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Migraine—Child

Definition

A migraine is a moderate to severe type of headache that makes it hard to focus on things like school.
Migraine
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Causes

Specific genes appear to be associated with migraines. These genes tend to run in families. Many times, the exact cause is not known.
Things that are thought to trigger an attack are:
  • Foods that contain tyramine or phenylalanine or that influence blood pressure
  • Hormone changes
  • Stress and anxiety
  • Not getting enough sleep and being very tired
  • Fast changes in temperatures
  • Exposure to light

Risk Factors

Migraines are more common in boys before puberty and girls after puberty. It is also more common in children who have other family members who have migraines.

Symptoms

Migraines often occur in these phases:

Warning

In the hours or days before a headache, a child may have these warning signs:
  • A change in mood, behavior, or activity
  • Feeling very tired
  • Food cravings or lack of hunger
  • Nausea or diarrhea
  • Sensitivity to light

Aura

Auras are feelings that may happen before some types of migraine.
The most common aura is visual. It lasts about 15 to 30 minutes and may cause:
  • Flashing lights, spots, or zig zag lines
  • Partial loss of vision
  • Problems speaking
  • A weakness in an arm or leg
  • Numbness or tingling in the face and hands

The Migraine Headache

When an aura happens, migraine pain starts within an hour after the aura ends. Headaches often last from 2 to 72 hours and may cause:
  • A headache on one or both sides that may be:
    • Moderate or severe
    • Throbbing or pulsating
    • Worse with movement
  • Nausea or vomiting
  • Sensitivity to light or sound
  • Lightheadedness

Diagnosis

You will be asked about your child’s symptoms and health history. A physical exam will be done. The diagnosis is usually based on your child's symptoms.

Treatment

The goal of treatment is to:
  • Treat headaches early
  • Reduce how severe the headaches are and how often and long they last
  • Improve quality of life
Choices may be:

Medicine

Medicine is the first treatment option for migraines. The type of medicine used depends on how severe the headaches are.
Options may be:
  • Acetaminophen
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • Triptans to constrict blood vessels and block inflammation
  • Dopamine receptor blockers
  • Antiseizure medications
  • Magnesium sulfate
  • Dihydroergotamine

Therapy

Therapy may be used with or without medicine to ease stress and improve how a child copes with pain. It may result in fewer headaches that do not last as long. Options are:

Preventing Migraines Before They Happen

Tracking and avoiding migraine triggers may help prevent headaches in some children. Some triggers may be certain foods, stress, and changes in temperature.
Children with severe or frequent migraines may need medicine to try to prevent or decrease them, such as:
  • Anti-seizure medicine
  • Antidepressants

Prevention

There are no current steps that can change a child’s likelihood of getting migraines.

RESOURCES

American Headache Society
https://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
https://www.canada.ca

References

Green A, Kabbouche M, et al. Managing Migraine Headaches in Children and Adolescents. Expert Rev Clin Pharmacol. 2016;9(3):477-482.
Headache in children. National Headache Foundation website. Available at: http://www.headaches.org/2007/10/25/headache-in-children. Accessed January 2, 2019.
Migraines. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/migraines. Updated September 3, 2019. Accessed January 2, 2020.
Migraine in children and adolescents. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/migraine-in-children-and-adolescents. Updated March 28, 2017. Accessed September 25, 2017.
Migraine prophylaxis in children and adolescents. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T259238/Migraine-prophylaxis-in-children-and-adolescents. Updated April 23, 2019. Accessed January 2, 2020.
Migraine—treatment of status migrainosus in children and adolescents. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/migraine-treatment-of-status-migrainosus-in-children-and-adolescents. Updated March 6, 2017. Accessed January 2, 2020.
Migraine—treatment of acute attack in children and adolescents. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/migraine-treatment-of-acute-attack-in-children-and-adolescents. Updated March 6, 2017. Accessed January 2, 2020.

Revision Information

  • Reviewer: EBSCO Medical Review Board Kari Kassir, MD
  • Review Date: 09/2019
  • Update Date: 06/12/2020
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