Migraines in Children

Migraines in children are severe, throbbing headaches that often come with nausea, vomiting, and sensitivity to light or sound. Migraines are one of the most common headache disorders in kids and teens, and they can begin as early as infancy. Overall, migraines affect about 1 in 10 children and become more common as they get older.

The symptoms of migraines in children may look different than in adults. Children are more likely to have pain on both sides of their head and headaches that last a shorter amount of time (from two to several hours). Some children may also have warning signs before a headache starts, called an aura, or feel tired and unwell after it ends.

Migraines can interfere with your child’s ability to go to school, take part in activities and enjoy daily life. They’re a long-term (chronic) condition, but they can be treated. Treatment focuses on reducing how often migraines happen and their severity. This may include making changes to daily habits, taking medications and figuring out triggers to prevent frequent attacks.

Types of migraines in children

Migraines that affect children and adolescents include:

• Migraine without aura: This is the more common type. It causes headaches with symptoms like nausea, vomiting, and sensitivity to light or sound, but no warning signs.
• Migraine with aura: This type includes warning signs before or during a headache. These may be visual changes, like flashing lights or zigzag lines.

Healthcare providers further classify migraines by how often they occur:

• Episodic migraine: This means your child has fewer than 15 headache days per month.
• Chronic migraine: This means your child has 15 or more headache days per month for at least three months.

What are the stages of a migraine?

The four stages (or phases) of a migraine include prodrome, aura, headache and postdrome:

• Prodrome: The prodrome, or warning phase, is the first stage of a migraine. It can last for a few hours or up to a few days. It causes symptoms like fatigue, irritability and neck stiffness. This phase affects some children with migraines, but it doesn’t always happen.
• Aura: During the aura stage, your child may see spots or flashing lights and have dizziness, numbness or confusion. This phase can last as long as an hour or as little as five minutes. Some children don’t experience aura. Some have aura and a headache at the same time.
• Headache: During the headache or “attack“ phase, your child may experience throbbing or pulsing pain in their head along with nausea, vomiting, and sensitivity to light and/or sound. Attacks are usually shorter in children than in adults.
• Postdrome: The postdrome stage is also called the “migraine hangover” or “triptan hangover.” Some children describe feeling drained, exhausted or like they have brain fog. Others feel a sense of euphoria or elation. This phase may go on for a day or two after a migraine.

Symptoms of migraines in children

Migraine attacks in children typically don’t last as long as migraines in adults, but they can still be severe. The most common symptom is pounding or throbbing head pain. In young children and teens, the pain usually affects the front or both sides of their head.

In older teens, the pain tends to be more like what adults get, affecting just one side of their head. The pain may get worse with movement.

Other pediatric migraine symptoms may include:

• Nausea and/or vomiting
• Sensitivity to light and/or sound
• Lightheadedness
• Dizziness
• Vertigo
• Blurred vision
• Loss of appetite
• Abdominal (belly) pain

Some children have symptoms before or after a headache, including:

• Fatigue or low energy
• Irritability or mood changes
• Trouble focusing
• Food cravings
• GI issues, like diarrhea
• Neck stiffness

Causes of migraines in kids

Experts believe changes in brain activity that affect how nerves communicate and process pain cause migraines. A combination of genetic and environmental factors can make a child more likely to have migraines.

Migraines tend to run in families. Most children who have migraine headaches also have an immediate biological family member (a parent or sibling) with a history of migraines.

Most children get migraines randomly — there isn’t a specific trigger that brings on an attack. But some children have migraine attacks due to a clear trigger or cause.

What are some common migraine triggers?

Things that trigger migraines differ for each child. But some common triggers in children and adolescents include:

Stress

Stress is one of the most common triggers of migraines, especially stress related to school and family problems. School-related stress may include after-school activities, friends or bullying.

Carefully reviewing what’s causing the stress can help your child figure out what to avoid. In some cases, your child may need a counselor to determine the cause of the stress and help manage it.

Food

Certain foods or food additives can trigger a migraine, including:

• Aged cheeses
• Pizza
• Lunch meats
• Sausages or hot dogs (which contain nitrates)
• Caffeine-containing foods and beverages, including chocolate, tea, coffee and cola
• Monosodium glutamate (MSG)-containing foods, like Doritos® and Ramen® noodles

Writing down what foods your child ate before the migraine attack may help you find potential triggers so your child can avoid them. It’s a good idea to check food labels for things like nitrates or MSG.

Medications

Some medications may trigger migraines. These can include:

• Certain oral contraceptives (birth control pills)
• Asthma treatments
• Stimulants, including many of the medications providers use to treat ADHD

If you think medicines are causing your child’s migraines, ask their provider about other options. Your child may also be able to take medications in different ways so their migraines are less frequent.

Menstruation and hormonal changes

Hormonal changes are a common migraine trigger. Migraines often begin around the start of puberty or after your child gets their first menstrual period (menarche). Changes in estrogen levels during the menstrual cycle can trigger migraine attacks in some people.

Before puberty, migraines affect both sexes at similar rates. After puberty, migraines become more common in females.

