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Migraine -- Child

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Definition

Migraine is a type of recurring headache that involves blood vessels, nerves, and brain chemicals. Sensations called auras may come before a migraine. Auras can include visual changes or numbness and tingling. There are two types of migraines:

  • Migraine occurring with an aura (formerly called “classic”)
  • Migraine occurring without an aura (formerly called “common”)
Migraine
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 Migraine headaches can affect a child’s performance in school, relationships with friends and family, and other factors in a child’s life.

Causes

The precise reason that a child is susceptible to migraines is unknown. Factors that may play a role include:

  • Genetics and environmental triggers
  • Changes in a nerve that serves as a major pain pathway
  • Imbalance in brain chemicals, like serotonin

Factors that can trigger a migraine include:

  • Physical exertion or too little physical activity
  • Too much sleep or too little sleep
  • Missing a meal
  • Motion sickness from traveling
  • Tiredness
  • Overuse of pain medicines
  • Being overweight
  • Smoking
  • Certain foods such as chocolate, citrus fruits, dairy, processed meats, or fried foods
  • Certain environmental triggers such as flashing lights, odors, loud noises, or weather changes

Risk Factors

Factors that increase your child’s chance of migraines may include:

  • Sex: More common in male children than female but more common in females after puberty
  • Age: average age a child may get a migraine headache is seven years old for boys and 10 years old for girls
  • Having family history of migraines
  • Infantile colic

Symptoms

Migraines occur in phases that may include:

Warning

A warning may come before a migraine. In the hours or days before the headache, symptoms may include:

  • A change in mood
  • A change in behavior
  • A change in the level of activity
  • Fatigue
  • Yawning
  • Food craving or decreased appetite
  • Nausea, diarrhea
  • Sensitivity to light

Aura

The most common aura is visual. The aura lasts about 15-30 minutes. It may produce the following sensations:

  • Flashing lights, spots, or zig zag lines
  • Temporary partial loss of vision
  • Speech difficulties
  • Weakness in an arm or leg
  • Numbness or tingling in the face and hands

The Migraine Headache

Migraine pain starts within an hour of the aura ending. Symptoms include:

  • A headache (usually on one side but may involve both sides) that often feels:
    • Moderate or severe in intensity
    • Throbbing or pulsating
    • More severe with movement
  • Nausea or vomiting
  • Sensitivity to light or sound
  • Lightheadedness or dizziness

A Post-Headache Period

Migraines usually last from 4-72 hours. They often go away with sleep. After the headache, your child may experience:

  • Trouble concentrating
  • Fatigue
  • Sore muscles
  • Irritability
  • Mood changes

Diagnosis

The doctor will ask about your child’s symptoms and medical history. A physical exam will be done. Your child may also be given a neurological exam. The diagnosis is often based on your child's symptoms. To rule out other complications, your doctor may order imaging tests such as:

The doctor may order blood tests or other tests before starting treatment.

Treatment

Migraine therapy aims to:

  • Prevent headaches
  • Reduce headache severity and frequency
  • Restore your child’s ability to function
  • Improve your child’s quality of life

Treatment options include:

Medications

Medicines often used as first line agents in children with headaches include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen
  • Acetaminophen

Note: Aspirin is not recommended for children or teens with a current or recent viral infection. This is because of the risk of Reye's syndrome . Ask your doctor which other medicines are safe for your child.

Your doctor may also recommend migraine medication.

Therapy

Therapy may also be used to reduce the length and frequency of migraine headaches. It may be used with or without medication and may include cognitive behavioral therapy, biofeedback, or relaxation methods.

Other Treatment During the Migraine

To help your child during a migraine:

  • Apply cold compresses to painful areas of your child’s head.
  • Have your child lie in a dark, quiet room.
  • Try applying constant gentle pressure to your child’s temples.
  • Try to help your child fall asleep.

Preventing Migraines

Keep a diary to understand what factors may trigger your child's migraines.

Some steps that may help prevent future migraines includes:

  • Have you or your child keep a diary. It will help identify what triggers migraines and what helps relieve them.
  • Maintain regular sleep patterns, even during the weekend or on vacation.
  • Learn stress management and relaxations techniques.
  • Do not skip meals.
  • Exercise regularly.
  • Foods are not proven to trigger migraine, but consider keeping track of what your child eats. Foods suspected by some to trigger migraine include:
    • Nuts and peanut butter
    • Beans (eg, lima, navy, pinto, and others)
    • Aged or cured meats
    • Aged cheese
    • Processed or canned meat
    • Caffeine (intake or withdrawal)
    • Canned soup
    • Buttermilk or sour cream
    • Meat tenderizer
    • Brewer's yeast
    • Avocados
    • Onions
    • Pickles
    • Red plums
    • Sauerkraut
    • Snow peas
    • Soy sauce
    • Anything with MSG (monosodium glutamate), tyramine, or nitrates

Prevention

Since the cause of migraines is unclear, there are no steps to prevent your child's predisposition to migraines.

Revision Information

  • Reviewer: Kari Kassir, MD
  • Review Date: 09/2013 -
  • Update Date: 09/30/2013 -
  • American Headache Society

    http://www.americanheadachesociety.org/

  • The National Migraine Association

    http://www.migraines.org/

  • The College of Family Physicians of Canada

    http://www.cfpc.ca/

  • Health Canada

    http://www.hc-sc.gc.ca

  • Headache in Children. National Headache Foundation website. Available at: http://www.headaches.org/education/Headache%5FTopic%5FSheets/Headache%5Fin%5FChildren . Accessed June 24, 2013.

  • Migraine in Children and Adolescents. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us . Updated April 22, 2013. Accessed June 24, 2013.

  • Migraines. American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/migraines.html . Accessed June 24, 2013.

  • 8/27/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Robberstad L, Dyb G, Hagen K, Stovner LJ, Holmen TL, Zwart JA. An unfavorable lifestyle and recurrent headaches among adolescents: The HUNT Study. Neurology. 2010;75(8):712-717.

  • 10/25/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php : Bruijn J, Locher H, Passchier J, Dijkstra N, Arts WF. Psychopathology in children and adolescents with migraine in clinical studies: a systematic review. Pediatrics. 2010;126(2):323-332.

  • 1/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Powers SW, Kashikar-Zuck SM, et al. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA. 2013 Dec 25;310(24):2622-30.

  • 1/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Huquet A, McGrath PJ, et al. Efficacy of psychological treatment for headaches: an overview of systematic reviews and analysis of potential modifiers of treatment efficacy. Clin J Pain. 2013. Jul 2.