Migraines In Children: Elements

Migraines In Children | Early Identification Of Triggers & Avoiding Them Will Reduce Onset Of Attacks

Migraines in children: Introduction, identifying and avoiding triggers, circadian rhythm, actions during a migraine attack, medications

Migraines in children: Migraines are also called vascular headaches and are usually inherited. Nearly, 70% of pediatric migraines have a positive family history. Approximately 5 percent of kids experiencing chronic headaches will be diagnosed with migraines.

Migraines can occur in very young preschool children but are more common in school-age children and teenagers. In teens, girls are more affected than boys but the converse is true in younger children.

The primary cause of a migraine is an electrical wave that spreads across the brain that leads to changes in blood flow and promotes inflammation (Trigeminovascular system).

The inflammation aggravates the blood vessels, which in turn triggers nerve cells to communicate back to the brain that there is a head pain.

Clinically, most older children suffer from typical migraine symptoms like those of adults. Fifteen percent will have aura where there is flashing lights, wavy lines seen by the child. A few minutes later the headache sets in and may be associated with photophobia (sensitivity to light) and vomiting.

A headache is usually severe and may be felt on one side of the head. However, migraine variants are common in children. They may present with cyclical abdominal pain and vomiting, dizziness confusional states, vertigo and motor weakness.

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Identifying and avoiding triggers

  • Foods: Chocolates, ages cheese, caffeine, MSG found in Oriental foods
  • Sleep disturbances – Sleep deprivation and oversleeping can both a precipitate migraine. Poor and disrupted sleep is a common complaint. Sometimes difficulty breathing at night — sleep apnea — can be an unnoticed trigger for a headache. If your child snores wake up frequently or are very tired during the day it may indicate sleep apnea
  • Menstruation

Maintain routine circadian rhythm

  • Regular sleep
  • Maintain weight- neither obese nor underweight
  • Not skipping meals

During a migraine attack

  • A child should rest and sleep, in a quiet, dark and cool room
  • Raising head up on a pillow and cool compress for the eyes or forehead
  • At school, a child should be allowed to go to the nurse’s office and rest. Sometimes a quick nap is all it takes and they can return to the rest of the school day


  • First line — Simple analgesics, such as acetaminophen or ibuprofen
  • Second line — Triptans are Serotonin Receptor Agonists. They constrict the blood vessels and reduce pain. They can be taken by mouth, under the tongue, nasal spray or patch for the skin. Three triptans almotriptan, zolmitriptan and rizatriptan and one combination triptan and non-steroidal anti-inflammatory sumatriptan/naproxen are FDA-approved for children
  • Anti emetic — To reduce or prevent nausea and vomiting
  • When migraine attacks are more than twice a week and interfere with school or social activities, a daily medicine to try to prevent headaches can be considered. Common preventive medicines include propranolol, tricyclic antidepressants, topiramate, and valproate

Please note: none of these medications are approved for migraine treatment in children.

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Key Features

A headache is serious if:

  • Associated with vomiting
  • Severe in degree
  • Progressive in nature
  • Stiff neck
  • Wakes up at night because of a headache
  • Neurological Deficit — slurring of speech, motor weakness, double vision
  • Photophobia — sensitive to light
  • High fever and or rash
  • Lethargy
  • Personality change

How to differentiate between a Tension headache and Migraine

Tension headaches

  • Occurring during times of obvious stress
  • Involving the neck and back of the head
  • Continuous pain
  • No nausea, vomiting, or abdominal pain
  • Family history of a migraine is less likely
  • In some patients, obvious symptoms of depression; in this subgroup, headaches are relieved when depression is treated

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Migraines In Children: Elements was last modified: April 10th, 2017 by Dr. Rajeshree Singhania

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