Can children experience migraines. What are the common causes of headaches in kids. How can parents identify different types of headaches in children. What treatments are available for childhood headaches. When should parents seek medical attention for a child’s headache.

Understanding Childhood Headaches: Types and Symptoms

Headaches are not exclusive to adults; children can also experience various types of headaches, including migraines. While the symptoms may differ slightly from those in adults, it’s crucial for parents to recognize the signs and understand the different types of headaches that can affect children.

Migraines in Children

Migraines are a common type of headache that can affect children of all ages, even infants. The symptoms of migraines in children may include:

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

It’s important to note that the duration of migraine pain in children may be shorter than in adults. While adult migraines typically last at least four hours, children may experience shorter episodes.

Tension-Type Headaches

Tension-type headaches are another common form of headache in children. These headaches 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)

Younger children experiencing tension-type headaches may withdraw from regular play and show a desire to sleep more. These headaches can last anywhere from 30 minutes to several days.

Cluster Headaches

While cluster headaches are less common in children, especially those under 10 years of age, they can still occur. Cluster headaches typically:

• Occur in groups of five or more episodes
• Involve sharp, stabbing pain on one side of the head
• Last less than three hours
• Are accompanied by teariness, congestion, runny nose, or restlessness

Chronic Daily Headaches

Chronic daily headaches (CDH) refer to migraines or tension-type headaches that occur more than 15 days a month. These persistent headaches may be caused by various factors, including infections, minor head injuries, or overuse of pain medications.

Common Causes of Headaches in Children

Understanding the underlying causes of headaches in children is crucial for proper management and prevention. Let’s explore some of the most common factors that can trigger headaches in kids:

Illness and Infections

Common illnesses such as colds, flu, and ear and sinus infections are frequent causes of headaches in children. In rare cases, more serious conditions like meningitis or encephalitis may also lead to headaches.

Head Trauma

Bumps and bruises to the head can result in headaches. While most head injuries are minor, it’s essential to seek prompt medical attention if a child experiences a significant head impact or if the pain steadily worsens after an injury.

Emotional Factors

Stress and anxiety, often stemming from problems with peers, teachers, or parents, can play a significant role in triggering headaches in children. Additionally, children suffering from depression may complain of headaches, particularly if they have difficulty recognizing feelings of sadness and loneliness.

Genetic Predisposition

Headaches, especially migraines, tend to run in families. Children with a family history of migraines or headaches may be more susceptible to experiencing them themselves.

Dietary Triggers

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

• Nitrates found in cured meats (e.g., bacon, bologna, hot dogs)
• MSG (monosodium glutamate), a common food additive
• Excessive caffeine consumption from soda, chocolates, and sports drinks

Neurological Issues

In rare cases, headaches may be caused by problems in the brain, such as tumors, abscesses, or bleeding. These situations typically present with additional symptoms like visual problems, dizziness, and lack of coordination.

Risk Factors for Childhood Headaches

While any child can develop headaches, certain factors may increase the likelihood of experiencing them:

• Gender: Girls are more prone to headaches after reaching puberty
• Family history: Children with a family history of headaches or migraines are at higher risk
• Age: Older teens are more likely to experience headaches

Preventive Measures for Childhood Headaches

Parents can take several steps to help prevent headaches or reduce their severity in children:

1. Ensure regular sleep schedules
2. Promote healthy eating habits
3. Encourage regular physical activity
4. Manage stress through relaxation techniques
5. Limit screen time and promote eye breaks
6. Stay hydrated
7. Identify and avoid potential food triggers

When to Seek Medical Attention

While most headaches in children are not serious, there are certain situations where prompt medical care is necessary. Parents should seek medical attention if their child’s headaches:

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

It’s always advisable to consult with a pediatrician if you have concerns or questions about your child’s headaches.

