Migraines in Children

What are migraines in children?

When you think about someone getting a migraine, you’re probably thinking of an adult. But children get migraines, too. Migraines in kids are the same disease that affects adults, but it impacts them in different ways. Children’s migraines typically affect both sides of their head, whereas adult migraines more often are one-sided. In addition, children’s migraine attacks are often shorter than adult migraines. However, childhood migraines can be disabling, causing children to miss school, sports and other activities.

What is a migraine?

A migraine is more than just a bad headache. A migraine is a neurological disease that causes various symptoms, including:

• Throbbing head pain.
• Nausea and vomiting.
• Dizziness.
• Vision problems, such as seeing spots or flashing lights.
• Light, sound and smell sensitivities.

Migraines often start mild and proceed to get worse. They usually last from 30 minutes to several hours, but some migraines can last up to several days. In addition, migraines are recurring, meaning they keep coming back.

How common are migraines in children?

Migraines affect children of all ages, including infants. Up to 2.5% of children younger than 7 years old have had a migraine. By the age of 10, about 5% of children have experienced a migraine. The prevalence of migraine continues to go up throughout childhood. Approximately 10% of children ages 5 to 15 get migraines, and 28% of teenagers have gotten a migraine.

In early childhood and before puberty, migraines affect both sexes equally. In adolescence, migraines affect girls more.

Types of migraines in children

Two main types of migraines affect children and adolescents:

• Migraine without aura: This type of migraine, which providers used to call a common migraine, occurs in 60% to 85% of children and adolescents who get a migraine.
• Migraine with aura: This type of migraine, which providers used to call a classic migraine, occurs in 15% to 30% of children and adolescents who get a migraine.

What is an aura?

An aura is a warning sign that a migraine is about to begin. An aura usually occurs about 30 minutes before a migraine starts. The most common auras are visual and include:

• Blurred or distorted vision.
• Blind spots.
• Brightly colored, flashing or moving lights or lines.

Other auras may include changes in the ability to speak, move, hear, smell, taste or touch.

What are the stages of a migraine?

The four stages of a migraine include prodrome, aura, headache and postdrome:

• Prodrome: The premonitory 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 such as fatigue, irritability and a stiff neck. The prodrome phase affects 67% of children with migraines.
• Aura: During the aura phase, your child may see spots or flashing lights and they may experience dizziness, numbness or confusion. This phase can last as long as one hour or as little as five minutes. Some children don’t experience an aura, and some have both the aura and the migraine at the same time.
• Headache: During the headache or attack phase, your child may experience throbbing or pulsing pain in their head along with other symptoms such as nausea, vomiting and light sensitivity. Attacks are usually shorter in children than in adults.
• Postdrome: The postdrome stage includes what some people call a migraine “hangover.” Some children describe feeling drained or exhausted, but others feel a sense of euphoria or elation. This phase may go on for a day or two after a migraine.

What are migraine symptoms in kids?

The most common symptom of migraines in children is pounding or throbbing head pain. In young children, the pain usually affects the front or both sides of their heads. But it can also affect their whole head or just a part of their head.

In younger teens, the pain typically affects both sides of their heads. In older adolescents, the pain tends to be more like what adults get, affecting just one side of their head.

Other pediatric migraine symptoms may include:

• Lightheadedness.
• Dizziness.
• Difficulty focusing.
• Sensitivity to sound.
• Sensitivity to light.
• Loss of appetite.
• Abdominal pain.
• Nausea and/or vomiting.

What causes migraines in children?

Until recently, researchers thought changes in blood flow in the brain caused migraines. Most now believe this can contribute to the pain but it isn’t what starts it. Today, scientists believe migraines are a brain malfunction — a disorder that mainly affects the brain and nerves, but also affects blood vessels. A release of certain chemicals (neurotransmitters) in the brain such as serotonin causes this “malfunction,” which leads to the inflammation and pain of the migraine.

Migraines are genetic, meaning they tend to run in families. Some 60% to 70% of people who have migraine headaches also have an immediate biological family member (parent or sibling) who has or may have had a migraine.

Most children get migraines randomly — they don’t do anything specific to trigger an attack. But some children have migraine attacks due to a clear trigger or cause.

What are some migraine triggers?

Things that trigger migraines differ for each person. However, some common migraine triggers in children and adolescents include:

Stress

Stress is one of the most common triggers of migraines, especially stress related to school (after-school activities, friends, bullying) and family problems. Carefully reviewing what causes stress can help determine what stress factors to avoid. In some cases, your child may need a counselor to determine the cause of the stress. Stress management includes:

• Regular exercise.
• Adequate rest and diet.
• Enjoying pleasant activities and hobbies.

