What are the common types of headaches in children. How can parents identify migraine symptoms in kids. What factors contribute to headaches in children. When should parents seek medical attention for a child’s headache. How can childhood headaches be prevented or managed.

Types of Headaches in Children: From Migraines to Tension Headaches

Children, like adults, can experience various types of headaches. The most common include migraines, tension-type headaches, and in rare cases, cluster headaches. Each type presents with distinct characteristics and symptoms, making it crucial for parents to understand these differences for proper management and treatment.

Migraines in Children: More Than Just a Headache

Migraines in children can be particularly challenging to diagnose, as their symptoms may differ from those experienced by adults. In children, migraine pain often lasts for a shorter duration compared to adults, where it typically persists for at least four hours.

Key migraine symptoms in children include:

• Pulsating or throbbing head pain
• Pain that worsens with physical activity
• Nausea and vomiting
• Abdominal pain
• Extreme sensitivity to light and sound

Is it possible for infants to experience migraines? Yes, even infants can suffer from migraines. However, due to their inability to verbalize their discomfort, they may express their pain through crying or rocking back and forth.

Tension-Type Headaches: The Most Common in Children

Tension-type headaches are another frequent occurrence in children. They are characterized by:

• A pressing tightness in the muscles of the head or neck
• Mild to moderate, non-pulsating pain on both sides of the head
• Pain that doesn’t worsen with physical activity
• Absence of nausea or vomiting (unlike migraines)

How long do tension-type headaches typically last in children? These headaches can persist anywhere from 30 minutes to several days. Younger children experiencing tension headaches may withdraw from regular play and exhibit a desire to sleep more.

Cluster Headaches: Rare but Intense

While uncommon in children under 10 years of age, cluster headaches can occur. They are characterized by:

• Sharp, stabbing pain on one side of the head
• Duration of less than three hours
• Accompanying symptoms like teariness, congestion, runny nose, or restlessness

Cluster headaches typically occur in groups of five or more episodes, ranging from one headache every other day to eight a day.

Chronic Daily Headaches in Children: When Pain Becomes Persistent

Chronic daily headaches (CDH) refer to migraines and tension-type headaches that occur more than 15 days a month. These persistent headaches can significantly impact a child’s quality of life and daily functioning.

What causes chronic daily headaches in children? CDH may result from various factors, including:

• Infections
• Minor head injuries
• Overuse of pain medications, even over-the-counter ones

Parents should be vigilant about their child’s headache frequency and consult a healthcare professional if headaches become a regular occurrence.

Recognizing Red Flags: When to Seek Medical Attention for Your Child’s Headaches

While most headaches in children are not serious, certain symptoms warrant immediate medical attention. Parents should be alert to the following red flags:

• Headaches that wake the child from sleep
• Increasing frequency or severity of headaches
• Changes in the child’s personality
• Headaches following a head injury
• Persistent vomiting or visual changes accompanying the headache
• Headaches accompanied by fever and neck pain or stiffness

If any of these symptoms occur, it’s crucial to seek prompt medical care. Even if these red flags are not present, parents should not hesitate to consult their child’s doctor if they have concerns or questions about their child’s headaches.

Unraveling the Causes: What Triggers Headaches in Children?

Understanding the underlying causes of headaches in children is essential for effective management and prevention. Several factors can contribute to the development of headaches in young individuals:

Illness and Infection: Common Culprits

Many childhood illnesses can trigger headaches. These include:

• Common colds
• Flu
• Ear infections
• Sinus infections

In rare cases, more serious conditions like meningitis or encephalitis may cause headaches. However, these typically present with other severe symptoms and require immediate medical attention.

Head Trauma: When Bumps and Bruises Lead to Headaches

Minor head injuries can result in headaches. While most head traumas in children are not severe, it’s essential to monitor symptoms closely. If your child experiences a hard fall or blow to the head, observe them carefully and seek medical attention if the headache worsens over time.

Emotional Factors: The Mind-Body Connection

Children, like adults, can experience headaches due to emotional stress. Common triggers include:

• Problems with peers
• Difficulties with teachers
• Family conflicts

Moreover, children with depression may complain of headaches, particularly if they struggle to recognize and express feelings of sadness and loneliness.

Genetic Predisposition: The Family Factor

Headaches, especially migraines, often run in families. If you or your partner suffer from migraines, your child may be more prone to developing them as well.

