Migraines in Children

Migraines in children are severe headaches that are more than just typical head pain. They are a neurological condition causing throbbing pain, often with nausea, vomiting, and extreme sensitivity to light and sound. Migraines can significantly disrupt a child's daily life, sometimes presenting differently than in adults, such as with pain on both sides of the head or stomach symptoms.

What is Migraines in Children?

Migraines in children are a type of severe headache that is actually a neurological condition, not just a bad headache. They typically cause throbbing pain, often on one side of the head, and are usually accompanied by symptoms like nausea, vomiting, and extreme sensitivity to light and sound. These episodes can be debilitating, significantly impacting a child's daily activities.

Migraines are more complex than common tension headaches. While adults often experience pain on one side of the head, younger children may feel pain on both sides. Migraine attacks in children also tend to be shorter than those in adults. Some children experience what is called an "abdominal migraine." This involves severe stomach pain, nausea, and vomiting, but without a significant headache. Other related conditions can include cyclical vomiting (repeated bouts of vomiting) and benign paroxysmal vertigo (sudden, brief episodes of dizziness). These intense episodes can make it hard for a child to go to school, play, or participate in other normal activities. Understanding that migraines are a real medical condition helps in seeking appropriate care and support for the child.

Symptoms

Migraine symptoms in children often include a throbbing head pain that can be moderate to severe and worsens with physical activity. Beyond head pain, children commonly experience nausea, vomiting, and heightened sensitivity to light (photophobia), sound (phonophobia), and sometimes smell (osmophobia). These symptoms can vary greatly from child to child and even from one migraine attack to another.

The head pain associated with migraines is typically described as throbbing or pulsing. While it can occur on one side, especially in older children and adolescents, it's common for younger children to feel pain on both sides of their head. This pain is often severe enough to stop a child from their usual activities. Many children also experience warning signs before a migraine starts, known as a prodrome. These can include mood changes, unusual fatigue, frequent yawning, neck stiffness, or even food cravings. After the headache subsides, a child might enter a postdrome phase, feeling tired, confused, or still experiencing neck stiffness or mood changes. Less commonly, some children may experience an aura, which are temporary sensory disturbances that happen before or during the headache. These can include visual changes like flashing lights, zigzag lines, or blind spots, or sensations like numbness or tingling. If your child experiences any of these symptoms, it's important to discuss them with a doctor.

Causes & risk factors

The exact cause of migraines in children is not fully understood, but a strong genetic link is common, meaning migraines often run in families. While not a direct cause, certain triggers can set off a migraine attack in a child who is already prone to them. These triggers vary widely among individuals and can include environmental or lifestyle factors.

Migraines are thought to involve changes in brain chemicals, particularly serotonin, which plays a role in pain regulation. If a parent or close relative has migraines, a child has a higher chance of developing them. This genetic predisposition suggests that some children's brains are simply more sensitive to certain stimuli. Many different factors can act as triggers. Common triggers include stress, not getting enough sleep, skipping meals, or becoming dehydrated. Environmental factors like bright lights, loud noises, strong smells, or changes in weather can also set off an attack. Certain foods or drinks, such as aged cheese, processed meats, chocolate, or caffeine, can be triggers for some children. Hormonal changes, especially during puberty, can also increase migraine frequency or severity in adolescents. Identifying and avoiding these personal triggers can be a key part of managing migraines.

How it's diagnosed

Diagnosing migraines in children primarily relies on a thorough review of the child's symptoms and medical history, along with a physical and neurological exam. There isn't a specific test, like a blood test or imaging scan, that can definitively diagnose a migraine. Instead, doctors use the child's description of their headaches and associated symptoms to make a diagnosis.

During the diagnostic process, the doctor will ask detailed questions about the child's headaches. This includes how often they occur, how long they last, the type and location of the pain, and any other symptoms like nausea, vomiting, or sensitivity to light and sound. It can be helpful for parents to keep a headache diary to track these details before the appointment. A physical and neurological exam helps the doctor check for any other underlying conditions that might be causing the headaches. This exam assesses the child's reflexes, balance, coordination, and vision. In most cases, brain imaging tests like an MRI (magnetic resonance imaging) or CT (computed tomography) scan are not necessary. These tests are usually only recommended if the doctor suspects another serious condition, such as if the headache is sudden and severe, or if there are unusual neurological symptoms like seizures, weakness, or changes in vision.

Treatment options

Treatment for migraines in children focuses on two main goals: stopping a migraine attack once it starts (acute treatment) and reducing how often or how severely migraines occur (preventive treatment). Acute treatments aim to relieve pain and other symptoms quickly, while preventive strategies involve lifestyle changes and sometimes daily medications to lessen migraine frequency.

