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Terre Haute Regional Hospital
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Migraine -- Child

Definition

Migraines are a type of recurring headache that involves blood vessels, nerves, and brain chemicals. One type of migraine has no preceding aura. The other type comes with an aura. Auras are sensations that come before a migraine headache occurs. They commonly include visual changes, or numbness and tingling.

Migraine
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Migraine headaches can affect a child’s performance in school, relationships with friends and family, and other factors in a child’s life. Medication should be started as soon as symptoms (pain or aura) appear. This will lessen the length of the migraine and reduce the time with associated symptoms like vomiting.

Causes

Specific genes, especially those that run in families, appear to be associated with migraines. Other causes may include nerve or blood vessel problems, environmental triggers, or a chemical imbalance. Many times, the exact cause may remain unknown.

Some factors that can trigger a migraine include:

  • Physical exertion or too little physical activity
  • Too much sleep or too little sleep
  • Missing a meal
  • Motion sickness from traveling
  • Overuse of pain medications
  • Being overweight
  • Smoking
  • Foods that contain tyramine or phenylalanine, or influence blood pressure
  • Certain environmental triggers such as flashing lights, odors, loud noises, or weather changes

Risk Factors

Migraines are more common in males before puberty and in females after puberty. The average age of onset is 7 years old (boys) and 10 years old (girls).

Factors that increase your child’s chance of migraines may include:

  • Family history of migraines
  • Infantile colic
  • Stress—migraines in children tend to increase during the school year

Symptoms

Migraines may occur in phases that may include:

Warning

A warning may come before a migraine. In the hours or days before the headache, symptoms may include:

  • A change in mood
  • A change in behavior
  • A change in the level of activity
  • Fatigue
  • Yawning
  • Food craving or decreased appetite
  • Nausea, diarrhea
  • Sensitivity to light

Aura

The most common aura is visual. The aura lasts about 15-30 minutes. It may produce the following sensations:

  • Flashing lights, spots, or zig zag lines
  • Temporary partial loss of vision
  • Speech difficulties
  • Weakness in an arm or leg
  • Numbness or tingling in the face and hands

Migraines can also occur without the presence of warning symptoms or an aura.

The Migraine Headache

Migraine pain starts within an hour of the aura ending. Symptoms include:

  • A headache (usually on one side but may involve both sides) that may be:
    • Moderate or severe in intensity
    • Throbbing or pulsating
    • More severe with movement
  • Nausea or vomiting
  • Sensitivity to light or sound
  • Lightheadedness

A Post-Headache Period

Migraines typically last from 4-72 hours. They often go away with sleep. After the headache, your child may experience:

  • Trouble concentrating
  • Fatigue
  • Sore muscles
  • Irritability
  • Mood changes

Diagnosis

You will be asked about your child’s symptoms and medical history. A physical exam will be done. Your child will also be given a neurological exam. The diagnosis is usually based on your child's symptoms.

Imaging tests may be done if your child's symptoms are severe or the neurological exam is not normal. These tests may include:

Treatment

The goal of treatment is to:

  • Treat headaches early
  • Reduce headache duration, severity, and frequency
  • Restore your child’s ability to function
  • Improve your child’s quality of life

Treatment includes a combination of therapies and may include:

Medications

Medications are considered first-line therapy for migraine headaches. The medications used depend on the severity of the headache and how your child responds to the treatment.

These may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • Acetaminophen
  • Triptans to constrict blood vessels and block inflammation—may depend on your child's age
  • Dopamine receptor blockers
  • Antiseizure medications
  • Magnesium sulfate
  • Dihydroergotamine
  • Steroids

Note: Aspirin can cause serious complications in some children with certain infections. It is best to avoid aspirin or aspirin products for children with infections.

Medications are usually taken by mouth, but may be needed as an IV in severe cases, especially with vomiting.

Therapy

Therapy may also be used to reduce the length and frequency of migraine headaches. It may be used with or without medication and may include cognitive behavioral therapy, biofeedback, or relaxation methods.

