Migraines in Children: Types, Symptoms, Causes and Treatment

Migraines in children can be a challenging and often misunderstood condition. These headaches can last a few hours to several days and may interfere with school and daily activities. Understanding the symptoms & treatment options for migraines in children is crucial for parents, caregivers, and doctors to provide effective support and care. This article explores the various aspects of migraines in children, including their types, triggers, and warning signs.

What are Migraines in Children?

Migraines in children are a complex and disabling condition that affects approximately 4% to 10% of young individuals. These severe headaches affect not only a child's physical well-being but also their academic performance and social life. Migraine is the most frequent primary headache disorder in children and adolescents. Unlike adult migraines, children's migraines often present differently, which can result in misdiagnosis or delayed diagnosis.

Types of Migraines in Children

Migraines in children can manifest in various forms, each with distinct characteristics. The various types of migraines that affect children and adolescents are:

• Migraine without Aura: Previously known as common migraine, this migraine is the most prevalent type, occurring in 60% to 85% of children and adolescents who experience migraines. 
• Migraine with Aura: Also called classic migraine, this migraine affects 15% to 30% of children and adolescents who suffer from migraines. This type is characterised by sensory disturbances that precede or accompany the headache. 
• Abdominal Migraine: This type manifests as unexplained abdominal pain, nausea, and sometimes chronic diarrhoea. It may occur with or without head pain, making diagnosing it particularly challenging.
• Chronic Migraine: It is the type that affects children, where headaches occur on 15 or more days per month for at least three months.

What Causes Migraines in Children?

The exact causes of migraines in children are not fully understood, but some research suggests that a combination of genetic and environmental components plays a significant role. 

• Genetics: Migraines tend to run in families. Studies indicate that if one parent has migraines, there is approximately a 50% chance that their child will also develop them. This likelihood increases to nearly 90% if both parents suffer from migraines.
• Physiological Stimuli: These triggers can include exposure to certain foods, changes in sleep patterns, stress, and hormonal fluctuations during puberty. Some children may be more susceptible to migraines due to specific genetic mutations, particularly in the case of hemiplegic migraines.
• Environmental Factors: Weather changes, such as variations in barometric pressure, extreme temperatures, or high humidity, can trigger migraine attacks. Additionally, bright lights, including those from computer or phone screens, and secondhand smoke may contribute to the onset of migraines in susceptible children.
• Stress: It is considered one of the most common triggers for migraines in children. This can be related to school pressures, social interactions, or family issues. 
   

Symptoms of Migraines in Children

Migraines in children can manifest with a range of symptoms that may differ from those experienced by adults. These may include:

• Throbbing Headache: It typically affects the forehead and temple areas or the entire head. This headache often worsens with physical activity and can last anywhere from 30 minutes to several hours.
• Nausea and Vomiting: Accompanying the headache, children may experience nausea and vomiting, which are particularly common in pediatric migraines. 
• Photophobia: Many children also develop sensitivity to light (photophobia) and sound, finding normal levels of brightness and noise uncomfortable or even painful. 
• Visual Disturbances: Some may experience visual disturbances, such as seeing spots, flashing lights, or unusual patterns of lines or circles.
• Other Symptoms: They may include dizziness, lightheadedness, fatigue, paleness, excessive sweat, clumsiness, numbness in their arms or legs, difficulty speaking, or trouble understanding others.
• GI Symptoms: Interestingly, some children may experience migraines without headache pain. Instead, they may have recurring bouts of stomach pain, vomiting, or dizziness. 

Diagnosis

The diagnosis of migraines in children relies primarily on clinical evaluation and includes:

• Medical History: Doctors gather a comprehensive headache history, focusing on the location, quality, severity, duration of the pain, and associated symptoms (nausea, vomiting, and sensitivity to light and sound).
• Physical Examination: It includes: 
  • Blood pressure measurement  
  • Palpation of the head to check for sinus tenderness and nuchal rigidity
  • Funduscopic evaluation to look for signs of increased intracranial pressure, such as papilledema or haemorrhage
  • A visual field examination and head circumference measurement 
  • Skin examination for neurocutaneous findings that could indicate conditions like neurofibromatosis or tuberous sclerosis, 
• Diary: To aid diagnosis, doctors may ask parents to keep a headache diary, recording details about frequency, severity, and possible triggers. The International Headache Society (IHS) questionnaire is often administered to both the child and parents to complete.
• Additional Tests: These may include neuroimaging studies such as MRI or CT scans to rule out other conditions that could be causing the headaches. In some cases, doctors may recommend a spinal tap if they suspect an underlying condition like meningitis.