Dietary Triggers: Food for Thought

Certain foods and beverages can trigger headaches in children. These include:

• Nitrates (found in cured meats like bacon, bologna, and hot dogs)
• MSG (a common food additive)
• Caffeine (present in soda, chocolates, and some sports drinks)

Excessive consumption of these substances can lead to headaches in susceptible children.

Brain-Related Issues: Rare but Serious Causes

In rare cases, headaches may be caused by problems within the brain itself. These can include:

• Brain tumors
• Brain abscesses
• Bleeding in the brain

These conditions typically present with other symptoms such as visual problems, dizziness, and lack of coordination. If you suspect any of these issues, immediate medical evaluation is crucial.

Risk Factors: Who’s More Likely to Experience Headaches?

While any child can develop headaches, certain factors may increase the likelihood. Children more prone to headaches include:

• Girls after puberty
• Children with a family history of headaches or migraines
• Older teenagers

Understanding these risk factors can help parents and healthcare providers be more vigilant in monitoring and managing headaches in susceptible children.

Prevention Strategies: Keeping Childhood Headaches at Bay

While it may not be possible to prevent all headaches, certain strategies can help reduce their frequency and severity in children:

Establish Healthy Lifestyle Habits

Encouraging a healthy lifestyle can significantly impact headache occurrence. Key habits include:

• Maintaining a regular sleep schedule
• Eating balanced meals at consistent times
• Staying hydrated throughout the day
• Engaging in regular physical activity

Manage Stress and Emotional Wellbeing

Given the role of emotional factors in triggering headaches, it’s crucial to help children develop stress management skills. This can include:

• Teaching relaxation techniques
• Encouraging open communication about feelings and concerns
• Ensuring a supportive home and school environment

Identify and Avoid Triggers

Help your child recognize potential headache triggers. This might involve keeping a headache diary to track patterns and identify specific foods, activities, or situations that precede headaches.

Limit Screen Time

Excessive screen time can contribute to eye strain and headaches. Implement reasonable limits on TV, computer, and smartphone use, especially before bedtime.

Regular Check-ups

Ensure your child has regular medical check-ups. This allows for early detection and management of any underlying health issues that might contribute to headaches.

Treatment Approaches: Managing Headaches in Children

When headaches do occur, various treatment options are available. The approach often depends on the type and severity of the headache:

Over-the-Counter Medications

For mild to moderate headaches, over-the-counter pain relievers such as acetaminophen or ibuprofen can be effective. However, it’s crucial to use these medications as directed and avoid overuse, which can lead to medication overuse headaches.

Prescription Medications

For more severe or frequent headaches, especially migraines, a doctor may prescribe specific medications. These might include triptans or other migraine-specific drugs.

Lifestyle Modifications

Often, simple lifestyle changes can make a significant difference. This might include adjusting sleep patterns, modifying diet, or implementing stress-reduction techniques.

Alternative Therapies

Some children may benefit from alternative approaches such as acupuncture, biofeedback, or cognitive-behavioral therapy. These should be explored under the guidance of a healthcare professional.

The Role of Parents: Supporting Children with Headaches

Parents play a crucial role in managing and preventing headaches in their children. Here are some ways to provide support:

Create a Supportive Environment

Ensure your child feels comfortable discussing their headaches. Create an open dialogue about their symptoms and concerns.

Help with Trigger Identification

Assist your child in identifying and avoiding potential headache triggers. This might involve keeping a headache diary or making gradual lifestyle adjustments.

Encourage Healthy Habits

Model and encourage healthy lifestyle choices that can help prevent headaches, such as regular exercise, proper hydration, and stress management techniques.

Advocate for Your Child

If headaches are impacting your child’s school performance or social life, work with teachers and school administrators to ensure appropriate accommodations are in place.

Seek Professional Help When Needed

Don’t hesitate to consult healthcare professionals if your child’s headaches are frequent, severe, or causing significant distress. A pediatric neurologist or headache specialist can provide valuable insights and treatment options.

Understanding and managing headaches in children requires a comprehensive approach. By recognizing symptoms, identifying triggers, implementing preventive strategies, and seeking appropriate treatment when necessary, parents can help their children navigate the challenges of childhood headaches. Remember, while headaches are common in children, they should not be dismissed or overlooked. With proper care and attention, most children can find relief and maintain a high quality of life despite occasional headaches.

Headaches in children – Symptoms & causes

Overview

Headaches in children are common and usually aren’t serious. Like adults, children can develop different types of headaches, including migraines or stress-related (tension) headaches. Children can also have chronic daily headaches.