Other Treatment During the Migraine

To help your child during a migraine:

  • Apply cold compresses to painful areas of your child’s head.
  • Have your child lie in a dark, quiet room.
  • Try applying constant gentle pressure to your child’s temples.
  • Try to help your child fall asleep.

Preventing Migraines

Keep a diary to understand what factors may trigger your child's migraines.

Some steps that may help prevent future migraines includes:

  • Have you or your child keep a diary. It will help identify what triggers migraines and what helps relieve them.
  • Maintain regular sleep patterns, even during the weekend or on vacation.
  • Learn stress management and relaxations techniques.
  • Do not skip meals.
  • Exercise regularly.
  • Foods are not proven to trigger migraine, but consider keeping track of what your child eats. Foods suspected by some to trigger migraine include:
    • Nuts and peanut butter
    • Beans—lima, navy, pinto, and others
    • Aged or cured meats
    • Aged cheese
    • Processed or canned meat
    • Caffeine—intake or withdrawal
    • Canned soup
    • Buttermilk or sour cream
    • Meat tenderizer
    • Brewer's yeast
    • Avocados
    • Onions
    • Pickles
    • Red plums
    • Sauerkraut
    • Snow peas
    • Soy sauce
    • Anything with MSG (monosodium glutamate), tyramine, or nitrates

Prevention

There are no current guidelines to prevent migraine in children since the cause is not known. If your child is prone to migraines, talk to their doctor about preventive medications.

Revision Information

  • Reviewer: Kari Kassir, MD
  • Review Date: 06/2017 -
  • Update Date: 06/05/2017 -
  • American Headache Society

    https://americanheadachesociety.org

  • The National Migraine Association

    http://www.migraines.org

  • Health Canada

    http://www.hc-sc.gc.ca

  • The College of Family Physicians of Canada

    http://www.cfpc.ca

  • Headache in children. National Headache Foundation website. Available at: http://www.headaches.org/2007/10/25/headache-in-children. Accessed June 5, 2017.

  • Migraine in children and adolescents. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T255012/Migraine-in-children-and-adolescents. Updated March 28, 2017. Accessed June 5, 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 February 27, 2017. Accessed June 5, 2017.

  • Migraine—treatment of status migrainosus in children and adolescents. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T917667/Migraine-treatment-of-status-migrainosus-in-children-and-adolescents. Updated March 6, 2017. Accessed June 5, 2017.

  • Migraine—treatment of acute attack in children and adolescents. EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T917653/Migraine-treatment-of-acute-attack-in-children-and-adolescents. Updated March 6, 2017. Accessed June 5, 2017.

  • Migraines. Family Doctor—American Academy of Family Physicians website. Available at: https://familydoctor.org/condition/migraines. Updated April 2014. Accessed June 5, 2017.

  • 8/27/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T114773/Headache: Robberstad L, Dyb G, Hagen K, Stovner LJ, Holmen TL, Zwart JA. An unfavorable lifestyle and recurrent headaches among adolescents: The HUNT Study. Neurology. 2010;75(8):712-717.

  • 10/25/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T255012/Migraine-in-children-and-adolescents: Bruijn J, Locher H, Passchier J, Dijkstra N, Arts WF. Psychopathology in children and adolescents with migraine in clinical studies: a systematic review. Pediatrics. 2010;126(2):323-332.

  • 1/2/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T259238/Migraine-prophylaxis-in-children-and-adolescents: Powers SW, Kashikar-Zuck SM, et al. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA. 2013;310(24):2622-2630.

  • 1/2/2014 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T255012/Migraine-in-children-and-adolescents: Huquet A, McGrath PJ, Stinson J, Tougas ME, Doucette S. Efficacy of psychological treatment for headaches: an overview of systematic reviews and analysis of potential modifiers of treatment efficacy. Clin J Pain. 2014;30(4):353-369.