Carl R. Darnall Army Medical Center - Health Library

Migraine—Child

Definition

Migraines are a severe type headache that involves blood vessels, nerves, and brain chemicals. It recurs often. Auras are sensations that come before a migraine occurs. One type of migraine has no aura before it starts. The other type comes with an aura. Auras often include visual changes, or numbness and tingling.

Migraines can affect a child’s performance in school. It can also effect relationships with friends and family. Medicine should be started as soon as symptoms appear. This will lessen the length of the migraine. Early treatment can also reduce the time with symptoms.

Migraine
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Causes  ^

Specific genes appear to be associated with migraines. These genes tend to run in families.

Other causes may include:

  • Nerve or blood vessel problems
  • Environmental triggers
  • Chemical imbalance in the body

Many times, the exact cause may remain unknown.

Some 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
  • Overuse of pain medications
  • Being overweight
  • Smoking
  • Foods that contain tyramine or phenylalanine, or influence blood pressure
  • Certain environmental triggers such as flashing lights, odors, loud noises, or weather changes

Risk Factors  ^

Migraines are more common in:

  • Males before puberty
  • Females after puberty
  • Ages 7 years old (boys) and 10 years old (girls)

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

  • Family history of migraines
  • Infantile colic
  • Stress—migraines in children tend to increase during the school year

Symptoms  ^

Migraines may 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

Not all migraines will have warning signs or auras.

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 may be:
    • Moderate or severe in intensity
    • Throbbing or pulsating
    • More severe with movement
  • Nausea or vomiting
  • Sensitivity to light or sound
  • Lightheadedness

A Post-Headache Period

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

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

Diagnosis  ^

You will be asked about your child’s symptoms and health history. A physical exam will be done. Your child will also be given an exam of the nervous system. The diagnosis is usually based on your child's symptoms.

Imaging tests may be done if your child's symptoms are severe. The doctor may also want to rule out other conditions. Image tests may include:

Treatment  ^

The goal of treatment is to:

  • Treat headaches early
  • Reduce headache duration, severity, and frequency
  • Restore the child’s ability to function
  • Improve the child’s quality of life

Treatment includes a combination of therapies which may include:

Medicine

Medicine is the first treatment option for migraines. The type of medicine will depend on how severe the headaches are. Your child’s response will also be tracked.

Options include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • Acetaminophen
  • Triptans to constrict blood vessels and block inflammation—may depend on the child's age
  • Dopamine receptor blockers
  • Antiseizure medications
  • Magnesium sulfate
  • Dihydroergotamine
  • Steroids

Most medicine will be taken by mouth. It may need to be given through IV for severe migraines. An IV may also help if there is vomiting.

Therapy

Therapy can promote relaxation. It may also improve the ability to cope with pain. Either way it has been shown to reduce the how often migraines occur and how long they last. It may be used with or without migraine medicine. Therapy options include:

Other Treatment During the Migraine

Home care that may help during a migraine include:

  • Apply cold compresses to painful areas of the child’s head.
  • Have the child lie in a dark, quiet room.
  • Try applying constant gentle pressure to the child’s temples.
  • Encourage the child to sleep.

Preventing Migraines

Some steps that may help prevent future migraines includes:

  • Have you or your child keep a diary. It will help to find what triggers their migraines. You may also find what helps to relieve symptoms.
  • Maintain regular sleep patterns. Continue 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:

Foods are not proven to trigger migraine. Consider keeping track of what your child eats. Foods suspected by some to trigger migraine include:

  • Nuts and peanut butter
  • Beans—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

If your child has severe or frequent migraines the doctor may recommend medicine. This medicine is given regularly to prevent or decrease migraines. Medicines that have been used for migraine prevention in children include:

  • Tricyclic antidepressants
  • Anticonvulsants
  • Anti serotonergic

Each of these medicines also carry some risk. Discuss the benefits and risks of these options for your child.

Prevention  ^

There are no current steps that change your child’s susceptibility to migraines.

RESOURCES:

American Headache Society
https://americanheadachesociety.org

The National Migraine Association
http://www.migraines.org

CANADIAN RESOURCES:

The College of Family Physicians of Canada
http://www.cfpc.ca

Health Canada
https://www.canada.ca

REFERENCES:

Headache in children. National Headache Foundation website. Available at: http://www.headaches.org/2007/10/25/headache-in-children. Published October 25, 2007. Accessed September 25, 2017.

Migraine in children and adolescents. EBSCO DynaMed Plus website. Available at:https://www.dynamed.com/topics/dmp~AN~T255012/Migraine-in-children-and-adolescents. Updated March 28, 2017. Accessed September 25, 2017.

Migraine prophylaxis in children and adolescents. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T259238/Migraine-prophylaxis-in-children-and-adolescents. Updated February 27, 2017. Accessed September 25, 2017.

Migraine—treatment of status migrainosus in children and adolescents. EBSCO DynaMed Plus website. Available at:https://www.dynamed.com/topics/dmp~AN~T917667/Migraine-treatment-of-status-migrainosus-in-children-and-adolescents. Updated March 6, 2017. Accessed September 25, 2017.

Migraine—treatment of acute attack in children and adolescents. EBSCO DynaMed Plus website. Available at:https://www.dynamed.com/topics/dmp~AN~T917653/Migraine-treatment-of-acute-attack-in-children-and-adolescents. Updated March 6, 2017. Accessed September 25, 2017.

Migraines. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/migraines. Updated April 2014. Accessed September 25, 2017.

8/27/2010 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T114773/Headache: 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 Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T255012/Migraine-in-children-and-adolescents: 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 Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T259238/Migraine-prophylaxis-in-children-and-adolescents: 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;310(24):2622-2630.

1/2/2014 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T255012/Migraine-in-children-and-adolescents: Huquet A, McGrath PJ, Stinson J, Tougas ME, Doucette S. Efficacy of psychological treatment for headaches: an overview of systematic reviews and analysis of potential modifiers of treatment efficacy. Clin J Pain. 2014;30(4):353-369.

Last reviewed September 2017 by EBSCO Medical Review Board Kari Kassir, MD  Last Updated: 7/12/2018