In some cases, headaches in children are caused by an infection, high levels of stress or anxiety, or minor head trauma. It’s important to pay attention to your child’s headache symptoms and consult a doctor if the headache worsens or occurs frequently.

Headaches in children usually can be treated with over-the-counter (OTC) pain medications and healthy habits such as a regular schedule for sleeping and eating.

Products & Services

Symptoms

Children get the same types of headaches adults do, but their symptoms may be a little different. For example, migraine pain in adults often lasts at least four hours — but in children, the pain may not last as long.

Differences in symptoms may make it difficult to pinpoint headache type in a child, especially in a younger child who can’t describe symptoms. In general, though, certain symptoms tend to fall more frequently into certain categories.

Migraine

Migraines can cause:

• Pulsating or throbbing head pain
• Pain that worsens with activity
• Nausea
• Vomiting
• Abdominal pain
• Extreme sensitivity to light and sound

Even infants can have migraines. A child who’s too young to tell you what’s wrong may cry or rock back and forth to indicate severe pain.

Tension-type headache

Tension-type headaches can cause:

• A pressing tightness in the muscles of the head or neck
• Mild to moderate, nonpulsating pain on both sides of the head
• Pain that’s not worsened by physical activity
• Headache that’s not accompanied by nausea or vomiting, as is often the case with migraine

Younger children may withdraw from regular play and want to sleep more. Tension-type headaches can last from 30 minutes to several days.

Cluster headache

Cluster headaches are uncommon in children under 10 years of age. They usually:

• Occur in groups of five or more episodes, ranging from one headache every other day to eight a day
• Involve sharp, stabbing pain on one side of the head that lasts less than three hours
• Are accompanied by teariness, congestion, runny nose, or restlessness or agitation

Chronic daily headache

Doctors use the phrase “chronic daily headache” (CDH) for migraines and tension-type headaches that occur more than 15 days a month. chronic daily headache (CDH) may be caused by an infection, minor head injury or taking pain medications — even nonprescription pain medications — too often.

When to see a doctor

Most headaches aren’t serious, but seek prompt medical care if your child’s headaches:

• Wake your child from sleep
• Worsen or become more frequent
• Change your child’s personality
• Follow an injury, such as a blow to the head
• Feature persistent vomiting or visual changes
• Are accompanied by fever and neck pain or stiffness

Talk to your child’s doctor if you’re worried or have questions about your child’s headaches.

Causes

A number of factors can cause your child to develop headaches. Factors include:

• Illness and infection. Common illnesses such as colds, flu, and ear and sinus infections are some of the most frequent causes of headaches in children. Very rarely, meningitis or encephalitis may cause headaches.
• Head trauma. Bumps and bruises can cause headaches. Although most head injuries are minor, seek prompt medical attention if your child falls hard on his or her head or gets hit hard in the head. Also, contact a doctor if your child’s head pain steadily worsens after a head injury.
• Emotional factors. Stress and anxiety — perhaps triggered by problems with peers, teachers or parents — can play a role in children’s headaches. Children with depression may complain of headaches, particularly if they have trouble recognizing feelings of sadness and loneliness.
• Genetic predisposition. Headaches, particularly migraines, tend to run in families.
• Certain foods and beverages. Nitrates — a food preservative found in cured meats, such as bacon, bologna and hot dogs — can trigger headaches, as can the food additive MSG. Also, too much caffeine — contained in soda, chocolates and sports drinks — can cause headaches.
• Problems in the brain. Rarely, a brain tumor or abscess or bleeding in the brain can press on areas of the brain, causing a chronic, worsening headache. Typically in these cases, however, there are other symptoms, such as visual problems, dizziness and lack of coordination.

Risk factors

Any child can develop headaches, but they’re more common in:

• Girls after they reach puberty
• Children who have a family history of headaches or migraines
• Older teens

Prevention

The following may help you prevent headaches or reduce the severity of headaches in children:

• Practice healthy behaviors. Behaviors that promote general good health also may help prevent headaches for your child. These lifestyle measures include getting plenty of sleep, staying physically active, eating healthy meals and snacks, drinking up to eight glasses of water daily, and limiting caffeine.
• Reduce stress. Stress and busy schedules may increase the frequency of headaches. Be alert for things that may cause stress in your child’s life, such as difficulty doing schoolwork or strained relationships with peers. If your child’s headaches are linked to anxiety or depression, consider talking to a counselor.

• Keep a headache diary. A diary can help you determine what causes your child’s headaches. Note when the headaches start, how long they last and what, if anything, provides relief.

