Migraines are a type of recurring headache that involves blood vessels, nerves, and brain chemicals. One type of migraine has no preceding aura. The other type comes with an aura. Auras are sensations that come before a migraine headache occurs. They commonly include visual changes, or numbness and tingling.
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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. Medication should be started as soon as symptoms (pain or aura) appear. This will lessen the length of the migraine and reduce the time with associated symptoms like vomiting.
Specific genes, especially those that run in families, appear to be associated with migraines. Other causes may include nerve or blood vessel problems, environmental triggers, or a chemical imbalance. 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
- Foods that contain tyramine or phenylalanine, or influence blood pressure
- Certain environmental triggers such as flashing lights, odors, loud noises, or weather changes
Migraines are more common in males before puberty and in females after puberty. The average age of onset is 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
Migraines may occur in phases that may include:
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
- Food craving or decreased appetite
- Sensitivity to light
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
Migraines can also occur without the presence of warning symptoms or an aura.
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
A Post-Headache Period
Migraines typically last from 4-72 hours. They often go away with sleep. After the headache, your child may experience:
- Trouble concentrating
- Sore muscles
- Mood changes
You will be asked about your child’s symptoms and medical history. A physical exam will be done. Your child will also be given a neurological exam. The diagnosis is usually based on your child's symptoms.
Imaging tests may be done if your child's symptoms are severe or the neurological exam is not normal. These tests may include:
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 and may include:
Medications are considered first-line therapy for migraine headaches. The medications used depend on the severity of the headache and how the child responds to the treatment.
These may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- Triptans to constrict blood vessels and block inflammation—may depend on the child's age
- Dopamine receptor blockers
- Antiseizure medications
- Magnesium sulfate
Medications are usually taken by mouth, but may be needed as an IV in severe cases, especially with vomiting.
Other Treatment During the Migraine
To help during a migraine:
- 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.
- Try to help the child fall asleep.
Keep a diary to understand what factors may trigger your child's migraines.
Some steps that may help prevent future migraines includes:
- 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—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
- Red plums
- Snow peas
- Soy sauce
- Anything with MSG (monosodium glutamate), tyramine, or nitrates
There are no current guidelines to prevent migraine in children since the cause is not known. If your child is prone to migraines, talk to their doctor about preventive medications.
American Headache Society
The National Migraine Association
The College of Family Physicians of Canada
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- Reviewer: EBSCO Medical Review Board
Kari Kassir, MD
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