Learning About Pediatric Migraines

By Sarah Faith

In this article I’m going to explore the phenomena of migraines in children. I plan to address five key points including the following:

  1. Most typical age at initial presentation,
  2. Symptoms as they present in children,
  3. How migraine is diagnosed and unfortunately often undiagnosed,
  4. Causes & Triggers, and
  5. Age appropriate treatment

Statistics Related To Age of Children Affected

Migraine can be present in children anywhere between the ages of five and seventeen.
Ten percent of those eventually diagnosed with Migraine will experience their first attack before the age of twelve. As adolescence approaches, the incidence increases much more rapidly in girls than in boys.

By age seventeen, 8% of boys and 23% of girls have experienced a migraine attack of some sort.

Presenting Symptoms in Children

Many of the children affected will experience mild to severe head pain with the attacks, however, as I mentioned in a previous blog, Migraine is a neurological disorder with multiple, varying, and often co-morbid symptoms.

Children can experience migraine with or without aura, but without is often more likely.

In addition to “attack” related symptoms such as head pain (which is often less severe than other symptoms and sometimes even absent), nausea, imbalance, light and heat sensitivity among others, the child is likely to experience anticipatory anxiety issues. In the next section I will address more comprehensively the multiple symptoms to be recognized.

Diagnosing Migraines in Children

Migraines in children often go undiagnosed and the diagnostic process is very involved, including the patient and family history, a diary of symptoms and other useful information by the parent or caregiver, diagnostic testing and more.

In order for a complete patient history it is tremendously helpful for the parent or caregiver to be able to recognize and journal multiple factors which I will explain here. It covers a lot of the symptoms, but I considered it especially relevant to this section, as it is so vital in the diagnostic process.

Some of the changes to look for before a migraine may occur are changes in behavior, decreased appetite, irritability, yawning and lethargy, food cravings, withdrawal, and mood swings.

The common sensitivities that occur with most acute migraine attacks can also be precursors. Light, smell, sound, and even touch are included here.

Other indicators include sleep disturbances such as sleep walking, talking, and night terrors.

Infant colic and motion sickness can also indicate a predisposition to migraines.

Doctors can use all of this information in the diagnostic process so it is helpful, as I mentioned, if you suspect your child has migraines to watch for these signs and if possible write them in a journal.

A “symptom diary” is also very helpful and can include the following:
– Description of pain (location, nature, and timing),
– Severity of symptoms,

– Frequency and Duration,
– Any identifiable triggers,
– Symptoms at onset (aura, lethargy, nausea, etc),
– Impact on quality of life, and
Any previous and current treatment

All of the above is part of a detailed history taken by your provider as well as a detailed family history. They will typically do a physical and also need to rule out any other reasons for the symptoms.

In order to do this tests may be run such as: blood tests, EEG, lumbar puncture, and neuroimaging (MRI, CAT scan).

Causes and Triggers

We do not currently know the precise cause of migraines, but it is believed to be a combination of genetic and environmental factors. If one parent has them, the child has a 50% chance of having them as well. If both parents have them that chance increases to 75%.

The most common triggers in children include: Inadequate sleep or changes in sleep, skipped meals, stress, weather changes, bright lights, loud noises, strong odors, and

hormonal fluctuations. There is also evidence linking certain foods as triggers.

Treatment Options

Unfortunately there are very few “headache specialists” that will see children, however a child who is either difficult to diagnose or does not respond to typical first line treatments should be seen by someone who does specialize in headaches if at all possible.

For some children, sleep alone is effective in relieving the symptoms of an acute attack.
There are very few FDA approved medications for use in children for migraine, but others can be used off label in some cases.

Certain over the counter medications can also be sufficiently effective depending on the age of the child and severity of attacks​. ​These also may carry with them less risk and fewer side effects.

In addition to medicine that alleviates the pain, antiemetics may be used since 90% of children experience lack of appetite, abdominal pain, and vomiting with attacks. Because of the risk of rebound headaches (headaches that are created by overuse or too frequent use of medicine) even the use of over the counter medicine should be closely monitored and limited as much as possible. If a child need to take something more than twice per week the MD should be consulted.

In conclusion, from my own experience and that of many of you reading this, pediatric migraines can be extremely debilitating in children, just as much as in adults. The parents or caregiver’s learning to see the warning signs of predisposition and later having a good handle on what is triggering or exacerbating the child’s migraines is of great importance. A thorough diagnostic process is essential and ensuing treatment should be careful but efficient.


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