Migraine in Children: Everything you Should Know

Everything You Should Know About Basilar Migraine
Everything about Status Migrainosus: Symptoms, Diagnosis, and Treatments
Chronic Silent Migraine: Causes, Treatments, and Medications
Migraine in children, like in adults, is primarily expressed by headaches, but migraine symptoms such as tiredness, fatigue, dimness, nausea, or vomiting are also possible.
Unlike in adults, migraines in children usually affect the entire head. Read all the important information about migraines in children here.
Migraine in Children
How common is migraine in children?
About three to four percent of all children suffer from migraines. 
Migraines are particularly common in children where the mother and father are also migraine sufferers. 
Before adolescence, many girls and boys are affected by migraines. 
In half of the children, the migraine goes during adolescence, while the rest of them continue to suffer from migraines. 
Girls are more often affected by migraines than boys.
Symptoms of Migraine in children:
Migraine in children is often ignored. One reason is that small children are not yet able to tell about their symptoms adequately. 
On the other hand, the symptoms are often different, as the headache in children is sometimes only slight or absent altogether.
In its place, children suffering from migraines suffer more often from additional symptoms such as abdominal pain, palpitations, reddening of the skin, high body temperature, dizziness, thirst, urgency, nausea, and vomiting.
The attacks of migraine in children are usually short term than in adults, lasting one to six hours.
Moreover, migraine headaches in children rarely affect one side of the head. 
The younger the child, the more likely it is that the headache is two-sided.
The pain is most often located in the forehead, temples, and around the eyes. 
Pain in the occipital part, on the other hand, is very abnormal of migraine in children and should be diagnosed immediately.
Aura symptoms
In addition to the headaches and the accompanying complaints already mentioned, migraines in children can also be accompanied by neurological abnormalities (“aura”). 
Typical aura feelings in children are optical hallucinations like bright colors and funny shapes, but also visual disturbances like flashes of light and shaky before the eyes. 
Doctors also speak of an “Alice in Wonderland syndrome.” 
Other typical aura symptoms of migraine in children are paraesthesia (for example, numbness, prickly in arms or legs), paralysis, and speech disorders.
All these aura symptoms of migraine in children are temporary. 
They usually occur before the actual migraine headaches begin. 
They usually last for about half an hour to an hour. 
They lessen with the start of the headache, and no neurological damage rests after the migraine attack.
How do you notice migraines in children?
In most circumstances, children do not describe migraines themselves. 
Small children, in particular, are not yet able to express what they feel. 
Therefore, pay attention to changes in your child’s behavior. 
Many of them stop playing, turn pale or red in the face, or would like to lie down and sleep. 
Other children become restless and irritable or complain of stomach aches. School children suddenly can no longer concentrate and have problems doing their homework.
Migraines in children: Causes
Similar to adults, migraines triggers in children are not yet fully understood. 
Doctors suspect a genetic predisposition, as migraines are more common in many families. 
Besides, individual trigger factors (triggers) are likely to be added to each person affected.
The trigger factors are similar to those of adults, but there are some differences. 
Stress is the essential trigger of migraines in children, but children are usually much more sensitive to influences that would not cause migraines in adults. 
The typical trigger factors of migraine in children are:
Trigger: Physical stress
Excessive physical pressure often causes headaches in children.
On the one hand, this may be due to insufficient fluid intake during sweat. 
Low blood sugar can also be the cause of headaches and migraines in children. 
Children are particularly sensitive to low blood sugar levels. 
Therefore, it is always best to ensure that children eat a carbohydrate-rich meal (for example, pasta) two to three hours before exercise.
During sport, children must drink water regularly to replace the fluid lost through sweating. 
If a child often complains of headaches after exercise, it is a good idea to do endurance sports such as swimming, running, or cycling. 
This is a gentle way to accustom the body to the physical strain.
Trigger: Irregular sleeping habits
Sleeping habits also have a major influence on the development of migraines in children. Both too little and too much sleep can lead to migraine attacks. 
The need for sleep in children depends on age and also varies from person to person. 
While for babies up to the first year of life, it is usually 13 to 18 hours, for children from one to four years of age at least twelve hours a day is recommended. 
Older children and adolescents should sleep about nine to twelve hours per night.
Very often, the sleep rhythm gets mixed up at the weekend when children go to bed too late and sleep longer. 
Especially children with migraines should, therefore, pay attention to a sleep rhythm that is as regular as possible with the same sleeping and getting up times throughout the week. 
