Migraines in Children and Adolescents
What is a migraine headache?
A migraine headache is considered a vascular headache because it is associated with changes in the size of the arteries within and outside of the brain.
For many years it was thought that a migraine headache was primarily a disorder of the blood vessels. We now know that migraine is a genetic disorder that is inherited. Four out of 5 migraine sufferers have a family history of migraines. If one parent has a history of migraines, the child has a 50% chance of developing migraines, and if both parents have a history of migraines, the risk jumps to 75%.
How common are migraine headaches among children and adolescents?
Migraines affect about 1.5 percent of children by age 7 and about 5 percent of children and adolescents by age 15. Disability from headaches can be significant with many days lost from school or play.
In early childhood and before puberty, migraines are more frequent among boys. In adolescence, migraines affect young women more than young men. As adults, women are three times more likely to suffer from migraines than men.
What are the types of migraine in children and adolescents?
Common Migraine or Migraine Without Aura*
This is the most frequent type of migraine in children and adolescents, making up about 80 to 85 percent of all migraines.
Classic Migraine or Migraine with Aura*
Less frequent than common migraine, classic migraine makes up about 15 to 20 percent of all migraines. In young children, classic migraine often begins in the late afternoon. As the child gets older, the onset of migraine may change to early morning.
*Aura is a warning sign that a migraine is about to begin. An aura usually occurs about 10 to 30 minutes before the onset of a migraine, although it can occur as early as the night before the onset. The most common auras are visual and include blurred or distorted vision; blind spots; or brightly colored, flashing or moving lights or lines. Other auras may include speech disturbances, motor weakness or sensory changes. The duration of an aura varies, but it generally lasts less than 20 minutes.
Complicated migraine syndromes are associated with neurological symptoms, including:
- A stroke-like weakness on one side of the body, associated with hemiplegic migraine
- Drooping eyelid and dilated pupil, associated with ophthalmoplegic migraine
- Pain at the base of the skull with numbness, visual changes and balance difficulties associated with basilar artery migraine
- A temporary period of confusion often initiated by minor head injury, associated with confusional migraine
Patients with complicated migraine syndromes require a complete neurological evaluation, which may include a magnetic resonance imaging (MRI) scan. Most patients with complicated migraine recover completely, and a structural abnormality is rarely the cause.
Migraine variants are disorders that cause periodic symptoms that come and go. Migraine variants include:
- Paroxysmal vertigo — dizziness that is marked by sudden, intense symptoms
- Paroxysmal torticollis — sudden contraction of one side of the neck muscles that causes the head to lean to that side
- Cyclic vomiting — uncontrolled vomiting that occurs repeatedly over a certain period of time
The key to diagnosing these migraine variants, which can be confused with other neurological syndromes, is their tendency to recur at intervals. The person does not have symptoms in between attacks.
What causes migraines?
The exact causes of migraines are unknown, although they are related to changes in the brain as well as to genetic causes. People with migraine headaches may inherit the tendency to be affected by certain migraine triggers, such as fatigue, bright lights, weather changes and others.
For many years, scientists believed that migraines were linked to the expanding (dilation) and constriction (narrowing) of blood vessels on the brain’s surface. However, it is now believed that migraine is caused by inherited abnormalities in certain areas of the brain.
There is a migraine “pain center” or generator in the mid-brain area. A migraine begins when hyperactive nerve cells send out impulses to the blood vessels, causing constriction, followed by the dilation of these vessels and the release of prostaglandins, serotonin and other inflammatory substances that cause the pulsation to be painful.
Certain brain cells that use serotonin as a messenger are involved in controlling mood, attention, sleep and pain. Therefore, chronic changes in serotonin can lead to anxiety, panic disorder and depression.
What are some migraine triggers?
In many children and adolescents, migraines are triggered by external factors. These “triggers” vary for each person. Some common migraine triggers include:
Emotional stress is one of the most common triggers of migraine headache. Migraine sufferers are generally found to be highly affected by stressful events. During stressful events, certain chemicals in the brain are released to combat the situation (know as the “flight or fight” response). The release of these chemicals can provoke vascular changes that can cause migraine. Repressed emotions surrounding stress, such as anxiety, worry, excitement and fatigue can increase muscle tension and dilated blood vessels can intensify the severity of migraine headaches.
Carefully reviewing what causes stress can help you determine what stress factors you can avoid. Stress management includes regular exercise, adequate rest and diet, and promoting pleasant activities such as enjoyable hobbies.
Ovulation or menstruation
Normal hormonal changes caused by ovulation and menstrual cycles can trigger migraines.
Changes in normal eating patterns
Skipping meals lowers the body’s blood sugar and can cause migraines. Eating three regular meals and not skipping breakfast can help.
Excessive caffeine consumption or withdrawal from caffeine can cause headaches when the caffeine level abruptly drops. The blood vessels seem to become sensitized to caffeine, and when caffeine is not ingested, a headache may occur. If you are trying to cut back on caffeine, do so gradually. Caffeine itself is often helpful in treating acute migraine attacks.
Weather changes such as storm fronts, barometric pressure changes, strong winds or changes in altitude can trigger migraines.
Some medications, such as oral contraceptives (birth control pills), and asthma treatments may trigger a migraine. Ask your healthcare provider if there are other alternatives to these medications.
Sensitivity to Specific Chemicals and Preservatives in Foods
Certain foods and beverages, such as aged cheese, alcoholic beverages, and food additives such as nitrates (in bacon, pepperoni, hot dogs, luncheon meats), phenylethylamine in chocolate and monosodium glutamate (MSG, commonly found in Chinese food) may be responsible for triggering up to 30% of migraines. These foods dilate blood vessels, causing a pain message to be sent back to the brain. Recalling what was eaten prior to a migraine attack may help you identify certain foods that are potential triggers so you can avoid them in the future.
Changes in regular routine
Personal routine changes such as lack of sleep, travel, riding in a car or illness can cause migraines. Exercising regularly and getting adequate rest can decrease the number of migraine attacks.
What are the symptoms of migraine?
The symptoms of migraine headaches can occur in various combinations and include:
Type of pain
The pain of a migraine can be described as a pounding or throbbing. The headache often begins as a dull ache and develops into throbbing pain. The pain is usually aggravated by physical activity.
Severity/intensity of pain
The pain of a migraine can be described as mild, moderate or severe.
Location of pain
In children and adolescents, the pain usually affects the front or both sides of the head. In adults, the pain usually affects one side of the head.
Duration of pain
Most migraines last about 4 hours although severe ones can last up to a week.
Frequency of headaches
The frequency of migraines varies widely among individuals. It is common for a migraine sufferer to get 2-4 headaches per month. Some people, however, may get headaches every few days, while others only get a migraine once or twice a year.
- Sensitivity to light, noise and odors
- Nausea and vomiting, stomach upset, abdominal pain
- Loss of appetite
- Sensations of being very warm or cold
- Paleness (pallor)
- Blurred vision
- Diarrhea (rare)
- Fever (rare)