Migraines in Children
Headaches are a common phenomenon in children (one we will discuss in detail at a later time), and have several different causes. A migraine, however, is different from a simple headache.
What is a migraine?
Migraine headaches are intense, often debilitating, and often come along with other symptoms in the body. They are usually localized to one specific part of the head in adults but commonly both sides in children. Head pain from a migraine usually worsens with activity and comes on suddenly and without warning. Migraines are often associated with symptoms other than head pain, including nausea, vomiting, vision changes such as seeing spots or lights, sensitivity to light and noise, tingling or numbness in hands and feet.
Migraines typically occur in distinct stages:
- Prodrome/warning phase – fatigue is common, along with mood changes
- Aura phase – visual changes, dizziness, weakness, tingling/numbness. This phase does not occur in every migraine sufferer.
- Headache phase – severe pain that is described as throbbing or pulsing. Associated nausea, vomiting, light sensitivity also occurs during this phase.
- Resolution phase – typically this occurs with sleep, which can last for several hours.
- Recovery phase – this typically lasts from hours to days and includes residual fatigue, some mild head pain.
Who gets migraines?
Any person is capable of experiencing a migraine. They are far more common in adults, but according to healthychildren.org, about 10% of children aged 5-15 years of age and nearly 30% of teenagers experience these types of headache.
Family history plays a big role in determining which children will suffer from migraines, as about half of children with migraines will have a parent who also gets them. When discussing migraines with parents in clinic, it is common to hear extensive family histories of experience with migraines.
Boys tend to have more migraines than girls prior to puberty, but the opposite occurs in later teen years and adulthood, where girls dominate.
Interestingly, there is some recent research that suggests children who were colicky infants have a much higher likelihood of experiencing migraines later on. Obviously more research needs to be done in order to explore this possible connection further, but it is an interesting look into the way the body works.
Additionally, there is ongoing research in regards to “post-traumatic” headaches that very closely resemble migraines and are treated as such. These are severe headaches that occur after head trauma such as concussion and can last for years after the initial incident. They often include the same symptoms of nausea, vomiting, numbness, light sensitivity, and confusion. These tend to be more common in female athletes.
What causes migraines?
While simple headaches usually have a distinct cause – dehydration, tension, etc – migraines instead have “triggers” that prompt them to occur. These include the following:
- Stress: increased periods of stress or sudden changes in stress levels
- Sleep: lack of adequate sleep or irregular sleep patterns
- Dehydration: while typically a cause of simple headaches, this can also prompt development of a migraine in those prone to them.
- Nutrition: skipping meals. For some people certain foods can trigger migraines. Most common culprits are chocolate, citrus, red and yellow food dyes, MSG (monosodium glutamate), and aspartame (an artificial sweetener).
- Weather: sudden changes in air pressure, extreme heat or cold.
How do we treat migraines?
There are two primary ways to treat migraines in children and teenagers: lifestyle modifications and medications.
Lifestyle modifications: sticking to a healthy routine can help prevent or at least reduce the severity/frequency of migraine headaches. Importantly, this includes a regular, appropriate sleep schedule that aims for 8-10h of quality sleep each night. Nutrition is also important in lifestyle modifications. Ensuring a well-balanced diet of 3 meals per day and avoidance of any identified trigger foods is key, along with adequate hydration. For some patients, Cognitive Behavioral Therapy, or CBT, can help by focusing on coping skills and early recognition of migraine symptoms.
Medications: initial treatment is with over-the-counter pain relievers, but it is important to watch for rebound headaches (symptoms worsen when these medications are taken consistently and frequently). When migraines become frequent or difficult to control, your child’s Pediatrician may prescribe medications to help. These may be quick acting (taken at onset of headache symptoms) or preventative (taken daily), depending on your child’s needs. Herbal medications and supplements have also been studied for reducing migraine symptoms, including feverfew, Vitamin B-12, Coenzyme Q10, and Magnesium. Please do not start any medication, herbal supplement, or vitamin without talking to the Pediatrician first.
Final thoughts
It is frustrating to watch your child go through any type of illness, but migraines seem to be one of the more difficult due to their severity. The feelings of helplessness when you cannot “make it better” are legitimate and tough to manage. Thankfully, most children do not experience migraines, and those who do have them infrequently. For those with chronic or debilitating migraines, there are options for treatment. Schedule your child with the Pediatrician if you have concerns.
Resources
Healthy Children: https://www.healthychildren.org/English/health-issues/conditions/head-neck-nervous-system/Pages/Migraine-Headaches-in-Children.aspx
Post-Traumatic Headache: https://americanmigrainefoundation.org/resource-library/concussion-and-post-traumatic-headache/
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