This can prevent migraine attacks in children.
Trigger: Psychological stress
Mental stress can also promote migraines in children. 
These include, for example, stimulus satiation from the use of electronic devices, lack of physical activity, family conflicts, and performance demands at school.
All these psychologically stressful factors can not only lead to psychological abnormalities but are also considered to be significant factors influencing the development of migraines in children. 
Parents should, therefore, make sure, for example, that their children’s daily media consumption is limited to a reasonable level and, in particular, that aggressive and stressful content is kept away from their children.
Trigger: Weather
A frequent trigger of migraines in children and adults is temperature change and high humidity. 
You cannot change the weather, but at least you can adjust your behavior on critical days. 
If, for example, a change in the weather is imminent or it is particularly warm and humid, you should always plan more rest breaks in your daily life. 
This can sometimes help prevent migraine attacks.
Trigger: Physical stimuli
Physical stimuli include in particular noise and changes in light. 
Noise has been shown to trigger a particularly strong stress reaction in humans. 
Noise is generated not only at construction sites or by road traffic but can also be caused by music that is too loud (especially with headphones). 
Such noise exposure can trigger migraines in children and adults.
Children also react very sensitively to changes in lighting conditions. For example, a desk placed directly in front of a window can be unfavorable.
Occupational physicians recommend placing a desk at a right angle to a window instead.
Flickering flashlights in discos can also cause migraines in teenagers.
Trigger: Chemical irritants
Children often react very sensitively to chemical irritants, which are often found in the home and school environment. 
Typical headache triggering substances are, for example:
  • exhaust fumes from cars
  • Dyes and adhesives
  • Perfume and deodorants
  • Domestic poisons (wood preservatives or solvents in furniture or floors)
  • Cigarette smoke
Trigger: Food
In general, children react more sensitively than adults to various foods. Why some foods trigger migraines is not known for sure. 
Certain ingredients may be the reason. 
For example, it is suspected that the so-called biogenic amines tyramine and histamine promote migraine – but proof of their effectiveness is still lacking. 
The following foods are discussed as possible triggers of migraine in children:
  • cow’s milk, eggs, cheese.
  • Chocolate, products containing cocoa
  • Caffeine
  • gluten-containing cereals
  • Tomatoes
  • Citrus fruit
  • fatty food like sausages, ham, salami, pork
Migraines in children: Diagnosis
If you suspect your child has migraines, the pediatrician or family doctor is the right person to talk to. 
The diagnosis of migraine in children is usually not so easy to make: 
Small children often cannot yet adequately express their pain and complaints. 
In some cases, migraines in children even begin before language acquisition.
To clarify a possible migraine in children, the doctor will first have a detailed conversation with the parents to record the medical history (anamnesis). 
Particularly with small children, the parents must describe what they noticed in their child. 
Friends, relatives, or caregivers at school or kindergarten can also provide information on behavioral problems if necessary. 
Somewhat larger children are themselves included in the anamnesis. The attending doctor will ask questions such as:
  • Can you show where it hurts you?
  • Since when does it hurt?
  • Do you have something like this more often, or is this the first time?
Where else does it hurt except in the stomach? (Children tend to project pain generally into the abdomen.)
Have you noticed if the pain always occurs after a certain situation?
After the medical history interview, the doctor will examine the child. In doing so, he will pay attention to whether any neurological abnormalities such as problems with the eyes, sense of balance, motor skills, or sensitivity become apparent. 
He also examines whether the mental and physical development of the child corresponds to his age.
In some cases, further examinations are necessary to exclude other causes of the headache. 
These include, for example, imaging examinations of the skull (such as magnetic resonance imaging, MRI).
Keep a headache calendar
It is a good idea to keep a headache calendar with your child and bring it with you to each visit to the doctor. 
In this calendar, you should enter exactly when the headache occurs, how severe it is, how long it lasts, and whether it is accompanied by other complaints (nausea, vomiting, stomach ache, etc.).
This detailed information makes it easier for the treating doctor to recognize migraines in children and to rule out other diseases. 
Besides, a headache calendar can also help you at home to recognize and avoid the individual trigger factors for headaches in your child.
Find out here which examinations can be useful in this disease:
Migraines in children: Treatment
The treatment of migraine in children is different from that for adults. 
Firstly, experience shows that non-drug treatments are significantly more effective in children than in adults. 
They should, therefore, always be given priority over the use of drugs.
The second difference between the treatment of migraines in children and adults is that other drugs are sometimes used. 