  Record your child’s response to taking any headache medication. Over time, the items you note in the headache diary should help you understand your child’s symptoms so that you can take specific preventive measures.

• Avoid headache triggers. Avoid any food or drinks, such as those containing caffeine, that seem to trigger headaches. Your headache diary can help you determine what prompts your child’s headaches, so you know what to avoid.
• Follow your doctor’s plan. Your doctor may recommend preventive medication if the headaches are severe, occur daily and interfere with your child’s normal lifestyle. Certain medications taken at regular intervals — such as certain antidepressants, anti-seizure medications or beta blockers — may reduce the frequency and severity of headaches.

Headaches in children – Symptoms & causes

Overview

Headaches in children are common and usually aren’t serious. Like adults, children can develop different types of headaches, including migraines or stress-related (tension) headaches. Children can also have chronic daily headaches.

In some cases, headaches in children are caused by an infection, high levels of stress or anxiety, or minor head trauma. It’s important to pay attention to your child’s headache symptoms and consult a doctor if the headache worsens or occurs frequently.

Headaches in children usually can be treated with over-the-counter (OTC) pain medications and healthy habits such as a regular schedule for sleeping and eating.

Products & Services

Symptoms

Children get the same types of headaches adults do, but their symptoms may be a little different. For example, migraine pain in adults often lasts at least four hours — but in children, the pain may not last as long.

Differences in symptoms may make it difficult to pinpoint headache type in a child, especially in a younger child who can’t describe symptoms. In general, though, certain symptoms tend to fall more frequently into certain categories.

Migraine

Migraines can cause:

• Pulsating or throbbing head pain
• Pain that worsens with activity
• Nausea
• Vomiting
• Abdominal pain
• Extreme sensitivity to light and sound

Even infants can have migraines. A child who’s too young to tell you what’s wrong may cry or rock back and forth to indicate severe pain.

Tension-type headache

Tension-type headaches can cause:

• A pressing tightness in the muscles of the head or neck
• Mild to moderate, nonpulsating pain on both sides of the head
• Pain that’s not worsened by physical activity
• Headache that’s not accompanied by nausea or vomiting, as is often the case with migraine

Younger children may withdraw from regular play and want to sleep more. Tension-type headaches can last from 30 minutes to several days.

Cluster headache

Cluster headaches are uncommon in children under 10 years of age. They usually:

• Occur in groups of five or more episodes, ranging from one headache every other day to eight a day
• Involve sharp, stabbing pain on one side of the head that lasts less than three hours
• Are accompanied by teariness, congestion, runny nose, or restlessness or agitation

Chronic daily headache

Doctors use the phrase “chronic daily headache” (CDH) for migraines and tension-type headaches that occur more than 15 days a month. chronic daily headache (CDH) may be caused by an infection, minor head injury or taking pain medications — even nonprescription pain medications — too often.

When to see a doctor

Most headaches aren’t serious, but seek prompt medical care if your child’s headaches:

• Wake your child from sleep
• Worsen or become more frequent
• Change your child’s personality
• Follow an injury, such as a blow to the head
• Feature persistent vomiting or visual changes
• Are accompanied by fever and neck pain or stiffness

Talk to your child’s doctor if you’re worried or have questions about your child’s headaches.

Causes

A number of factors can cause your child to develop headaches. Factors include:

• Illness and infection. Common illnesses such as colds, flu, and ear and sinus infections are some of the most frequent causes of headaches in children. Very rarely, meningitis or encephalitis may cause headaches.
• Head trauma. Bumps and bruises can cause headaches. Although most head injuries are minor, seek prompt medical attention if your child falls hard on his or her head or gets hit hard in the head. Also, contact a doctor if your child’s head pain steadily worsens after a head injury.
• Emotional factors. Stress and anxiety — perhaps triggered by problems with peers, teachers or parents — can play a role in children’s headaches. Children with depression may complain of headaches, particularly if they have trouble recognizing feelings of sadness and loneliness.
• Genetic predisposition. Headaches, particularly migraines, tend to run in families.
• Certain foods and beverages. Nitrates — a food preservative found in cured meats, such as bacon, bologna and hot dogs — can trigger headaches, as can the food additive MSG. Also, too much caffeine — contained in soda, chocolates and sports drinks — can cause headaches.
• Problems in the brain. Rarely, a brain tumor or abscess or bleeding in the brain can press on areas of the brain, causing a chronic, worsening headache. Typically in these cases, however, there are other symptoms, such as visual problems, dizziness and lack of coordination.

