Causes, symptoms and lifespan

About 3 to 10% of children suffer from migraine. The prevalence increases with age until puberty, when about half of these children or young adolescents stop having migraine episodes.

Alternatively, if migraine symptoms start in their teenage years, the person is more likely to continue to suffer from the condition into adulthood.

Before puberty, migraine is just as likely to affect men as it does women. After puberty, women are more likely to experience it.

Children with migraine experience many of the same symptoms as adults. These may include:

• a headache that lasts 2 to 72 hours
• a headache on one side of the head
• moderate to severe pain
• pain that gets worse with physical activity
• sensitivity to light or sound
• nausea or vomiting
• aura, sensory disturbances such as flashing lights in the field of vision which may be the first symptom

According to the UK’s National Migraine Center, children are more likely to have pain in more than one place or all over their head than adults.

Also, episodes in children may be shorter than those in adults.

It can be difficult to diagnose migraine in young children, who may be unable to describe their symptoms. Another challenge is the subjectivity of the intensity of pain – children and their parents or guardians may have little or nothing to use for comparison. For these reasons, doctors rarely diagnose migraine in children younger than 2 years old.

Finally, it should be noted that for some migraine sufferers, a headache is absent or a minor symptom.

Researchers don’t know why some children get migraines while others don’t. However, many children with migraine have family members with the condition, which suggests that there is a genetic component.

Experts know that certain genetic mutations predispose children to certain types of migraine. For example, if a child has hemiplegic migraine, a type that causes temporary weakness and paralysis, they may have a mutation in one of the following genes:

Research into the causes of other types of migraine is ongoing.

People with migraine often find that certain foods, situations, or environmental factors trigger migraine episodes. Identifying these triggers can often help prevent episodes.

However, identifying the triggers can take time. It should also be noted that several triggers often overlap to contribute to the development of a migraine episode.

This can help keep a record of a child’s migraine symptoms and all possible causes. We give specific ideas on what to note in the “Home Care” section below.

Common triggers to consider include:

• Changes in sleep patterns: A child can have an episode if they sleep too much or not enough. It can help to establish and maintain a regular sleep schedule.
• Dehydration: Making sure a child drinks enough water, especially after physical activity, can help reduce migraine symptoms.
• Food and drinks: Specific foods can trigger symptoms and therefore eat too little. Take note of what a child ate on symptom days and look for a pattern.
• Stress: Stress and overstimulation can contribute to migraine. If a child often feels stressed and anxious, they can benefit from a quiet space where they can calm down. Mindfulness activities for children can also help.
• Environmental triggers: These can include changes in the weather, secondhand smoke, and bright lights, including those on computer or phone screens, for example.

Not all migraine triggers are preventable, but avoiding them as much as possible can reduce the frequency of episodes.

If a child has symptoms of migraine, a doctor may recommend an appropriate dosage of an over-the-counter (OTC) medicine, such as:

However, these drugs and dosages are not always suitable for children. Check with a doctor or pharmacist before giving an over-the-counter medicine to a child.

If a child experiences frequent or severe migraine episodes, a doctor may also prescribe a drug from a family of drugs called triptans. These work specifically to prevent migraine episodes.

The Food and Drug Administration (FDA) has approved sumatriptan (Imitrex) and rizatriptan (Maxalt) for use in children.

If a child does not respond well to triptans, the doctor may prescribe:

• beta-blockers
• amitriptyline (Elavil) or nortriptyline (Pamelor)
• antiepileptic drugs

Some children may also respond to relaxation or biofeedback training.

In addition to administering medications and helping prevent exposure to triggers, caregivers and children can use other strategies to help manage migraine symptoms:

During an episode

When migraine symptoms appear, try:

• move the child to a quiet, dark room
• applying cold or hot compresses to their head
• give them an eye mask to block any light, if they are sensitive to light
• massaging tight or sore muscles
• encourage the child to sleep, if this helps alleviate their symptoms

Anyone who keeps a symptom diary should take note:

• the time and date the symptoms first appeared
• the duration and severity of the episode
• whether any treatments or strategies have helped
• all possible triggers

Preparation

Being prepared for migraine episodes can help limit their effects. A person could:

• Prepare one or more migraine kits, including items such as medicine, hot or cold compresses, an eye mask, water, and a symptom diary.
• Discover the potential triggers and identify specific ones.
• Help identify the warning signs of symptom onset.
• Inform schools, daycares and other caregivers about the child’s experiences and what to do with a migraine episode.

It should be kept in mind that giving pain medication as soon as possible can help stop the progression of the migraine episode.

Emotional support

It can be difficult to assess the extent of a child’s migraine symptoms. Depending on their age, they may not understand or be afraid of their condition.

During an episode, it is important to be reassuring and calm. Subsequently, it may be helpful to teach the child about the disease or have a doctor explain it to him.

Understanding what a migraine is and that each episode eventually ends can allay some fears. It can also help the child take a proactive role in the management of the disease, for example by keeping or helping to keep a symptom diary.

Contact a doctor about a child’s migraine symptoms. They may prescribe medications to reduce the severity and frequency of episodes. It is also important that they rule out other possible causes of the symptoms.

Some symptoms of migraine are similar to those of more serious health problems. Seek emergency medical care if a child experiences:

• a sudden, severe headache with no other migraine symptoms
• a headache with the worst pain they have ever felt
• a headache after a head injury
• a headache and any of the following:
  • a stiff neck
  • confusion
  • a crisis
  • loss of consciousness

Talk to a doctor right away if a child has symptoms of migraine in addition to:

• changes in vision, balance or coordination
• excessive vomiting
• persistent pain
• a recent change in personality or behavior

All of the above may indicate a different underlying condition.

In children, migraine is not uncommon and symptoms can appear from a young age. Taking over-the-counter pain relievers as soon as symptoms appear may stop or limit their effects. Instead, a doctor may prescribe targeted migraine medications.

It is important to get medical attention for any symptoms of migraine. A doctor should be sure of the cause because some symptoms are similar to those of other health problems.

In addition to prescribing medication, the doctor can provide advice on identifying triggers and managing episodes.