years ) ; migraine without aura 668 ( 83.5% ) ; migraine with typical aura 18 ( 2.25% ) ; probable migraine 114 ( 14.25% ) . migraine with aura appears to be uncommon in indian subjects in the present study.exactly 41.38% of subjects had unilateral onset of migraine headache of which little over one - half ( 53.17% ) had ocular location of pain at onset and little over one - third ( 38.67% ) had location of pain at onset in the temple region . in about one - third of subjects with unilateral onset , pain had been side locked.bilateral/central ( vertex ) location of pain at onset was experienced by 32.25% of subjects . majority ( 51.16% ) of them had bitemporal pulsating pain to start with followed by 27.91% experiencing onset pain at the vertex region.exactly 26.38% of subjects noted a cervico - occipital location of pain at onset , of which 14.63% had predominantly occipital region onset and 11.75% had predominantly cervical region onset of pain . as in many cases , it had been difficult to clearly distinguish between cervical or occipital location of onset pain ; these two areas had been grouped togetherin 47.4% of subjects with unilateral ocular , frontal and temporal location of pain at onset , pain remained at the same site during established headaches.approximately one - third of subjects with location of pain at onset in unilateral ocular , frontal and temporal regions subsequently developed ipsilateral hemicranial pain during established spells of migraine headaches.only 19.6% of subjects with unilateral location of pain at onset developed bilateral or holocranial headaches during established phase of the migraine attack.in 56.98% of subjects with bilateral or vertex location of pain at onset ( n  =  258 ) , pain remained at the same site during established migraine attacks . about 70% of subjects with bitemporal onset of throbbing pain , continued to experience pain at the same site but in about 30% pain subsequently became holocranial . over half ( 56.9% ) of subjects having onset pain at vertex region , experienced holocranial headaches subsequently.in 41.23% of subjects with cervico - occipital location of pain at onset subsequently experienced holocranial headaches . about a quarter of subjects subsequently developed hemicranial headaches.in all , although during established migraine attacks 40.5% of subjects experienced strictly unilateral pain , only 20.88% had truly hemicranial headaches . demographic features include : n  =  800 ; m : f 1:4.56 ; age 1642  years ( mean 26  years ) ; duration 118  years(mean 6.8  years ) ; migraine without aura 668 ( 83.5% ) ; migraine with typical aura 18 ( 2.25% ) ; probable migraine 114 ( 14.25% ) . exactly 41.38% of subjects had unilateral onset of migraine headache of which little over one - half ( 53.17% ) had ocular location of pain at onset and little over one - third ( 38.67% ) had location of pain at onset in the temple region . in about one - third of subjects with unilateral onset bilateral / central ( vertex ) location of pain at onset was experienced by 32.25% of subjects . majority ( 51.16% ) of them had bitemporal pulsating pain to start with followed by 27.91% experiencing onset pain at the vertex region . exactly 26.38% of subjects noted a cervico - occipital location of pain at onset , of which 14.63% had predominantly occipital region onset and 11.75% had predominantly cervical region onset of pain . as in many cases , it had been difficult to clearly distinguish between cervical or occipital location of onset pain ; these two areas had been grouped together in 47.4% of subjects with unilateral ocular , frontal and temporal location of pain at onset , pain remained at the same site during established headaches . approximately one - third of subjects with location of pain at onset in unilateral ocular , frontal and temporal regions subsequently developed ipsilateral hemicranial pain during established spells of migraine headaches . only 19.6% of subjects with unilateral location of pain at onset developed bilateral or holocranial headaches during established phase of the migraine attack . in 56.98% of subjects with bilateral or vertex location of pain at onset ( n  =  258 ) , pain remained at the same site during established migraine attacks . about 70% of subjects with bitemporal onset of throbbing pain , continued to experience pain at the same site but in about 30% pain subsequently became holocranial . over half ( 56.9% ) of subjects having onset pain at vertex region , experienced holocranial headaches subsequently . in 41.23% of subjects with cervico - occipital location of pain at onset subsequently experienced holocranial headaches . about a quarter of subjects subsequently developed hemicranial headaches . in all , although during established migraine attacks 40.5% of subjects experienced strictly unilateral pain , only 20.88% had truly hemicranial headaches . on the whole literature documenting migraine pain location