Risk factors

Any child can develop headaches, but they’re more common in:

• Girls after they reach puberty
• Children who have a family history of headaches or migraines
• Older teens

Prevention

The following may help you prevent headaches or reduce the severity of headaches in children:

• Practice healthy behaviors. Behaviors that promote general good health also may help prevent headaches for your child. These lifestyle measures include getting plenty of sleep, staying physically active, eating healthy meals and snacks, drinking up to eight glasses of water daily, and limiting caffeine.
• Reduce stress. Stress and busy schedules may increase the frequency of headaches. Be alert for things that may cause stress in your child’s life, such as difficulty doing schoolwork or strained relationships with peers. If your child’s headaches are linked to anxiety or depression, consider talking to a counselor.

• Keep a headache diary. A diary can help you determine what causes your child’s headaches. Note when the headaches start, how long they last and what, if anything, provides relief.

  Record your child’s response to taking any headache medication. Over time, the items you note in the headache diary should help you understand your child’s symptoms so that you can take specific preventive measures.

• Avoid headache triggers. Avoid any food or drinks, such as those containing caffeine, that seem to trigger headaches. Your headache diary can help you determine what prompts your child’s headaches, so you know what to avoid.
• Follow your doctor’s plan. Your doctor may recommend preventive medication if the headaches are severe, occur daily and interfere with your child’s normal lifestyle. Certain medications taken at regular intervals — such as certain antidepressants, anti-seizure medications or beta blockers — may reduce the frequency and severity of headaches.

Migraine in children | Rassvet Clinic

Do children have headaches? Yes, it definitely hurts. Children are characterized by approximately the same types of headaches as adults. One of the most common and worrying is migraine, and let’s talk about it.

Migraine in a child can occur at any age and manifest itself in different ways. Infants do not complain of headache, but they can see its precursors, such as benign paroxysmal torticollis: head-tilting episodes that may be accompanied by vomiting and loss of body control. There are also studies showing a link between migraine without aura and colic.

Young children may have episodes during which they are less active than usual. Occasionally, vomiting occurs and the child may cry, rock in place, or hide, which may indicate a headache. In some cases, babies with migraine act as if they are dizzy: for example, they are afraid to walk.

School-age children can complain about headaches and how they feel about them. At this age, pain most often affects the forehead. Migraine pain lasts from 1 hour or more, is often accompanied by sensitivity to light and noise, there may be nausea and vomiting.

Symptoms of migraine in adolescents are similar to those in adults. It is pulsating, one-sided, accompanied by nausea or vomiting. Adolescents recognize their pain quite clearly and can pay attention to the aura, mood swings before an attack, and the gradual development of pain. A migraine attack at this age usually lasts from 4 to 72 hours.

Some children with migraine experience vision changes, tingling and numbness of the extremities, or difficulty speaking within a few minutes (5 to 60) before the onset of the headache. These neurological symptoms that precede the headache are called “aura”.

Visual aura is most common and may include flashing lights, zigzag lines or partial loss of vision (for cattle), visual “snow” or unusual phenomena: the image of an object remains in the field of view when the object itself has already been removed (palinopsia). It is important to know that a migraine aura usually occurs in front of one eye, spreads gradually, is usually flat, and has no specific colors.

Migraine is a primary headache, so we will not find changes on MRI, CT and other examination methods. In most cases, the cause of a child’s headache can be determined by obtaining a complete medical history and examination. Additional research is usually not required.

Diagnosis

In order to make a diagnosis of migraine, doctors use special diagnostic criteria that are suitable for children over 5 years of age.

A. At least five attacks of headache fulfilling criteria B to D.

B. Headache lasting 30 minutes or longer (without treatment).

C. Headache has at least one of the following characteristics:

• pain of moderate or severe intensity;
• unilateral or bilateral headache;
• throbbing or pressing pain;
• exercise intolerance, avoidance of walking or playing.

D. Headache associated with at least one of the following symptoms:

• loss of appetite, stomach discomfort or dizziness;
• sensitivity to light and sounds, as evidenced by the inability to watch TV or play on a computer, set-top box;
• Presence of nausea or vomiting during headache.

Е. Headache was not associated with other nosologies.

But in some cases, MRI examination of the brain is still worth it. What are these cases?

• Changes in the state that the neurologist finds during the examination.
• Sudden onset of headache.
• Pain is aggravated by straining, coughing, sneezing.
• Pain is worse when lying down.
• Under 6 years of age.
• No family history of headache.
• Recently had a head injury.
• Headache accompanied by fever.
• Headache that is new or progressive.

