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Migraines In Children: Types, Symptoms, Treatment And Prevention

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Migraines are moderate to severe throbbing headaches that may last from two to 48 hours and occur two to four times a month (1). The pain may be unilateral (one-sided) or bilateral (two-sided) (2). Sometimes, migraines in children go undiagnosed, although around 60% of children aged seven to 15 years experience headaches (3).

Migraines may occur in around 3% of preschool-aged children, 4–11% of elementary school-aged children, and 8–15% of high school-aged children (1). Read this post to understand the types, causes, treatment, home care, and prevention of migraines in children.

Difference Between A Migraine And A Headache

A migraine is more than a headache. Headache is a symptom of migraine. Pain arising from an episode of migraine is severe, worsens with activity, and often includes throbbing on one side of the head. It is accompanied by other symptoms, such as nausea, vision problems, vomiting, hypersensitivity to light and sound, and tingling sensations (4).

Types Of Migraines

There are two main types of migraines in children (1):

1. Common migraine

  • It is a migraine without an aura.
  • It occurs in about 60% of children and adolescents experiencing migraine headaches.

2. Classic migraine

  • It is a migraine with an aura.
  • It occurs in about 15 to 30% of children experiencing migraine headaches.

In young children, migraine often begins in the late afternoon, but in older children, it begins in the early morning.

Etiology Of Migraines In Children

The following are the causes, risk factors, and triggers of migraine in children (4):

  1. Family history: Migraines have a familial tendency. If one of the parents has migraines, the child has a 50% chance of developing it. However, if both parents have migraines, the chances rise to 90%.
  1. Gender: Before puberty, migraine is more common in males, but it is more common in females in adolescence. In adulthood, women are three times more susceptible to developing migraines compared to men (1).
  1. Stress and sleep: Too much, too little, and irregular sleep patterns are migraine triggers. Stress can also exacerbate it.
  1. Exercise: While exercise may trigger migraines, regular exercise may help prevent or reduce the recurrence and intensity of migraine attacks.
  1. Food and fluids: Skipping meals, dehydration, and certain foods, such as aged cheese, meat, chocolates, citrus fruits, red and yellow food dyes, monosodium glutamate (MSG), artificial sweeteners (aspartame), caffeine, spicy foods, and some beverages, can trigger migraines (5).
  1. Weather: Extreme heat or cold, stormy weather with changes in atmospheric pressure, sudden exposure to bright light or sunlight, dry air, high humidity, etc., can trigger a migraine attack.

Symptoms Of Migraines In Children

Children may exhibit the symptoms of migraines differently. However, the following are the most common symptoms of migraine in children (6).

  • Pain in one or both sides of the head or even all over the head.
  • Throbbing, pounding, or pulsating headache (younger children may not be able to explain it)
  • Sensitivity to light or sound
  • Nausea with or without vomiting
  • Abdominal discomfort
  • Sweating
  • Child becomes quiet or pale
  • Experiencing an aura before the migraine, such as seeing flashing lights or experiencing vision changes or funny smells.

Diagnosing Migraine In Children

The doctor may begin with a comprehensive medical history combined with a physical and neurological examination. Blood tests, MRIs, or lumbar punctures may be needed sometimes. According to the American Academy of Pediatrics, pediatricians and pediatric neurologists use a Pediatric Migraine Disability Assessment (PedMIDAS) tool, which uses six questions to help the doctor diagnose migraines (4).

In the last three months, how many __

  1. Full school days were missed due to headaches?
  2. Partial school days were missed due to headaches?
  3. Days did the child function at less than half of their ability in school because of a headache?
  4. Days were they unable to do chores, homework, etc., at home?
  5. Days were they unable to participate in activities, such as playing, going out, and sports due to headaches?
  6. Days did the child function at less than half of their ability while participating in these activities?

On adding up the total number of days, the score is inferred as follows:

Less than 10Little or no impact
Between 11 to 30Mild
Between 31 to 50Moderate
Above 50Severe

Signs You Should Call The Doctor

Consult a doctor if the child generally feels unwell or if the headaches interfere with routine activities. Furthermore, you should contact the doctor if the child has the following symptoms (3):

  • Stiff neck
  • Rash
  • Problems with walking and talking
  • Facial droop
  • Weakness anywhere in the body
  • Difficult to wake them up
  • Problems with vision
  • The headache starts under the age of seven years.
  • The type of headache changes.
  • A sudden increase in frequency, severity, or duration of attacks.
  • Recent school failure
  • Personality or behavioral changes
  • Fits
  • Problems with balance or coordination
  • Failure to grow or attain normal developmental goals
  • Headaches that do not improve with paracetamol or ibuprofen

Take the child to the doctor immediately if they show signs of severe headache accompanied by seizures, persistent vomiting, fever, or fainting fits.

Treatment Of Migraine In Children

The doctor may advise giving your child paracetamol or ibuprofen as soon as the symptoms appear. If the child complains of experiencing an aura before the symptoms start, administer the medications immediately. Follow the dosage as per the doctor’s advice. In some cases, doctors prescribe medicines administered through a drip or sprayed into the nose in a hospital setting.

Medicines containing codeine or caffeine are not suggested as they might increase the frequency and duration of the migraine episode (3) (4) (5).

Some daily preventive medications may be advised to reduce the severity and frequency of migraines. They are not approved by the US Food and Drug Administration, but your doctor might prescribe them if the benefits outweigh the risks. These medicines may include (4)

  • Cardiovascular drugs: propranolol
  • Antidepressants: amitriptyline
  • Antiseizure drugs: topiramate
  • Antihistamines: cyproheptadine
  • Antimigraine medicines: pizotifen (3)

Home Care For Migraine In Children

The following steps can help you provide effective home care to your child during a migraine attack (3).

  • Make the child rest in a quiet, dark room.
  • Consider using a hot or cold compress to ease the symptoms.
  • A gentle massage when mild symptoms begin can help prevent them from worsening.
  • Encourage the child to sleep during an attack as it helps ease the symptoms faster.
  • Ask them to eat or drink something to help them feel better.

Prevention Of Migraine In Children

The identification of triggers plays a pivotal role in preventing migraines. Maintain a headache diary for your child, where you can enter the possible triggers of every migraine episode. Write down details, such as when the headache started, the pain’s location, severity and duration, and effective medicines. Also, write down the amount of sleep your child got, meals, fluid intake, physical activity level, any factors that may have contributed to stress, changes in the weather, etc. (4).

The following lifestyle modifications can help prevent migraine attacks in children (4).

  • Ensure eight to ten hours of sleep daily.
  • If the child has trouble sleeping, the pediatrician may recommend tests to monitor snoring or other sleep disorders predisposing them to migraine attacks.
  • Turn screens off an hour before bedtime.
  • Ensure regular meals thrice a day at the same time.
  • Avoid heavily processed meals that may be loaded with additives, preservatives, artificial colors, or sweeteners.
  • Ensure that the child consumes ample fluids to prevent dehydration.

Inform your child’s school and teachers about their condition, and ensure they are equipped with the necessary medicines and knowledge to care for the child. Younger children may feel afraid during an episode of intense pain. Thus, it is essential for the parent to stay calm and reassure the child in these scenarios. Contact your child’s doctor if you notice any new, unusual symptoms.

References:

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Dr. Ritika Shah

Dr. Ritika Shah is a dental surgeon with more than seven years of clinical experience across various cities in India. During her clinical practice, pediatric dentistry was her particular area of interest, and she constantly thrived to inculcate the latest advancements in the field of dentistry into her practice. Dr. Shah's deep interest in the well-being of babies and children... more