both in adults and children is sparse . in children , wober  bingol et al . noted unilateral pain in 29.8% and bilateral pain in 55.4% of their subjects . in a recent review , lewis and winner mentioned unilateral location as uncommon in childhood migraine wherein a bifrontal or retro - orbital localization occurred more frequently . more recently , hershey et al . commented that one of the most common reasons for children not meeting the ichd-2 criteria fully is the requirement of unilateral location . in adults , kelman reported that highest location frequencies were in the eyes , temporal and frontal regions . all these studies reported migraine pain location during established headaches and unlike the present report did not highlight on pain location at onset and its subsequent evolution . the purpose of the present report had been , however , to document differences in migraine pain location at onset and during established headache between children and adult subjects . the differences observed may be little elaborated as follows : unilateral onset pain is twice as common in adults than children . in children commonest unilateral location site in frontal ( 60.9% ) whereas it is ocular in adults ( 53.17% ) followed by temporal ( 38.67%).side locked onset pain is unusual in children.vertex location of onset pain is unusual in children.holocranial onset pain occurs in over one - third of children but unusual in adults.cervico-occipital onset pain does occur in small proportion ( 11.5% ) of children but much less common than in adults ( 26.43% ) . in children most became holocranial later but in adults many experienced hemicranial headaches.transformation to hemicranial pain from unilateral ocular , frontal or temporal pain occurred more frequently in adults than children ( 33 vs. 19.5% ) . majority of children with unilateral onset pain developed bilateral or holocranial pain ( 48.5% ) in contrast to adults ( 19.6%).unilateral pain during established headache occurs in only small proportion of children ( 10.5% ) but occurs much more commonly in adults ( 40.5% ) . commonest unilateral location site in frontal ( 60.9% ) whereas it is ocular in adults ( 53.17% ) followed by temporal ( 38.67% ) . holocranial onset pain occurs in over one - third of children but unusual in adults . cervico - occipital onset pain does occur in small proportion ( 11.5% ) of children but much less common than in adults ( 26.43% ) . in children most became holocranial later but in adults many experienced hemicranial headaches . transformation to hemicranial pain from unilateral ocular , frontal or temporal pain occurred more frequently in adults than children ( 33 vs. 19.5% ) . majority of children with unilateral onset pain developed bilateral or holocranial pain ( 48.5% ) in contrast to adults ( 19.6% ) . unilateral pain during established headache occurs in only small proportion of children ( 10.5% ) but occurs much more commonly in adults ( 40.5% ) . although brief mention about difference in pain location between children and adults had been mentioned in the ichd-2 ,   no detailed comparative study like the present report had been made earlier . the present study clearly highlights that adult migraine in contrast to pediatric , is mostly an unilateral phenomenon at onset or during established headaches . the study clearly points out the need for a separate diagnostic criterion for migraine in children stressing the inclusion of bilateral and holocranial location of pain . it can only be postulated that this may be the result of differences in degree of brain maturation comprising myelination , new synapse formation and synaptic reorganization . clearly , further studies are warranted specially localization studies in an age stratified manner to more clearly highlight the evolution of a mostly bilateral phenomenon into a mostly unilateral phenomenon with advancing age from childhood to adult life .
the present report provides a detailed head to head comparative study of migraine pain location at onset and during established headache between children and adults belonging to the same ethnic group . migraine pain location in 200 children and adolescents 
 had already been reported ( chakravarty et al . in cephalalgia 27:11091114 , 2007 ) . 
 the present report includes data collected simultaneously and in a similar fashion from 800 adult migraineurs . 
 significant differences have been noted in migraine pain location . 
 unilateral onset pain is common in adults , side locked and vertex onset pain unusual in children , holocranial onset pain much common in children and cervico - occipital onset pain much less common in children . 
 there have been differences in evolution of migraine pain as well . during established headache unilateral pain was recorded in only a small proportion of children ( 10.5% ) whereas it was noted in many adults subjects ( 40.5% ) . 
 such a detailed comparative study had not been made earlier .