If any of these criteria are met, the doctor will order an MRI of the brain to rule out other causes of the headache.

Diagnosis – migraine. What to do?

Learn to stop an attack.

For migraine it is important to stop the attack as soon as possible. For this, ibuprofen, paracetamol or naproxen can be used in children.

It is important not to use combined analgesics and preparations containing caffeine, because their frequent use can lead to an increase in headaches. It is also necessary to abandon analgin and aspirin due to their side effects.

If these drugs do not help, you can talk to your doctor about using triptans. In Russia, children are allowed sumatriptan from the age of 18 (abroad from the age of 5). The most common side effects of triptans are jaw or chest tightness and mild drowsiness.

It is important to know that active movement, relaxing music and aromatherapy cannot help a child at the moment of an attack – these remedies will rather exacerbate the headache. It is better to invite the child to lie down in a quiet and dark place.

Learn to prevent the development of headaches.

Prevention of migraine begins with the search for triggers – stimuli that provoke the development of a headache. For each person, these incentives are different, but there are several of the most frequent ones: stress, disruption of the regimen, reduced sleep, menstruation.

Find out what triggers your child’s migraine with a headache diary. For an effective assessment of the diary, it is necessary to keep it for 3 months, noting in it when the headache began, how long it lasted, how it was stopped, what was provoked, how it started, what was accompanied. You can download the diary here, keep it on paper yourself or use applications and bots, for example, migrebot.

Non-drug methods.

Cognitive Behavioral Therapy – not only helps with anxiety and depression, which affect the frequency of headaches, but also with nervous cognitive attitudes associated with headaches (for example, “I will always have a headache”).

Mindfullness is a mindfulness training based on meditation. Helps reduce stress, improve psychological well-being and reduce headache days.

Cefaly is a transcutaneous trigeminal nerve stimulator, which is one of the main links in the development of migraine. It can help and stop a headache, and prevent it.

Medical methods.

Headache can be prevented by medication using certain anticonvulsants (topiramate, valproic acid), antidepressants (amitriptyline), and beta-blockers (propranolol). However, modern studies show that the effect of most of them is comparable to placebo. Therefore, some experts now suggest choosing cognitive-behavioral therapy and learning to live with migraine to start treatment. If these methods are not available, doctors, together with the patient, decide on the appointment of one of the drugs described above, based on the presence of concomitant diseases and side effects. For example, topiramate is contraindicated in people with urolithiasis and underweight, and amitriptyline is contraindicated in people with arrhythmias.

Effective in adults but not needed in children:

• botulinum toxin – indicated and proven effective in treating chronic migraine in adults, was as effective as saline in a study on chronic migraine in children;
• monoclonal antibodies are a good method, but not indicated for children, due to the risk of cessation of growth;
• biofeedback – in children has limited evidence-based effectiveness, in several studies comparing classical therapy and biofeedback, biofeedback clearly loses.

Migraine is an insidious disease and significantly reduces the quality of life, but timely diagnosis and rationally selected therapy will improve a child’s life and help him enjoy every new day again.

Author:

Frolova Anastasia Valentinovna
pediatric neurologist

Migraine in children. What is migraine in children?

IMPORTANT
The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Migraine in children is a type of primary headache that has a polyetiological origin and is paroxysmal in nature. The disease is manifested by unilateral or bilateral cephalalgia in the frontotemporal zone, nausea and vomiting, autonomic symptoms. Its development is preceded by a prodromal period and, in some patients, an aura. Clinical examination is enough to diagnose pathology. Brain MRI, general clinical, immunological and serological tests help to clarify the causes. Treatment of migraine includes modification of daily life, pain relief with analgesics and serotonin receptor agonists, anti-relapse therapy.

ICD-10

G43.0 G43.1

• Causes
• Pathogenesis
• Classification
• Symptoms of migraine in children
• Complications
• Diagnostics
• Treatment of migraine in children
  • Non-drug therapy
  • Conservative therapy
  • Experimental treatment
• Prognosis and prevention
• Prices for treatment

General information

The peak incidence occurs in adolescence, when the frequency of migraine is about 15%. Girls get sick 3 times more often than boys. In schoolchildren of primary and secondary grades, the condition occurs in 5% of cases, and among preschoolers, about 2. 5% suffer from migraine. There is evidence that the disease can begin in infancy and early childhood, and its equivalents are infantile intestinal colic. In modern pediatrics, doctors often face a chronic process – 1-2% of adolescents over 12 years of age are diagnosed with chronic migraine.