Treatment for Migraines in Children

The treatment of migraines in children typically involves a multifaceted approach, including:

• Pharmacological Approaches:
  • Rest and sleep in a dark, quiet room often provide relief during an acute attack. 
  • Applying cold packs to the head or massaging the head, neck, and temples can also help ease discomfort.
  • Over-the-counter medications for pain relief. 
  • In more severe cases, doctors may prescribe triptans, which are specific migraine medications.
  • When migraines occur frequently, doctors prescribe preventive medications like beta-blockers, calcium channel antagonists, antiepileptics, antidepressants, or serotonin antagonists.
• Non-pharmacological Approaches: 
  • Cognitive behavioural therapy
  • Biofeedback
  • Mindfulness techniques

When to See a Doctor

It's crucial to consult a doctor if a child's migraines are: 

• Becoming more frequent or severe
• Lasting longer than usual
• Occurring more than once a week 
• Interfering with school attendance or daily activities
• Waking them at night or is present upon waking in the morning. 
• Worsening with coughing, sneezing, or bending down
• Associated with persistent vomiting, squinting, or an inability to look upward. 
• Accompanied with any new weakness, coordination problems, loss of balance, problems with speech or memory, or shows signs of drowsiness or confusion

Prevention

Preventing migraines in children involves identifying and managing triggers while maintaining healthy lifestyle habits. These include:

• Adequate Sleep: One of the most effective preventive measures is ensuring adequate sleep. Children with migraines should aim for 8-10 hours of sleep daily. Parents should set a consistent sleep schedule and create a relaxing bedtime routine. Turning off electronic devices like TVs, mobile phones, computers, and tablets at least an hour before bedtime is crucial, as these can interfere with sleep quality.
• A Healthy Diet: Children should eat three regular meals at consistent times each day. It's advisable to avoid heavily processed foods, which often contain additives and artificial colours that may trigger migraines. 
• Staying Hydrated: Children should drink plenty of water and other healthy beverages throughout the day.
• Regular Exercise: Engaging in moderate-intensity aerobic activity for 30 to 50 minutes three to five days a week can be beneficial. 
• Identifying and Managing Stress: Parents should help their children develop stress management techniques, such as relaxation exercises. It's also essential to plan ahead for potentially stressful periods, such as exams.
• Headache Diary: Maintaining a headache diary can help identify specific triggers for each child. 

Conclusion

Migraines in children are a complex health issue with far-reaching effects on their well-being and daily lives. Understanding the various types, causes, and symptoms is crucial to providing effective support and care. By recognising the signs early and seeking appropriate medical advice, parents and caregivers can play a vital role in managing this condition. The proper treatment approach, combining medication and lifestyle changes, can help to decrease the frequency and severity of migraine attacks.

FAQs

1. What are the stages of migraine in children?

Migraines in children typically progress through several stages, although not all children experience every stage. 

• Premonitory Phase: The premonitory or warning phase can last up to 24 hours and may include symptoms such as tiredness, excessive yawning, food cravings, mood changes, and neck stiffness. 
• Aura: Some children experience an aura involving visual disturbances, numbness, or difficulty speaking. 
• Headache Phase: The headache phase follows, characterised by moderate to severe pain in the head, often accompanied by nausea and sensitivity to light and sound. 
• Recovery Stage: This stage involves a drained or fatigued feeling that can last for hours or days.

2. What to do for a child with migraine?

When a child experiences a migraine, providing a calm and comfortable environment is crucial. Encourage the child to rest in a quiet, dark room with a cool cloth on their forehead. Ensure they stay hydrated and consider offering over-the-counter pain relief medications as a doctor recommends. Keeping a migraine diary can also help identify triggers and patterns. Maintaining regular sleep schedules, eating habits, and exercise routines is also essential to prevent future attacks.

3. Can childhood migraines go away?

While migraines in children may not completely disappear, studies show that some children experience improvement over time. Research indicates that approximately 20-25% of adolescents diagnosed initially with migraine have remission of symptoms within five to seven years.

4. At what age do migraines stop?

There is no specific age at which migraines stop. Some studies suggest that boys often find their migraines improve around puberty, while girls may experience worsening migraines due to hormonal changes during their teenage years.

5. Can migraine in kids be cured?

Currently, there is no cure for migraines in children. However, effective management strategies can significantly decrease the frequency and severity of attacks. Treatment approaches include lifestyle modifications, identifying and avoiding triggers, and, in some cases, preventive medications.