By Dr Yousra
Migraines in Children and Adolescents
What is a migraine headache?
Migraine is a moderate-to-severe headache that lasts from 2 to 48 hours and usually occurs two to four times per month.
Migraine, also called an acute recurrent headache, occurs in about 3% of children of preschool children, 4% to 11% of elementary school-aged children, and 8% to 15% of high school-aged children. In early childhood and before puberty, migraine is more commonly seen in boys than girls. In adolescence, migraine affects young women more than young men. As adults, women are three times more likely to have a migraine than men.
What types of migraine occur in children and adolescents?
There are two main types. A migraine without an aura (called common migraine) occurs in 60% to 85% of children and adolescents who get a migraine. A migraine with an aura (called classic migraine) occurs in 15% to 30%.
What causes a migraine?
Until recently, migraine was thought to be caused by the changing size of blood vessels in the brain. Today, migraine is thought to be a brain malfunction – a disorder that mainly affects the brain and nerves but also affects blood vessels. The “malfunction” is caused, in part, by the release of chemicals in the brain. One of these chemicals is serotonin. This cycle of changes cause inflammation and the pain of the migraine.
Migraine is genetic, meaning it tends to run in families. Some 60% to 70% of people who have migraine headaches also have an immediate family member (mother, father, sister, or brother) who have or may have had a migraine.
A migraine can cause great discomfort, disability, and interfere with activities. However, they do not usually cause damage to the body. Migraine headaches are not related to brain tumors or strokes.
What are the symptoms of migraine?
Although symptoms can vary from person to person, general symptoms include:
- Pounding or throbbing head pain. In children, the pain usually affects the front or both sides of the head. In adolescents and adults, the pain may affect one side of the head.
- Pale skin color
- Irritable, moody
- Sensitivity to sound
- Sensitivity to light
- Loss of appetite
- Nausea and/or vomiting
What are some migraine triggers?
Things that trigger migraine differ for each person. However, some common migraine triggers in children and adolescents include:
- Stress – especially related to school (after school activities, friends, bullying) and family problems.
- Lack of sleep – results in less energy for coping with stress. Aim for 8 hours of sleep nightly.
- Menstruation – normal hormonal changes caused by the menstrual cycle can trigger migraine.
- Changes in normal eating patterns – skipping meals can cause migraine. Eating three regular meals and not skipping breakfast can help.
- Caffeine – caffeine is a habit-forming substance and headache is a major symptom of caffeine ingestion and withdrawal.
- Weather changes – storm fronts or changes in barometric pressure can trigger migraine in some people.
- Medications – some medications such as oral contraceptives (birth control pills), asthma treatments, and stimulants (including many of the drugs used to treat attention-deficit hyperactivity disorder [ADHD]), may occasionally trigger a migraine. If you think medicines are causing the headache, ask your doctor about other options.
- Travel – the motion sickness sometimes caused by travel in a car or boat can trigger a migraine.
- Diet –certain foods or food additives can trigger a migraine.
- How is a migraine diagnosed?
Gathering details about the headaches is the key to making the diagnosis. The headache history should be obtained from both the patient and his or her parents.
Patients with complicated migraine with neurological symptoms require a more thorough neurological exam, more laboratory tests, and imaging scans. MRI (magnetic resonance imaging) and MRA (magnetic resonance imaging of the arteries) scans allow the tissues and arteries within the brain to be seen and evaluated. Most patients with complicated migraine recover completely. A structural problem, such as a brain tumor, is rarely found.
How are migraine headaches treated in children and adolescents?
Basic lifestyle changes can help control a migraine. Whenever possible, avoiding the known triggers can help reduce the frequency and severity of migraine attacks.
Biofeedback and stress reduction.
Vitamins, minerals, and herbal products. These products have shown some effectiveness in migraine. They include magnesium, riboflavin, and coenzyme Q10.
Medications. Headache medications can be grouped into three different categories: symptomatic relief, abortive therapy, and preventive therapy. Each type of medication is most effective when used in combination with other medical recommendations, such as dietary and lifestyle changes, exercise, and relaxation therapy.
Important: If symptomatic relief medications are used more than twice a week, see your doctor. Overuse of symptomatic medications can actually cause more frequent headaches or worsen headache symptoms. This is called rebound or medication overuse headache.
Often a combination of symptomatic and preventive medications may be needed. Patients should be started at a low dose, with the dose slowly increased over time. Medication works best when combined with lifestyle changes and patient education.