Migraine in children

Causes

Migraine is a polyetiological disease, which makes it difficult to identify specific provoking factors. It is believed that hereditary predisposition plays a large role, since the disorder often occurs in several family members. Autoimmune pathologies, viral and bacterial infections can be a predisposing factor. The onset of a pain attack in children is associated with the influence of triggers, which are:

• Psycho-emotional factors. Migraine develops under stress, severe mental strain, unfavorable psychological climate in the family. In adolescents, it is usually provoked by preparing for exams and admission.
• Food products. The provocative role of chocolate, some types of hard cheeses, products with spicy and extractive substances has been proven. In adolescence, a headache attack can be caused by alcohol intake.
• Exogenous incentives. The risk of migraine paroxysm increases when exposed to bright flashing lights, harsh aromas, loud sounds. In some children, pain occurs when climatic conditions change.
• Hormonal changes. In 60% of adolescent girls, the rhythm of the appearance of paroxysms depends on the menstrual cycle. Headaches are associated with changes in the levels of estrogen and progesterone in the body.

Pathogenesis

In practical pediatric neurology, the theory of neurovascular cephalgia is taken as a basis. According to her, the symptoms of the disease are caused by a primary dysfunction of the central nervous system, which triggers the trigemino-vascular system of neurogenic inflammation. Pain sensations arise under the influence of certain triggers and are due to dilatation of cerebral vessels. The vasoactive substances glyceryl trinitrate and calcitonin gene-related peptide play a role in the development of an attack.

Classification

When evaluating symptoms and anamnestic data, specialists are guided by the recommendations of the International Headache Society, which were revised in 2004. Migraine is classified as primary cephalalgia (not having an organic origin) and is divided into several categories:

• Migraine without aura. It occurs in 70% of primary school children and about 35% of adolescents. The condition is characterized by simple attacks of cephalalgia without visual, olfactory, tactile symptoms.
• Migraine with aura. The main variant of the disease during puberty. The appearance of cephalalgia is preceded by specific neurological signs that last for several hours.
• Periodic syndromes of childhood. These include cyclic vomiting, abdominal migraine, paroxysmal benign dizziness in children.
• Retinal migraine. The disease is characterized by a combination of cephalalgia with visual disturbances or temporary blindness on the side of the lesion. A rare variant in pediatrics.

Symptoms of migraine in children

A migraine attack begins with a prodromal phase that lasts from 2 hours to several days. The symptoms of this period are non-specific, so parents do not always notice and interpret them correctly. The child becomes restless and irritable, his mood changes rapidly for no apparent reason. Babies have digestive disorders, a decrease or increase in appetite. Difficulty falling asleep and frequent nocturnal awakenings.

In children of preschool and primary school age, paroxysms of migraine differ from those in adolescents and adults. Symptoms are short-term (from half an hour to 3 hours), and the headache has a bilateral localization. The pain syndrome is most intense in the frontal and temporal region, discomfort occurs less frequently in the parietal zone, and cephalalgia in the occipital region is uncommon in children. The patient may describe the pain as squeezing, pressing, throbbing.

The intensity of a migraine ranges from mild discomfort when the child can play and study, to severe pain, which is forced to lie still in a dark room. The attack is supplemented by vegetative symptoms. The patient becomes pale, “dark” circles are clearly visible under the eyes, the face and neck sweat heavily. Sometimes there is tearing, redness of the eyes, clear discharge from the nose.

In adolescents, the symptoms of migraine resemble its classic course in adults. Headache is localized on one side (hemicrania), symptoms persist for 8-12 hours or more. The disorder is usually accompanied by an aura. These are mainly visual effects (flickering dots and lines, loss of visual fields), less often there is a feeling of crawling, a violation of the sensitivity of individual zones on the trunk or limbs.

Complications

If anti-relapse treatment of the disease is not carried out, the risk of developing migraine status increases. Moreover, all the symptoms last more than 3 days, which is extremely difficult for a child to tolerate. Even more dangerous is migraine cerebral infarction, which begins with a typical migraine attack with aura and is subsequently supplemented by a persistent neurological deficit. These conditions require urgent hospitalization.

In pediatric neurology, there is an increase in cases of chronic migraine, which accounts for more than 73% of all recurrent headaches in children. The complication occurs more often in girls aged 13-17 years. When the disorder is chronic, specific symptoms bother the child for more than 15 days per month for at least the last 3 months. Treatment of chronic migraine is difficult, and it often causes psycho-emotional and neurological disorders.

