Migraine—Child

Definition

Migraine is a type of recurring headache. It involves blood vessels, nerves, and brain chemicals. Sensations may come before a migraine. This can include visual changes or numbness and tingling, called auras. 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 cause is unknown. Among the suspected causes are genetics and environmental triggers. Migraines may be caused by changes in a nerve that serves as a major pain pathway. An imbalance in brain chemicals, like serotonin, may also play a role.

Risk Factors

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

  • Environmental triggers (eg, flashing lights, odors, loud noises, weather changes)
  • Sex: More common in male children than female; once puberty occurs, migraine headaches occur more often in females
  • Age: The average age a child may get a migraine headache is seven years old for boys and 10 years old for girls. A headache can occur at younger ages as well.
  • Having family members with migraines
  • Dietary triggers (eg, chocolate, citrus fruits, dairy, processed meats, fried foods)
  • 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

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

More rarely, an aura can occur by itself. In these cases, it is important to seek medical attention to make sure the symptoms are not due to a more serious cause, like a seizure or stroke .

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. If the doctor suspects other conditions, she might do tests to rule these out, such as:

  • CT scan —a type of x-ray that uses a computer to make pictures of structures inside the head
  • MRI scan —a test that uses magnetic waves to make pictures of structures inside the body

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.

Many of the medicines used to treat or prevent migraine headaches in adults are not currently approved by the United States Food and Drug Administration (FDA) to treat migraine headaches in children. However, your child’s doctor may decide to prescribe your child medicines used for adults.

Other Treatment During the 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.

If your child is diagnosed with a migraine, follow the doctor's instructions.

Prevention

Methods for preventing migraine include:

  • Avoid things that trigger the headache.
  • Establish other healthy habits.
  • The doctor may consider using medicines (including antiseizure medicines and antidepressants) in an attempt to prevent headaches.

Suggestions for your child include:

  • 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

RESOURCES:

American Headache Society
http://www.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
http://www.hc-sc.gc.ca/index_e.html/

References:

American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html . Accessed July 20, 2009.

American Academy of Neurology website. Available at: http://www.aan.com/ . Accessed July 20, 2009.

Benoliel R, Birman N, Eliav E, Sharav Y. International Classification of Headache Disorders. 2nd ed. London, England: The International Headache Society; 2003.

Boes CJ, Capobianco DJ, Cutrer FM, Dodick DW, Garza I, Swanson JW. Headache and other craniofacial pain. Neurology in Clinical Practice website. Available at: http://www.expertconsultbook.com/expertconsult/o/login.do?method=display . Accessed February 3, 2009.

Cephalalgia: An International Journal of Headache . 2004;24(suppl 1).

Dambro MR. Griffith's 5-Minute Clinical Consult . Philadelphia, PA: Lippincott Williams & Wilkins; 1999.

Gladstone JP. Migraine. Medlink website. Available at: http://www.medlink.com . Accessed February 23, 2008.

Goetz CG, Pappert EJ. Textbook of Clinical Neurology . Philadelphia, PA: WB Saunders Co; 1999.

Migraine in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated February 2009. Accessed February 3, 2009.

Lewis DW. Pediatric Migraine. Neurol Clinics . 2009;27(2):481-501.

Matteucci R. Headaches, migraine, in children. EBSCO Nursing Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=860 . Published October 30, 2009. Accessed June 29, 2010.

Mayo Clinic Staff. Migraine. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/migraine-headache/DS00120/DSECTION=causes . Updated June 6, 2009. Accessed June 29, 2010.

Migraine prophylaxis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated February 2009. Accessed February 3, 2009.

National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.nih.gov/ . Accessed July 20, 2009.

Silberstein SD, Lipton RB. Headache in Clinical Practice. London, England: Martin Dunitz Ltd; 2002.

The Vestibular Disorders Association website. Available at: http://www.vestibular.org/migraine.html . Accessed November 15, 2004.

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.



Last reviewed June 2011 by Kari Kassir, MD


Last updated Updated: 6/6/2011

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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