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.
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.
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.
Yes, other types are grouped as either complicated migraine or migraine variants.
Complicated migraines are migraines with neurological symptoms, including:
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.
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.
Although symptoms can vary from person to person, general symptoms include:
Things that trigger migraine differ for each person. However, some common migraine triggers in children and adolescents include:
Gathering details about the headaches is the key to making the diagnosis. The headache history should be obtained from both the patient and his or her parents.
The history includes a description of current and previous headaches – specifically, how the patient feels before, during, and after the headache. Information on how often the headaches occur, how long they last, and any other symptoms are also collected. The names of medications taken in the past, current medications, and names of medications that have worked the best are also gathered.
After taking the medical history, your doctor will perform a physical and neurological examination. The exam is usually normal. Sometimes additional tests are needed, such as additional lab work, CT or MRI scan. In typical patients with migraine, no additional tests are needed. Based on all the information collected, your doctor can determine the type and cause of the headaches.
Patients with complicated migraine with neurological symptoms require a more thorough neurological exam, more laboratory tests, and imaging scans. MRI (magnetic resonance imaging) and MRA (magnetic resonance imaging of the arteries) scans allow the tissues and arteries within the brain to be seen and evaluated. Most patients with complicated migraine recover completely. A structural problem, such as a brain tumor, is rarely found.
Basic lifestyle changes can help control a migraine. Whenever possible, avoiding the known triggers can help reduce the frequency and severity of migraine attacks.
Biofeedback and stress reduction. Biofeedback helps a person learn stress-reducing skills by providing information about muscle tension, heart rate, and other vital signs as a person attempts to relax. It is used to gain control over certain bodily functions that cause tension and physical pain.
Biofeedback can be used to help patients learn how their body responds in stressful situations, and how to better cope. Some people choose biofeedback instead of medications.
Other stress reduction options include counseling, exercising, and yoga.
Vitamins, minerals, and herbal products. These products have shown some effectiveness in migraine. They include magnesium, riboflavin, and coenzyme Q10.
Medications. Headache medications can be grouped into three different categories: symptomatic relief, abortive therapy, and preventive therapy. Each type of medication is most effective when used in combination with other medical recommendations, such as dietary and lifestyle changes, exercise, and relaxation therapy.
Symptomatic relief. These medicines are used to relieve symptoms associated with headaches, including the pain of a headache or the nausea and vomiting associated with migraine. These medications include simple analgesics (ibuprofen or acetaminophen), anti-emetics (for nausea/vomiting), or sedatives (to help sleep; sleep relieves migraine). Some of these medications may require a prescription; others are available over-the-counter without the need for a prescription, but should only be taken on the advice or recommendation of a physician.
Important: If symptomatic relief medications are used more than twice a week, see your doctor. Overuse of symptomatic medications can actually cause more frequent headaches or worsen headache symptoms. This is called rebound or medication overuse headache.
Abortive therapy. These medications help stop the headache process and prevent migraine symptoms including pain, nausea, and light sensitivity. They are taken at the first sign of a migraine.
Abortive medications include:
Preventive therapy__\_._ These medications are taken daily to reduce the frequency and severity of the migraine over time. Some commonly prescribed preventive medications include:
Often a combination of symptomatic and preventive medications may be needed. Patients should be started at a low dose, with the dose slowly increased over time. Medication works best when combined with lifestyle changes and patient education.
What treatment approaches can be tried in children and adolescents with migraine?
Young children: Infrequent migraine
These symptomatic medications are useful:
Young children: Frequent migraine
These preventive medications may be prescribed:
Adolescents: Infrequent migraine (with or without aura)
These symptomatic medications can be useful:
If symptomatic medications alone are unsuccessful, the following abortive medications can be added the symptomatic medication:
Adolescents: Frequent migraine
These preventive medications can be tried:
Adolescents: Severe migraine (unresponsive to other medications and lasting > 24 hours)
Adolescents experiencing severe migraine should be seen by a headache specialist.
When headaches – and especially migraine headaches – last longer than 24 hours and other medications have been unsuccessful in managing the attacks, medication administered in an “infusion suite” can be considered. An infusion suite is a designated set of rooms at a hospital or clinic that are monitored by a nurse and where intravenous drugs are prescribed by a physician. The intravenous drugs are usually able to end the migraine attack. Patients’ length of stay at the infusion suite can range from several hours to all day.
Treatment helps most children and adolescents with migraine. Fifty percent of children and adolescents report migraine improvement within 6 months after treatment. However, in about 60% of adolescents who experience their first migraine as an adolescent, the migraine may continue off and on for many years.
It should be noted that many of the medications listed in this handout have not been approved by the by the Food and Drug Administration (FDA) for use in children and adolescents with headaches. This is a common practice in the field of medicine and is called ‘off-label’ prescribing. It is one of the ways new and important uses are found for already approved drugs. Many times, positive findings lead to formal clinical trials of the drug for new conditions and indications.
Rehabilitation program. Some hospitals and/or other health care facilities offer inpatient headache management programs for children and adolescents; ask your doctor if their facility offers such programs.
Patients typically accepted into these programs are those who have a chronic daily headache (greater than 15 days a month), missed an excessive amount of school, have overused over-the-counter medications, and have headache pain that is controlling their lives. The staff of such programs can include psychologists, pediatric rehabilitation specialists, occupational and physical therapists as well as access to a child psychiatrist. Stress factors are an important focus of this program; not rapid changes in medications.
Clinical trials. Some children and adolescents with migraine don’t experience headache relief despite trying many of the currently available medications. If this is the case for your child, ask your doctor about possible participation in a clinical trial. Clinical trials provide access to drugs not yet approved by the FDA. Such drugs are not available through “regular” doctors’ offices; they are only available through doctors and health care organizations that have agreed to participate in the clinical trials. Your doctor will help determine if your child is an appropriate candidate for this type of research study.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 08/25/2017