What is a migraine headache?

Migraine is a moderate-to-severe headache that lasts from 2 to 48 hours and usually occurs two to four times per month.

Migraine, also called an acute recurrent headache, occurs in about 3% of children of preschool children, 4% to 11% of elementary school-aged children, and 8% to 15% of high school-aged children. In early childhood and before puberty, migraine is more commonly seen in boys than girls. In adolescence, migraine affects young women more than young men. As adults, women are three times more likely to have a migraine than men.

What types of migraine occur in children and adolescents?

There are two main types. A migraine without an aura (called common migraine) occurs in 60% to 85% of children and adolescents who get a migraine. A migraine with an aura (called classic migraine) occurs in 15% to 30%. In young children, migraine often begins in the late afternoon. As the child gets older, migraine often begins in the early morning.

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; or brightly colored, flashing, or moving lights or lines. Other auras may include changes in ability to speak, move, hear, smell, taste, or touch. Auras last about 20 minutes.

Are there other types of migraine that occur in children and adolescents?

Yes, other types are grouped as either complicated migraine or migraine variants.

Complicated migraines are migraines with neurological symptoms, including:

  • Paralysis or weakness of the eye muscles that keep the eye in its normal position and control its movement. This was previously called an ophthalmoplegic migraine.
  • Weakness on one side of the body. This is called a hemiplegic migraine.
  • Pain at the base of the skull as well as numbness, tingling, visual changes and balance difficulties (such as a spinning sensation [vertigo]). This is called basilar migraine.
  • Confusion and speech and language problems. This is called confusional migraine and may also occur after a minor head injury.
  • Migraine variants are disorders in which the symptoms appear and disappear from time to time. Headache pain may be absent. Migraine variants are more common in children who have a family history of migraine or who will develop migraine later in life. Migraine variants include:
  • Paroxysmal vertigo – dizziness and vertigo (spinning) that is brief, sudden, intense, and recurs.
  • Paroxysmal torticollis – sudden contraction of the neck muscles on one side of the head that causes the head to “tilt” to one side.
  • Cyclic vomiting – uncontrolled vomiting that lasts about 24 hours and occurs every 60 to 90 days.
  • Abdominal migraine – pain in the belly, usually near the belly button (navel). Pain usually lasts 1 to 2 hours.

Migraine variants can sometimes be confused with other neurological disorders. A key difference is that migraine variants recur from time to time. There is complete recovery and no symptoms between attacks.

What causes a migraine?

Until recently, migraine was thought to be caused by the changing size of blood vessels in the brain. These changes either increase or decrease blood flow, which then trigger other changes. Today, migraine is thought to be a brain malfunction – a disorder that mainly affects the brain and nerves but also affects blood vessels. The “malfunction” is caused, in part, by the release of chemicals in the brain. One of these chemicals is serotonin. This cycle of changes cause inflammation and the pain of the migraine.

Migraine is genetic, meaning it tends to run in families. Some 60% to 70% of people who have migraine headaches also have an immediate family member (mother, father, sister, or brother) who have or may have had a migraine.

A migraine can cause great discomfort, disability, and interfere with activities. However, they do not usually cause damage to the body. Migraine headaches are not related to brain tumors or strokes.

What are the symptoms of migraine?

Although symptoms can vary from person to person, general symptoms include:

  • Pounding or throbbing head pain. In children, the pain usually affects the front or both sides of the head. In adolescents and adults, the pain may affect one side of the head.
  • Pale skin color
  • Irritable, moody
  • Sensitivity to sound
  • Sensitivity to light
  • Loss of appetite
  • Nausea and/or vomiting

What are some migraine triggers?

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

  • Stress – especially 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, a counselor may be needed to determine the cause of the stress. Stress management includes regular exercise, adequate rest and diet, and enjoying pleasant activities and hobbies.
  • Lack of sleep – results in less energy for coping with stress. Aim for 8 hours of sleep nightly.
  • Menstruation – normal hormonal changes caused by the menstrual cycle can trigger 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. If you are trying to cut back on caffeine, do so gradually. The goal is not to consume any caffeine at all.
  • Weather changes – storm fronts or changes in barometric pressure can trigger migraine in some people.
  • Medications – some medications such as oral contraceptives (birth control pills), asthma treatments, and stimulants (including many of the drugs used to treat attention-deficit hyperactivity disorder [ADHD]), may occasionally trigger a migraine. If you think medicines are causing the headache, ask your doctor about other options.
  • Alcohol – may cause the brain’s arteries to expand, resulting in a migraine.
  • Travel – the motion sickness sometimes caused by travel in a car or boat can trigger a migraine.
  • Diet –certain foods or food additives can trigger a migraine. These foods include aged cheeses; pizza; luncheon meats; sausage or hot dogs (which contain nitrates); caffeine-containing foods and beverages including chocolate, teas, coffee, colas; and monosodium glutamate (MSG)-containing foods such as Doritos®, Ramen® noodles, and Oriental foods. Remembering what foods were eaten before the migraine attack may help identify potential food triggers so they can be avoided.
  • Changes in regular routine – such as lack of sleep, travel, or illness can trigger a migraine.

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