For acute treatment, over-the-counter pain relievers like ibuprofen or naproxen can be effective if taken at the first sign of a migraine. For more severe attacks, a doctor might prescribe specific migraine medications called triptans. Examples include sumatriptan nasal spray, zolmitriptan nasal spray, or rizatriptan orally disintegrating tablets, which are approved for use in children and adolescents. Anti-nausea medications may also be prescribed if vomiting is a significant problem. Resting in a dark, quiet room can also help ease symptoms during an attack. Preventive treatments are considered if migraines are frequent, severe, or significantly interfere with a child's life. These can include daily medications such as beta-blockers, tricyclic antidepressants, or anti-seizure drugs. For adolescents, newer medications like CGRP inhibitors might be an option. Lifestyle adjustments are also a crucial part of prevention. These include maintaining a regular sleep schedule, eating meals at consistent times, staying well-hydrated, and getting regular physical activity. Stress management techniques, biofeedback, and cognitive behavioral therapy can also help children learn to cope with and potentially reduce their migraines.

Recovery & outlook

The outlook for children with migraines is generally positive, as many children experience improvement as they get older. For some, migraines become less frequent or even disappear entirely. However, about half of children who experience migraines will continue to have them into adulthood. With proper management and treatment, migraines can often be controlled, allowing children to lead full and active lives.

It is common for the pattern of migraines to change as a child grows. Some children find that their migraines become less severe or occur less often during their teenage years. For others, migraines may persist but become more manageable with effective treatment strategies and lifestyle adjustments. Even if migraines continue into adulthood, there are many effective treatments available to help manage the condition. Learning to identify and avoid triggers, along with having a clear treatment plan for acute attacks, can significantly improve a child's quality of life. Working closely with a healthcare provider is key to finding the best approach for each child. This includes regularly reviewing symptoms, adjusting medications if needed, and exploring non-pharmacological therapies. Support from family and school can also play a vital role in helping a child cope with migraines.

When to see a doctor

It is important to see a doctor if your child experiences any severe or unusual headaches, especially if they are accompanied by other concerning symptoms. While many headaches are not serious, certain signs could indicate a more urgent medical issue. Always seek medical advice for new, worsening, or significantly disruptive headaches.

You should seek immediate medical attention if your child has a sudden, very severe headache, or a headache that occurs after a head injury. Also, be alert for headaches accompanied by a fever, stiff neck, skin rash, confusion, or seizures. These symptoms could point to a more serious underlying condition that requires prompt evaluation. Other red-flag symptoms include double vision, weakness or numbness on one side of the body, or difficulty speaking. If your child's chronic headaches are getting worse over time, or if they are so frequent or severe that they interfere with school, sleep, or daily activities, it's crucial to consult a doctor. A healthcare provider can properly evaluate your child's symptoms, rule out other causes, and develop an appropriate treatment plan. Early diagnosis and management can help reduce the impact of migraines on a child's life.

Frequently asked questions

Are migraines in children different from adult migraines?

Yes, migraines can present differently in children. Younger children often experience pain on both sides of the head, unlike adults who typically have one-sided pain. Children's migraine attacks also tend to be shorter in duration, and some may experience "abdominal migraines" with stomach pain instead of head pain.

Can certain foods trigger migraines in children?

Yes, certain foods and drinks can act as triggers for some children. Common examples include aged cheese, processed meats, chocolate, and caffeine. Skipping meals or becoming dehydrated can also trigger migraines. Identifying and avoiding these personal triggers is an important part of migraine management.

Are migraines hereditary, meaning do they run in families?

Yes, migraines often have a strong genetic link. If a parent or close relative experiences migraines, a child has a higher chance of developing them. This suggests a genetic predisposition makes some children's brains more sensitive to migraine triggers.

What is an "abdominal migraine"?

An abdominal migraine is a type of migraine that primarily causes severe stomach pain, often with nausea and vomiting, instead of a prominent headache. It is more common in children and is considered a migraine variant. Children who experience abdominal migraines may develop typical head migraines later in life.

How can I help my child during a migraine attack?

During a migraine attack, encourage your child to rest in a dark, quiet room. Over-the-counter pain relievers like ibuprofen or naproxen can help if given early. If prescribed, administer specific migraine medications (triptans) or anti-nausea drugs as directed by their doctor.

Will my child outgrow migraines?

Many children do experience improvement with age, with migraines becoming less frequent or severe, and some even outgrow them entirely. However, about half of children with migraines will continue to experience them into adulthood. Effective management can help control symptoms regardless of age.

Sources

• MedlinePlus — Migraines in Children
• Mayo Clinic — Migraines in Children
• Cochrane Library — Migraines in Children