An Overview of Migraine in Children

Symptoms, Causes, Diagnosis, Treatment, Prevention, and Coping

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It may be surprising to many parents, but headaches—both migraines and tension headaches—are actually quite common in the pediatric population. Migraines become more prevalent the older kids get; they're estimated to occur in up to 2.5 percent of kids under the age of 7 years, nearly 10 percent of kids ages 5 to 15 years, and around 28 percent of teens ages 15 to 19 years. Boys tend to get migraines more often before adolescence, and girls have them more frequently after puberty, likely due to the role of estrogen.

Symptoms

Migraines are usually more severe than other types of headaches, and the symptoms in children may be different those in adults. For instance, the pain can last for less than two hours in younger kids, while it typically lasts at least four hours in older teens and adults.

Migraine symptoms in children can include:

  • Moderate to severe headache pain on both sides of the head (bilateral), though as kids get to their late teens and early 20s, this will likely start following the adult pattern of being mostly on one side of the head (unilateral)
  • Pulsing or throbbing head pain
  • Nausea or vomiting
  • Sensitivity to light (photophobia)
  • Sensitivity to sound (phonophobia)
  • Aversion to odors (osmophobia)
  • Abdominal pain, which can actually be an abdominal migraine
  • An aura that starts before the migraine or as it begins and which can include visual disruptions, or, less often, muscle weakness on one side of the body (hemiparesis) or language impairment (aphasia)

These symptoms are typically made worse by routine physical activities, such as walking or climbing stairs.

You may notice that your child acts out at home and/or at school when he or she has a migraine. Very young children who can't describe their symptoms may hold their heads and cry.

Rarely, kids may show symptoms of migraine with brainstem aura, including:

  • Episodes of slow or slurred speech (dysarthria)
  • Vertigo (dizziness)
  • Ringing in the ears (tinnitus)
  • Double vision (diplopia)
  • Visual disruptions
  • Abnormal, clumsy movements (ataxia)
  • Decreased levels of consciousness
  • Decreased hearing
  • Simultaneous numbness and a tingling feeling on both sides (bilateral paresthesias) before the migraine begins

If you notice any other symptoms, such as blurred vision or mood swings, it's best to contact your child's pediatrician to make sure there isn't something more serious than migraines going on.

Causes

Migraines tend to run in families, so if you have them yourself, it's entirely plausible that your child's headaches are (or will be) migraines.

Besides these potential genetic and environmental factors, no one knows exactly what causes migraines. Theories include changes in the brain that involve a decline in a neurotransmitter called serotonin and an increase in a protein called calcitonin gene-related peptide (CGRP).

As in adults, migraines in children who are prone to them can also be triggered by one or more of a variety of factors, including:

  • Stress and anxiety
  • Weather changes
  • Dehydration
  • Hunger
  • Lack of sleep or a change in sleep patterns

Diagnosis

Although tests such as a computerized tomography (CT) scan or magnetic resonance imaging (MRI) of the brain, a sinus X-ray, or a lumbar puncture are sometimes done when your child has regular headaches in order to rule out other causes, the diagnosis of migraine is usually made simply by examining the pattern of your child's symptoms.

Imaging tests are usually not needed if your child has recurrent migraines and a normal neurological exam unless he or she has suddenly started having severe head pain, the migraines are changing (becoming more severe or more frequent, for example), or if your doctor discovers neurological abnormalities during a physical exam.

There are a number of different types of migraine, but the most common is migraine without aura, followed by migraine with aura. Your child's doctor will likely use the International Classification of Headache Disorders 3rd edition (ICHD-3) to specify what type of migraine your son or daughter has, which includes diagnostic criteria such as:

  • Your child has experienced at least five migraine attacks without aura or at least two migraine attacks with aura.
  • The migraine attacks last between two and 72 hours when untreated or unsuccessfully treated.
  • The migraine has at least two of these features: pulsing pain, unilateral pain (though, as mentioned above, kids often feel pain on both sides of their head), moderate to severe pain, or the pain gets worse with physical activity.
  • During the migraine, your child experiences sensitivity to light and sensitivity to sound and/or nausea, vomiting, or both.
  • There are one or more of these types of aura symptoms: visual, sensory, motor, brainstem, speech and/or language, or retinal.

Your doctor will also make sure that your child doesn't have any signs or symptoms that could indicate that the head pain has a different source, such as tension headaches, cluster headaches, or headaches that are caused by something else like an infection, trauma to the head or neck, or a cerebrovascular disorder.