Sensory triggers

Certain triggers involve your child’s senses. These may include:

• Scents or fragrances
• Certain types of light, like fluorescent lighting
• Sounds, especially specific types (like high or low frequencies, or very loud sounds)

Other triggers

There are many other possible migraine triggers, including:

• Lack of sleep: A lack of good sleep results in less energy for coping with stress. Your child should aim for at least eight hours of sleep each night.
• Changes in normal eating patterns: Skipping meals can cause migraines. Eating three regular meals and not skipping breakfast can help.
• Weather changes: Storm fronts or changes in barometric pressure can trigger migraines in some children.
• Travel: Traveling by car or boat can sometimes cause motion sickness that triggers migraines.
• Changes in regular routine: Changes in your child’s routine — like lack of sleep, travel or illness — can trigger migraines.

Complications of migraines in children

Migraines can affect your child’s quality of life and may lead to:

• Missed school or activities
• Trouble focusing or learning
• Sleep problems
• Anxiety or depression
• Chronic migraine

How doctors diagnose migraines in children

Your child’s healthcare provider will ask about their medical history and symptoms. They’ll also do a physical exam and a neurological exam. But gathering details about your child’s migraines is the key to making a diagnosis. Your child’s provider will want you to keep track of your child’s migraine history — for example, by keeping a headache diary. There are also specialized smartphone apps that can help with this.

Your child’s migraine history should include a description of current and previous headaches. Specifically, you should track:

• How your child feels before, during and after their migraines
• How often their migraines occur
• How long each migraine lasts
• Any other symptoms

Make sure you’ve also gathered the names of medications your child has taken in the past, current medications and names of medications that have worked the best.

In most cases, children with typical migraine symptoms and a normal exam don’t need imaging tests, like MRI or CT scans. But your child may need imaging if there are unusual symptoms or “red flags” that could suggest another condition.

PedMIDAS

Your child’s provider may also use a tool called the Pediatric Migraine Disability Assessment (PedMIDAS). This tool helps them understand how migraines affect your child’s daily life. PedMIDAS asks how many days in the past three months your child:

• Missed a full school day due to headaches
• Missed part of a school day due to headaches
• Functioned at less than half their ability at school
• Couldn’t do activities at home, like chores or homework
• Missed other activities, like sports or social events
• Took part in these activities but at less than half their ability

Scores help classify the impact migraines have on your child:

• Less than 10: Little or no impact
• 11 to 30: Mild impact
• 31 to 50: Moderate impact
• More than 50: Severe impact

How are migraines in children treated?

Pediatric migraine treatment can help manage symptoms and reduce how often your child gets them.

One of the most important factors in treatment is making sure your child has overall healthy habits. Your child’s healthcare provider will educate you and your child on everyday practices that may help improve their migraines. These may include:

• Getting enough sleep each night
• Avoiding skipping meals
• Getting plenty of physical activity
• Drinking lots of water
• Managing stress

Your child should also try to identify and avoid any possible triggers. Keeping a headache diary is a good way to help figure out your child’s triggers.

Your child’s provider may also recommend finding an effective medication that your child can take when a migraine comes on. These medications should provide pain relief within an hour so your child can continue with their daily activities.

The first line of treatment includes over-the-counter (OTC) pain relievers, like acetaminophen (Tylenol^®) and ibuprofen (Advil^®). Your provider may also talk with you about overuse of these medications. They can be associated with side effects if your child takes them too frequently.

For severe migraines, your child’s provider may prescribe a triptan. Triptans change how blood flows through your child’s brain and how their brain processes pain signals. Types of triptans include:

• Rizatriptan (Maxalt^®)
• Sumatriptan (Imitrex^®)
• Almotriptan (Axert^™)

If your child gets more than one migraine a week, their provider may recommend preventive medications or supplements to reduce migraine frequency and severity. Your child may take a medication like amitriptyline or topiramate, or a supplement like magnesium, each day for several months.

Or your child’s provider may recommend a monoclonal antibody. Fremanezumab (Ajovy^®) is currently the only FDA-approved option for children. This medication is a monthly injectable approved for children as young as 6, as long as they weigh at least 45 kilograms (99.2 pounds).

Other treatment options include psychological therapies, like:

• Biofeedback
• Relaxation techniques
• Cognitive behavioral therapy

What can I do to help my child?

If your child has a migraine, encourage them to:

• Rest in a dark, quiet room
• Use a cool compress on their head
• Take a nap or go to bed
• Drink fluids
• Take OTC or prescription medications, as directed

Recovery time

Migraine attacks in children can last from about two hours to several hours. Many children feel better after sleeping. Some may feel tired or have trouble focusing for a short time after the headache ends.

When should my child see their healthcare provider?

Contact your child’s provider if they:

• Have frequent or severe headaches
• Miss school or activities because of headaches
• Have migraines that are getting worse over time
• Don’t get relief from treatment

Seek medical care right away if your child has:

• A sudden, severe headache (“worst headache of their life”)
• Headache with fever, neck stiffness or confusion
• Weakness, vision changes or trouble speaking
• Headache after a head injury
• Headaches that wake them from sleep

What can I expect if my child gets migraines?

For some children, the migraines improve as they get older, especially with the right treatment and lifestyle changes. But up to 3 out of 4 will continue to have migraines into adulthood.

With proper care, most children can manage their symptoms and continue their normal activities. Learning triggers and building healthy habits can make a big difference in reducing migraine attacks.