Migraine Headaches in Children & Teens

Migraine Headaches in Children & Teens

Roughly 39 million people in the United States suffer from migraines. While they most often strike adults, many children also experience intense, throbbing headaches and other symptoms of migraines. Read on for helpful information about the signs, symptoms and causes of migraines and how to help children and teens dealing with them.

What is the difference between a migraine and a headache?

Migraine pain usually more severe. It often includes throbbing on one side of the head that often worsens with activity. Migraine headaches also tend to strike with other symptoms, such as nausea, vomiting, vision problems (seeing spots or flashing lights, for example), light and sound sensitivity, and tingling.

At what age can children get migraines?

Any child can get a migraine. About 10% of children age 5-15 and up to 28% of teens get them. Half of people who get migraines have their first attack before age of 12. Migraines have even been reported in children as young as 18 months!

Childhood migraines: a colic connection?
Recent research suggests that children who had colic as babies may be more prone to develop migraines. One study found children with migraines were seven times more likely to have been colicky infants.

What are some migraine causes, risk factors, and triggers?

Family history: Migraines tend to run in families. If one parent has migraines, there is roughly 50% chance that their child will too. If both parents have them, the chance is close to 90%.

Gender: Before puberty, boys have more migraines than girls. That flips in teen years and by age 17, as many as 8% of boys and 23% of girls have had a migraine. For adults, migraines are more common in women.

Stress & sleep: Irregular sleep schedules – getting too much or too little sleep – can be migraine triggers. So are changes in stress levels.

Exercise: While exercise can sometimes trigger migraines, regular exercise may help prevent or reduce the number of attacks.

Food & fluids: Skipping meals and eating certain foods and additives can set off migraines. Common triggers include aged cheeses and meats, chocolate, citrus fruits, red and yellow food dyes, monosodium glutamate (MSG), and the artificial sweetener aspartame. Too much caffeine and spicy foods can also trigger migraines, but sometimes help headaches because they act as vasodilators and expand blood vessels. Not drinking enough water and other beverages can cause dehydration, another migraine trigger.

Weather: Stormy weather with changes in barometric pressure, extreme heat or cold, bright sunlight and glare, high humidity, or very dry air can all be triggers.

Are there different stages of migraines?

Migraines often develop in stages:

  • Stage 1: Premonitory or warning phase– tiredness, stiff neck, mood changes (can last up to 24 hours).
  • Stage 2: Aura– seeing spots, squiggly lines, dizziness, weakness, numbness and/or confusion. These symptoms, which don’t happen with al types of migraines, may last up to an hour.
  • Stage 3: Headache or attack– severe, throbbing/pulsating pain with nausea, vomiting, and light sensitivity.
  • Stage 4: Resolution– sleep ends the headache pain for some children.
  • Stage 5: Recovery- feeling tired (lasts hours to days).

How is migraine diagnosed?

The diagnosis of a migraine is usually based on a thorough medical history along with physical and neurological exams. Occasionally, tests like bloodwork, MRI, or lumbar punctures may be recommended.

Mild, moderate, or severe?
To measure how strongly migraines impact a child’s school, home, and social activities, pediatricians and pediatric neurologists use a tool called the Pediatric Migraine Disability Assessment (PedMIDAS), which consists of 6 questions:

In the last 3 months, how many…
1. Full days of school were missed due to headaches?
2. Partial days of school were missed due to headaches?
3. Days did you function at less than half your ability in school because of a headache?
4. Days were you not able to do things at home (e.g., chores, homework, etc.)?
5. Days you did not participate in other activities due to headache (e.g., play, go out, sports, etc.)?
6. Days did you participate in these activities, but functioned at less than half your abilities?

The total number of days are then added up. A score of less than 10 is considered little to no impact; 11-30 is mild; 31-50 is moderate, and more than 50 is severe.

How are migraines treated?

Lifestyle changes. Keeping healthy, regular routines can help prevent or reduce the frequency and severity of migraines:

  • Sleep hygiene: Children, especially those with migraines, should get 8-10 hours of sleep daily. If your child has trouble sleeping, your pediatrician may recommend tests to monitor for snoring or sleep disorders, which have been linked to migraines. Make sure TVs, cell phones, tablets, and other media devices are turned off an hour before bedtime, since they can interfere with sleep.
  • Healthy diet: Eat three regular meals each day at consistent times. Avoid heavily processed foods, which tend to contain more migraine triggers like additives and artificial colors and sweeteners. Drink plenty of water and other healthy beverages to stay hydrated.

Helpful tip: keep a headache diary
If your child has migraines, keeping a headache diary can help you start to recognize triggers and see which therapies are most helpful. Simply write down when the headache started, where the pain was located, how severe the pain was, how long it lasted, any other symptoms, and if medications were effective. You may also want to keep track of how much sleep your child had, meals, fluids, as well as weather changes and amounts of exercise and stress.

Acute medications: Your child’s doctor may recommend or prescribe medications that can help during a migraine attack. These work best when taken at the first sign of an attack. Keep in mind that medication overuse headaches may start if these are used daily or frequently. Examples of medicines that can help during a migraine include:

  • Analgesic pain medicines such as acetaminophen and products that combine acetaminophen, aspirin, and caffeine, and nonsteroidal anti-inflammatory medicines such as ibuprofen and naproxen.
  • Triptans, a category of drugs called selective serotonin receptor agonists. Evidence shows that combination sumatriptan/naproxen tablets and zolmitriptan nasal spray can stop headache pain within two hours.

Preventative medications: There are some medications that when taken daily can help reduce the severity and/or frequency of migraines. Those tend to be “off-label”, meaning they are not approved by the U.S. Food and Drug Administration for migraines. Their risks and benefits should be discussed with your doctor. Options include:

  • Cardiovascular drugs: propanolol
  • Antidepressants drugs: amitriptyline
  • Anti-seizure drugs: topiramate
  • Antihistamines: cyproheptadine

Do Botox treatments help children with migraines?
Although botulinum toxin (Botox) is approved and shown to be effective for adults who get chronic migraines, a recent American Academy of Neurology report found that it is not effective for children and teens.

Are there any alternative therapies shown to help migraines?

There are some alternative or natural and non-pharmaceutical approaches to migraine treatment that may help. These include:

Cognitive behavioral therapy (CBT), which focuses on coping skills, positive thinking, sticking to healthy habits, and relaxation techniques to help ease migraine pain. Research also has found that CBT combined with migraine medications is more helpful in treating migraines than medication alone.

Herbs, vitamins, and minerals– certain extracts and supplements may help with migraines although some should be avoided for safety reasons. Talk with your child’s doctor before using any herbal or vitamin supplements. Common supplements include:

  • Feverfew: this plant contains parthenolide, which some small studies suggest may help prevent migraines in some people. However, the evidence remains mixed.
  • Riboflavin (vitamin B-2), coenzyme Q10, and magnesium supplements may decrease the frequency of migraines.
  • Butterbur extract: plant containing petasins is NOT recommended because of long-term liver disease risk.

How can I help my child avoid missing school from migraines?

Children who suffer from migraines are absent from school twice as often as other students. Talk with your child’s teachers and school nurse about ways to help avoid missed class time. A letter from the doctor explaining your child’s diagnosis and the medications they take when they feel a migraine coming on can help the conversation. Helpful accommodations may include making sure your child has ready access to water and snacks, for example.

Additional information: