What are they?
Significant or severe headache that often is felt on one side of the head. Often they present with nausea or vomiting as well as the headache, and at times there is a family history of this condition.
They are different from those in adults in terms of duration, location and diagnosis. Children’s symptoms can be more ill-defined or vague. In the younger child they may present as recurrent abdominal pain making it difficult to diagnose.
How are they defined?
Episodic or chronic.
With or without aura.
Aura – is the warning that a migraine is about to occur due to the change in electrical activity of the brain. Though often visual in nature, it can affect any of the senses. The commonest symptoms are visual blurring, flashing lights or dots. The other senses can give rise to numbness or tingling, slurred words or speech, unusual tastes or smells.
How common are migraines?
They are very common, increasing in frequency through childhood, becoming more female predominant over the age of 15.
They can occur in the young child 1-3% in ages 3-7 years, up to 11% in ages 7-11 years and up to 23% in those over 15 years (1).
3% school age – to 20% adolescents
How are migraines diagnosed?
Your doctor will ask a lot of questions to rule in and rule out a range of things that may cause or contribute to the headaches. After examining the child and looking into other possibilities, the diagnosis will be arrived at. It may be important for your child to have their eyes checked.
What is the treatment?
If the headaches are infrequent then giving analgesia (pain relief) at the time is the best. A recent review found that Ibuprofen at a dose of 10mg per kg is the most effective (3). Being in a quiet dark room to rest will see most migraines subside.
If the migraines are happening frequently enough to justify a regular daily medication, then I have had good success with riboflavin (vitamin B2). The most recent review in the Journal of American Association (3) supports propranolol as being the most effective with levetiracetam, though the latter has more side effects and so is not the preferred medication. There is still the ability to give pain relief for a breakthrough migraine headache while on a regular medication, and there are others that may be trialed.
Is there anything else I can do?
There are many triggers to migraines which are different for each person but looking at the lifestyle issues should not be forgotten as with careful attention to these factors you may be able to avoid medication at all. That is not to say that inability to reduce migraines by altering these factors is a failure, or that you need to totally avoid the dietary contributors, just be mindful of them and their contribution. Remember the adage "all things in moderation".
Some of the triggers are; lack of water (dehydration), lack of sleep, hormonal changes, stress, and various foods (cheese, chocolate, caffeine, cured meats etc). Keeping a diary of headaches when they occur and what may have happened prior can help to work out what the triggers are.
Episodic Migraines in Children: Limited Evidence on Preventive Pharmacological Treatments
Tatyana A. Shamliyan, MD, MS, Robert L. Kane, MD, et al.
Journal of Child Neurology, 28(10), 1320-1341.
Short-term Treatment of Migraine in Children and Adolescents
Irene Patniyot, MD; William Qubty, MD.
JAMA Pediatr. 2020;174(8):789-790.