Diet

Certain foods or food additives can trigger a migraine. These foods include:

• Aged cheeses.
• Pizza.
• Lunch meats.
• Sausage or hot dogs (which contain nitrates).
• Caffeine-containing foods and beverages, including chocolate, teas, coffee and colas.
• Monosodium glutamate (MSG)-containing foods such as Doritos® and Ramen® noodles.

Remembering what foods your child ate before the migraine attack may help identify potential food triggers so they can be avoided. It's a good idea to check food labels for things like nitrates or MSG.

Medications

Some medications may occasionally trigger a migraine. These medications include:

• Oral contraceptives (birth control pills).
• Asthma treatments.
• Stimulants, including many of the drugs used to treat attention-deficit/hyperactivity disorder (ADHD).

If you think medicines are causing your child’s migraines, ask their provider about other options.

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 eight hours of sleep a night.
• Menstruation: Normal hormonal changes caused by your child’s menstrual cycle can trigger a migraine.
• Changes in normal eating patterns: Skipping meals can cause migraine. Eating three regular meals and not skipping breakfast can help.
• Caffeine: Caffeine is a habit-forming substance and headache is a major symptom of caffeine ingestion and withdrawal.
• Weather changes: Storm fronts or changes in barometric pressure can trigger migraine in some people.
• Travel: The motion sickness sometimes caused by travel in a car or boat can trigger a migraine.
• Changes in regular routine: Changes in your child’s routine such as lack of sleep, travel or illness can trigger a migraine.

How are migraines in children diagnosed?

Gathering details about your child’s migraines is the key to making the diagnosis. Your child’s provider will want you to keep track of your child’s migraine history.

Your child’s history should include a description of current and previous headaches — specifically, how your child feels before, during and after their migraines. You’ll want to collect information on how often their migraines occur, how long they last and any other symptoms. Make sure you’ve gathered the names of medications your child has taken in the past, current medications and names of medications that have worked the best.

After taking your child’s medical history, your child’s provider will perform a physical exam and neurological examination. Based on all the information collected, your child’s provider can usually determine the type and cause of your child’s migraines. Sometimes, they’ll request additional tests, such as lab work, CT or MRI scan.

How are migraines in children treated?

Pediatric migraine treatment usually involves multiple components. One of the most important factors in treatment is making sure your child is leading an overall healthy lifestyle. Your child’s provider will educate you and your child on everyday practices that may help improve their migraines. These practices may include:

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

In addition, your child should identify and avoid any possible migraine triggers. Maintaining a headache diary is a good way to help identify 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 should include over-the-counter (OTC) pain medications like nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen. For severe migraines, your child’s provider may prescribe medications such as triptans (for example, sumatriptan).

If your child gets more than one migraine a week, their provider may recommend preventive medications or supplements to reduce their frequency and severity. Medications such as amitriptyline and supplements such as magnesium are taken daily over several months.

Can migraines in children be prevented?

Pediatric migraine prevention starts with maintaining a healthy lifestyle. Make sure your child is getting an adequate amount of sleep and managing their stress levels. In addition, your child should eat a healthy diet and make sure to exercise regularly.

Beyond leading a healthy lifestyle, the best way to prevent migraines is to avoid known triggers. Keeping a headache diary can help track triggers so your child can try to avoid them in the future.

What is the outlook (prognosis) for children with migraines?

Treatment helps most children and adolescents with migraine. Fifty percent of children and adolescents report migraine improvement within six months after treatment. But in about 60% of adolescents who experience their first migraine as an adolescent, migraines may continue off and on for many years.

What can I do to help my child if they have a migraine?

If your child has a migraine, you can take the following steps to help them until it passes:

• Encourage your child to rest in a dark, quiet room with a cool washcloth laid across their forehead.
• Try to get your child to take a nap or go to bed.
• If directed by their healthcare provider, give your child OTC or prescription medications.

When should my child see their healthcare provider?

If your child has migraine symptoms, you should make an appointment with their healthcare provider. You should take your child in immediately if they have a headache that starts after a head injury or wakes them up from sleeping. In addition, take your child in if they have a severe or sudden headache or one that comes along with other symptoms, like:

• Vomiting.
• Neck pain or stiffness.
• Vision problems.
• Confusion.
• Loss of balance.
• Fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher.

These may be a sign of a more serious type of headache.