Migraine in children is so different from migraine in adults that it isn’t recognized and often goes undiagnosed. Yet one in ten children have migraine attacks and 1 out 5 of them had their first migraine between the ages of two and five. Getting a diagnosis is difficult because symptoms differ from expectations, they are subjective and small children are not skilled in communicating how they feel and cannot describe their symptoms accurately and well.
The main symptom of migraine in children is not a headache, but stomach related pain, nausea and (sometimes) vomiting. Children usually do not have an aura and may not even have a headache at all.
Duration: An migraine attack that lasts for 2 – 72 hours with full recovery in between attacks. Most children seek out quiet, dark spaces and will naturally fall asleep within an hour if given the opportunity. Sleep usually provides relief or even ends the attack. In children, attacks are usually shorter.
Headache or abdominal pain with at least two of the following characteristics:
- Usually bilateral (on both sides) in children, but can be one-sided. Some children, particularly younger children, may not have a headache at all.
- The headache pain is throbbing in nature
- Moderate to severe intensity, inhibiting or preventing daily activity
- Aggravated by physical activity.
At least one of the following accompanies the pain
- Nausea, vomiting or both
- Photophobia (light sensitivity), phonophobia (sensitivity to sound) or both
Aura (uncommon in children under 15)
- One or more fully reversible aura symptoms including focal cortical, brainstem dysfunction or both
- At least one aura symptom that develops gradually over more than four minutes or two or more that occur in succession.
- No aura symptoms lasting >60 minutes.
- Headache follows aura within 60 minutes. *
One of my early memories is that of a severe migraine. I was about three or four gathered around the kitchen table with two or three friends, all stretching to reach the fruit in the fruit bowl on the large kitchen table. The sunlight was bright. We had come indoors because I had complained about the outside being too bright. I sat down on the floor. I didn’t want a piece of fruit. I felt sick. My head hurt. My stomach hurt. The sound of their voices hurt. The light hurt. The world felt surreal. It felt like the borders of my imagination were expanding and mixing with reality. Dust motes sparkled in the air, bright with neon tails. I was sure I was going to throw up.
I remember later. It was dark. Outside and in my bedroom. I was groggy. My mouth tasted bitter from throwing up. My head throbbed. My stomach hurt. My mother, a life-time migraineur was on the phone to the doctor. I couldn’t hear the conversation. She returned with a cool damp cloth for my forehead and paracetamol. I went back to sleep. I felt fine when I woke up.
I never stopped having migraine attacks. Fifty percent of children continue to have migraine episodes into adulthood. Many do not receive a diagnosis until their teens or early adulthood. I was lucky to receive a diagnosis early because it runs in my family.
Migraine is not just a headache. It is a neurological condition that can be debilitating. If it becomes chronic, severe or resistant to treatment, it can dictate your whole life. The effects are even harder for children who are often unsupported, undiagnosed and have no coping skills. They may not even realize that what they are experiencing is not just a part of normal life.
Migraine attacks responds well to treatment and lifestyle management for the majority of people. Getting a diagnosis and consequently an appropriate management strategy in place, can make a significant difference on how debilitating it can be both physically and psychologically.
Patient UK recommends following these general measures as the primary strategy for managing migraine in children:
- Explanation and reassurance. This should emphasise what migraine is and how realistically attacks can be reduced. Fears about brain tumours and more serious conditions should be discussed and fears allayed.
- Identification of triggers and predisposing factors, often with a trigger/headache diary. This may be important in the development of a behavioural strategy. Dietary sensitivities affect only about 20% of migraine sufferers. In children, the following triggers have been identified as important: sleep, stress, dehydration/warm weather, missed meals, video games. Stress management has been shown to improve severity and frequency of headache.
- Behavioural management strategy. This should emphasise routine around sleeping, eating and avoiding an overloaded routine to help prevent migraine, as well as strategies for dealing with an attack (lie in a cool, dark, quiet room and encourage sleep with pharmacological or non-pharmacological support as recommended by a medical professional).
First published on 6 December 2013. Updated: 28 March 2015.