Treatment

There is no cure for migraines, but current migraine treatments can usually help decrease how often your child has migraines and lessen the severity of his or her migraine symptoms. Your doctor will come up with a treatment plan based on your child's individual needs that consider these factors:

  • How often your child has migraines
  • How long the migraines last
  • How severe they are
  • Whether or not they respond to over-the-counter pain medications like Tylenol (acetaminophen), Aleve (naproxen), or Motrin (ibuprofen)
  • The extent to which migraines are impacting your child's life
  • Any other medical conditions your child may have

Migraine treatments can include:

  • An age-appropriate dose of an over-the-counter pain reliever (acetaminophen, naproxen, or ibuprofen) as soon as possible when the migraine begins, but avoiding more than three doses a week, as taking them too often can sometimes cause rebound headaches
  • An anti-nausea medicine, such as Zofran (ondansetron), if nausea and vomiting is a big part of your child's migraine attacks
  • A prescription pain reliever called a triptan, such as Zomig (zolmitriptan) nasal spray, Imitrex (sumatriptan), Axert (almotriptan), or Maxalt (rizatriptan), if Tylenol, Aleve, or Motrin aren't effective enough

If neither a triptan or an over-the-counter medication is doing the trick alone, your doctor may have your child use one of each in combination.

The prognosis for children with migraines is good; although many kids continue to have them as adults, some may outgrow them as they get older.

Prevention

Another way to treat migraines is to try and prevent them by taking a prophylactic or preventative medication every day, even when your child doesn't have a migraine. In general, four to six migraines a month is considered a lot. At that rate, most people want to do something to prevent those migraine attacks, even if it means taking medication every day. But your considerations should not be limited to frequency.

You also have to consider how severe your child's migraines are:

  • Do the migraines interfere with your child's daily routine and day-to-day activities?
  • Is he or she missing a lot of school or other activities?
  • Do the migraines not respond to the above-mentioned medications?
  • Is he or she having to take medications often?

If any of these apply, then a prophylactic medicine to prevent migraines might be a good idea.

Commonly used preventive medications for kids with migraines include:

  • Periactin (cyproheptadine), an antihistamine
  • Elavil (amitriptyline), an antidepressant
  • Depakote (valproic acid) or Topamax (topiramate), anticonvulsants
  • Inderal (propranolol), a beta blocker
  • Vitamin B2 (riboflavin)

Cognitive-Behavioral Therapy

Though medications are typically the go-to for preventing migraines in children, there actually isn't a lot of strong evidence that they work all that much better than placebos, plus they often have unpleasant side effects.

There's actually more evidence that cognitive-behavioral therapy (CBT), either alone or with a preventive medication, is more effective in preventing migraines. CBT may include biofeedback training and/or relaxation techniques. It can help kids learn to sleep better, cope with their pain, and has even been shown to reduce the frequency and severity of migraines.

Lifestyle

You can help your child cope with migraines or even work toward reducing their frequency and severity by implementing some lifestyle measures as well, such as:

  • Avoid common migraine triggers: This includes dietary triggers, skipping meals, poor sleep habits, not getting enough exercise, and not drinking enough water. Keep in mind that common foods, including many kids' favorites, are thought to trigger migraines, including diet drinks (because of the aspartame in them), cheese, hot dogs and other processed meats (nitrites), soda (caffeine), MSG, and fatty foods.
  • Keep a record: You might want to start a headache diary to see if you can find and avoid specific triggers for your child's migraines. Is she getting enough sleep? Does stress seem to be a trigger? Or does he get them after eating or drinking certain things? Or after skipping meals? This diary can also help your doctor in deciding on effective treatment for your child.
  • Encourage healthy behavior: Since obesity is linked to migraines, make sure your child is getting enough physical activity, eating a diet that consists of plenty of fruits, vegetables, and whole grains, and drinking plenty of water. A consistent sleeping and eating schedule can minimize triggers too.
  • Minimize stress: Avoid overscheduling your child and teach him or her coping strategies to deal with anxiety and conflict. Tackle problems as they occur, whether they're at school or at home.
  • Find what works: Try cold compresses or ice packs on your child's head when she gets a migraine. Have him lie down and rest in a dark room for a while when he feels one coming on. Consider looking into a TENS unit or utilizing light therapy. Sometimes even seemingly-strange remedies can help, such as nibbling on a bit of dark chocolate, drinking an electrolyte beverage, or eating a banana.
  • Consider adding supplements: There are limited studies on the effectiveness of specific supplements other than vitamin B12 in helping to prevent migraine, but some find that coenzyme Q10, butterbur, ginkgolide B, and magnesium help. Be sure to first talk to your doctor or pharmacist about any interactions these could have with other medications your child is taking.

A Word From Verywell

It can be tricky to treat and manage migraines in children simply because of the lack of established evidence, but you can be an advocate for your child and help his or her doctor come up with a balanced treatment plan. Do your research, be open to trying different strategies, and keep your child's doctor informed so treatment can be adjusted as needed. A pediatric neurologist might be helpful to manage your child's migraines, especially if his or her head pain isn't getting under better control after four to six months or if the migraines are starting to get worse.

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