Typical migraine medications such as acetylsalicylic acid or metoclopramide should not be used in children. 
Under no circumstances should parents who suffer from migraines themselves simply administer their medication to their child! 
Otherwise, life-threatening consequences can occur, especially due to incorrect dosage! 
A doctor must select the migraine medication specifically for a child and calculate the correct dosage.
Generally speaking, migraines in children are usually best treated with a combination of non-drug and drug treatments.
Migraine in children: Non-drug measures
Non-drug therapy for migraines in children and adults includes physical therapy (such as heat applications), relaxation techniques, autogenic training, and so-called biofeedback. 
Some of these methods are suitable both for the acute migraine attack and for the prevention (prophylaxis) of further migraine attacks. 
According to the German Migraine and Headache Society (DMKG), the non-drug procedures are quite as effective as pure drug prophylaxis. 
In particular, the biofeedback method seems to be very effective, especially in children and adolescents.
Parents often feel helpless when their child has a migraine attack. Even very simple measures can be very effective:
In the case of an acute migraine attack, children should above all be given rest. 
Take your child into a darkened room. You should completely avoid noise sources such as radio or television, as this can make the headache worse. 
A few hours of sleep, a cool cloth on the forehead or a neck massage with peppermint oil (not for babies and toddlers!) will, in most cases, make headaches and migraines in children go away quickly.
Especially small children can fall asleep easily, even while playing. 
Sleep does your child good, and he or she may wake up without headaches. 
Even the smallest activities, such as walking around or watching television, can make a child’s migraines worse.
Migraines in children: Seizure medication
The same applies to migraines in children as in adults: the sooner the medication is administered, the better. 
This means that the drugs should be taken as soon as the first migraine symptoms appear. Then sometimes, a migraine attack can still be stopped.
The treatment of the acute migraine attack is started with a so-called antiemetic. 
It not only combats nausea that also frequently occurs but above all, it increases the effectiveness of the painkillers given afterward. 
In children, the prescription active substance domperidone is used as an antiemetic (as a tablet or suppository). 
The doctor usually determines the correct dose based on the child’s weight. 
The dosage must be chosen very carefully and must be strictly adhered to: Too high a dose can cause serious side effects.
The next step is to administer an analgesic about 15 minutes after the antiemetic. 
For children and adolescents, ibuprofen or paracetamol is recommended. 
The acetylsalicylic acid frequently used in adults, on the other hand, is absolutely taboo: in children and adolescents, taking it can lead to life-threatening Reye syndrome.
Flunarizine and topiramate have been approved by the FDA for adolescents with migraine. 
There are indications of efficacy for propanolol, but valproic acid is not effective in children and adolescents. Studies suggest that botulinum toxin A is effective in adolescents.
If the migraine in children does not improve with the above-mentioned painkillers, active ingredients from the triptans or (less frequently) ergotamines are also available. 
However, these should be used with caution in migraines in children and should generally only be given from the age of 12. 
For smaller children, they can be prescribed by a headache specialist in very severe cases. 
These drugs are available as tablets, suppositories, or sometimes as nasal sprays.
Migraines in children: Medicines for prevention
In contrast to the drug treatment of the acute migraine attack, the drugs must be taken permanently to prevent another attack. 
This also explains why problems often arise in this case, as the adverse drug effects usually affect children even more than adults. 
This is why drugs to prevent migraines in children are only used if non-drug treatments and, in particular, behavioral therapy measures do not help sufficiently.
As with adults, beta-blockers are used (there are indications that propranolol is effective). Valproic acid is not effective in children and young people. 
Studies suggest that botulinum toxin is effective in adolescents). 
Parents should be informed in detail by the doctor about the possible side effects of the drugs.
Therapies that can help:
  • Biofeedback
  • Botox
  • Chiropractor
  • Foot reflexology
Migraines in children: Prognosis
Migraine in children is not uncommon. In many cases, however, the signs are not recognized early enough and are not taken seriously. 
Therapy often starts late. By then problems have often already arisen at school or in the family.
The prognosis for migraines in children is often good. In about half of the cases, migraines in children continue into adulthood. 
In the other half, the migraine attacks disappear with puberty. 
But they often come back later. 
Ultimately, only about a quarter of all children with migraines will remain migraine free in adulthood permanently.
The decisive factor for a favorable prognosis is how well trigger factors can be avoided. 
Permanent stress, for example, significantly worsens the prognosis of migraines in children.