Diagnosis

When examining a child with a pediatric neurologist, a detailed collection of complaints and anamnesis of the disease is of decisive importance. To objectively assess symptoms, a visual analog scale is used. Diagnosis is based on international criteria for migraine. Instrumental and laboratory diagnostics are designed to exclude other causes of cephalalgia and identify the etiology of the disease. Usually held:

• Brain MRI. Neuroimaging is prescribed to exclude organic lesions of the nervous tissue that provoke a secondary headache. In the pictures, the doctor examines in detail the structure of the brain and its membranes, and MR angiography is shown to study the condition of the cerebral vessels. In young children, MRI is being replaced by neurosonography.
• EEG. If the symptoms are supplemented by twitching of individual muscles or full-fledged convulsions, an electroencephalogram is performed to check the threshold for convulsive cerebral readiness. In the study, dysfunction of the median structures of the brain, separate foci of increased excitability are noted. The data obtained make it possible to differentiate between migraine and epilepsy.
• Blood tests. In the hemogram, an increase in ESR is sometimes found, which indicates an inflammatory process. The neurologist receives valuable information when assessing acute-phase blood parameters. To clarify the immune status of the body, an extended immunogram is performed with the determination of the activity of the cellular and humoral defense link.
• Serological reactions. In many children, the chronicity of the disease is associated with a persistent viral infection. Routine methods detect antibodies to a group of herpes viruses, which are most often associated with headaches. According to indications, they put a test for the presence of antibodies to Borrelia to exclude Lyme disease.

Treatment of migraine in children

Non-drug therapy

Children’s neurologists recommend that you first adjust your lifestyle: reasonably correlate physical and mental activity, avoid stress and family conflicts, and ensure a good night’s sleep. In the diet, reduce the number of caffeinated drinks, spicy foods, chocolate and nuts, as these foods provoke migraine attacks. If necessary, psychotherapeutic correction, exercise therapy and relaxing massage are prescribed.

Conservative therapy

Treatment of migraine in children consists of 2 phases: attack relief and anti-relapse therapy. To eliminate the painful symptoms, drugs of the group of non-steroidal anti-inflammatory drugs (paracetamol, ibuprofen, metamizole sodium) are mainly used. NSAIDs successfully cope with pain of moderate intensity. Second-line therapy includes selective serotonin receptor agonists, caffeinated combination agents, beta-blockers, and calcium channel blockers.

Treatment with analgesics requires care not to provoke drug-induced headache. Reception of NSAIDs is allowed no more than 12 times a month, and the use of funds of the second group – up to 2 times a week. To stop vomiting during the attack period, treatment is carried out with specific antiemetics. Taking these medications significantly improves the child’s well-being and increases the effectiveness of pain relief.

Prophylactic treatment of migraine is recommended when cephalgia in children increases up to 2-3 times a month, the duration of headaches is over 24-48 hours without a break. The indications for anti-relapse therapy include a high intensity of the pain syndrome, which significantly disrupts the daily activity of the child, the presence of comorbid pathologies in the form of insomnia, anxiety disorders, and obesity.

In the interictal period, therapy includes several groups of drugs: antihistamines, antidepressants, anticonvulsants. In adolescents, drug treatment lasts at least 6 months; in primary school age, therapy begins with short courses of 8-12 weeks. To prevent side effects, drugs are prescribed in minimal therapeutic doses, gradually increasing the dosage.

Experimental treatment

In the USA and Europe, a new group of drugs has been developed – monoclonal antibodies to calcitonin-gene-related peptide (CGRP), which is involved in the pathophysiology of neurovascular pain attack. The treatment is at the stage of clinical trials in pediatric practice, but doctors can already judge its effectiveness in preventing relapses and chronicizing the process.

Prognosis and prevention

It is impossible to completely get rid of migraines, but in 25-30% of children, attacks disappear when they reach adulthood. For the rest, treatment with non-drug methods and anti-relapse therapy significantly reduces the frequency of headaches and improves the quality of life. Secondary prevention measures include the normalization of the child’s lifestyle, the exclusion of typical triggers.

You can share your medical history, what helped you in the treatment of migraine in children.

Sources

1. Migraine in children. Features of diagnostics and modern possibilities of therapy / A.V. Sergeev // RMJ “Medical Review”. – 2018.
2. Migraine in children. Clinical recommendations of the All-Russian Society of Neurologists.