Migraines

What are migraines?

Migraines are a type of headache. While often thought of as a condition that only adults get, migraine headaches are common in children, affecting 3% of preschool-age children, 4 to 11% of elementary school-age children, and 8 to 23% of high schoolers.

Before puberty, migraines are more common in boys; after puberty, they're more common in girls. Migraines often become more troublesome at the onset of puberty or even slightly before the outward signs of puberty appear. In girls, menstrual periods can be a potent migraine trigger, particularly for the first several years of cycling.

Migraines are most often hereditary. If a child has migraines, it's likely that a family member suffers from them, too. However, the severity and frequency of migraine attacks can differ dramatically among family members. One family member may experience migraine attacks rarely, such as only after consuming alcohol (a "hangover headache") or during menstrual cycles, while another may have daily migraines.

Learn more about migraines and what you can do if your child experiences symptoms.

Symptoms of migraines in children

Signs and symptoms of migraines include:

• Throbbing or pounding pain (unlike adults, young children often feel this on both sides of the head)
• Sensitivity to light, sound or head movements
• Nausea and vomiting
• Worsening of pain with movement
• Dizziness or vertigo
• Scalp tenderness
• Visual disturbances, such as seeing flashes of light or experiencing blind spots
• Abnormal body sensations (called paresthesia), such as tingling, numbing or prickling

Young children may experience a form of migraines called abdominal migraines, which causes regular episodes of vomiting or abdominal pain without any other sign of illness. Kids who have abdominal migrainess are more likely to have migraines headaches when they're older.

Migraines can occur anytime – day or night. In children, migraines attacks can be as short as one hour.

Some kids have specific symptoms before a migraines starts, such as:

• Fatigue
• Irritability
• Stiff neck
• Unusually pale face

Keeping a headache diary

Headache diaries can be helpful for your child's diagnosis and treatment, so it is a good idea to start keeping one before an appointment with your child's pediatrician or headache specialist. Every time your child has a headache, note:

• When the headache started and ended
• What the pain felt like and its severity
• The pain's location in the head (for instance, on both sides or behind the eyes)
• Any other symptoms your child experienced
• Any medication your child took to treat the headache (record the medication name, dose, and whether it was effective)
• What your child ate and was doing before the headache started

Diagnosis of migraines

Migraines are diagnosed based on the child's description of their symptoms and a neurological exam. No laboratory or imaging tests are needed to make the diagnosis. The doctor will ask about the severity, frequency and duration of your child's headaches; any other symptoms they have; and any medications they take.

Treatment of migraines

Migraine treatments include identifying and avoiding migraine triggers along with medications to treat or prevent migraine attacks.

Avoiding migraine triggers

A number of factors can trigger migraine attacks. Identifying and avoiding these triggers are keys to managing your child's headaches. Keeping a headache diary can help you identify your child's triggers.

Common triggers include:

• Environmental factors. These include factors such as changes in weather or temperature, glaring or fluorescent lights, computer screens, strong odors and high altitude.
• Hormones. Many women and girls have migraine attacks just before their menstrual period or during the first few days. This is due to fluctuations in estrogen levels. Menstrual-related migraines can be more debilitating, difficult to treat and prolonged than other migraines. They typically subside as women age, particularly after menopause.
• Sleep. Too much or too little sleep can trigger a migraine.
• Stress and anxiety. Emotional stress or daily pressure may trigger a migraine attack. Stress-relieving techniques, such as exercise or biofeedback, may bring relief.
• Diet. Nitrates – found in certain foods, such as cured meats – can lead to a migraine within a couple hours of consumption. Although it's typically not a concern for kids, alcohol can also trigger a migraine attack.

Medications to treat migraines

Over-the-counter pain relievers, such as acetaminophen and ibuprofen, are typically recommended as initial treatments. If these don't relieve the pain, your child's doctor may prescribe a migraine-specific medication, such as a medicine from a class of drugs called triptans. Some triptans have been approved by the Food and Drug Administration (FDA) for use in children and adolescents.

Many migraine drugs work best when taken as soon as the person feels an attack coming on. Your child's doctor will work with you and your child to determine the most effective treatments based on the severity of the migraine attacks and whether other symptoms, such as nausea, occur. Treatments manage but don't cure the condition.

Medications to prevent migraines

If your child experiences frequent migraines, the doctor may recommend a preventive medication to make the attacks less frequent and shorter.

Some medications used to treat other conditions – such as beta-blockers for high blood pressure and tricyclic antidepressants for depression – can also work to prevent migraines. The dosages used for migraines are sometimes different from the dosages used to treat other conditions.

• Tricyclic antidepressants. Although your child may not be depressed, the doctor may prescribe certain antidepressants, such as amitriptyline or doxepin, to reduce the frequency and severity of the headaches.
• Beta-blockers. A drug for high blood pressure, such as propranolol, may be helpful and is generally well tolerated by people with normal blood pressure.
• Anti-seizure medications. Several medicines used to control seizures in people with epilepsy have been found to be effective for migraines.

If your child is on preventive medications, be sure they continue taking them even while being treated for an acute attack.

If your child's doctor prescribes medication, be sure to ask:

• How often your child should take the medication
• Whether it should be taken with meals or on an empty stomach
• What to do if pain or other symptoms persist