Diagnosis and Treatment Options for Childhood Headaches

Accurate diagnosis is crucial for effective management of childhood headaches. Healthcare providers may use various methods to diagnose the type and cause of headaches in children:

Diagnostic Approaches

• Medical history review
• Physical examination
• Neurological assessment
• Headache diary to track frequency, duration, and potential triggers
• Imaging studies (in some cases) such as CT scans or MRI

Once a diagnosis is established, treatment options can be explored. The approach to treating childhood headaches often involves a combination of strategies:

Medication

Over-the-counter pain relievers such as ibuprofen or acetaminophen may be recommended for occasional headaches. In cases of frequent or severe headaches, prescription medications might be necessary. It’s crucial to use medications under the guidance of a healthcare provider to avoid overuse, which can lead to rebound headaches.

Lifestyle Modifications

Implementing healthy lifestyle habits can significantly impact headache frequency and severity:

• Regular sleep schedule
• Balanced diet
• Adequate hydration
• Stress management techniques
• Regular exercise

Behavioral Therapies

For some children, behavioral interventions can be beneficial in managing headaches:

• Cognitive-behavioral therapy (CBT)
• Biofeedback
• Relaxation techniques
• Mindfulness practices

Alternative Therapies

Some families may explore complementary and alternative therapies, such as:

• Acupuncture
• Herbal supplements (under medical supervision)
• Massage therapy

It’s important to discuss any alternative treatments with a healthcare provider before implementation.

Impact of Childhood Headaches on Quality of Life

Chronic headaches can significantly affect a child’s quality of life, impacting various aspects of their daily functioning:

Academic Performance

Frequent headaches can lead to missed school days and difficulty concentrating, potentially affecting academic performance. How can parents and educators support children with chronic headaches in their educational journey? Implementing accommodations such as extended time for assignments, providing a quiet space for rest during headache episodes, and maintaining open communication with teachers can help mitigate the academic impact of headaches.

Social Interactions

Headaches may limit a child’s participation in social activities and sports, potentially affecting their relationships with peers. What strategies can help children maintain social connections despite chronic headaches? Encouraging participation in low-impact activities, fostering understanding among peers, and helping the child develop coping strategies for social situations can be beneficial.

Emotional Well-being

The unpredictability and pain associated with chronic headaches can lead to anxiety, depression, and frustration in children. How can parents support their child’s emotional health when dealing with chronic headaches? Providing emotional support, teaching stress management techniques, and considering professional counseling when necessary can help children cope with the emotional challenges of chronic headaches.

Family Dynamics

Managing a child’s chronic headaches can impact the entire family. How can families maintain balance while supporting a child with chronic headaches? Open communication, involving siblings in the care process, and seeking support from healthcare providers or support groups can help families navigate the challenges associated with childhood headaches.

Emerging Research and Future Directions in Childhood Headache Management

The field of childhood headache research is continuously evolving, with new insights and treatment approaches emerging. Let’s explore some of the current areas of focus and potential future directions:

Genetic Studies

Researchers are delving deeper into the genetic factors that may predispose children to headaches, particularly migraines. What potential implications could genetic research have for childhood headache management? Understanding genetic markers could lead to more personalized treatment approaches and potentially help identify children at higher risk for developing chronic headaches.

Neuroimaging Advancements

Advanced neuroimaging techniques are providing new insights into the brain mechanisms underlying childhood headaches. How might these advancements impact diagnosis and treatment? Improved imaging could lead to earlier and more accurate diagnosis, as well as help tailor treatments based on individual brain characteristics.

Novel Pharmacological Approaches

New medications specifically designed for pediatric headache management are being developed and tested. What potential benefits could these novel treatments offer? Targeted medications could provide more effective relief with fewer side effects, improving quality of life for children with chronic headaches.

Digital Health Solutions

The integration of technology in headache management is an emerging area of interest. How might digital tools enhance childhood headache care? Mobile apps for tracking headaches, telemedicine consultations, and virtual reality for pain management are some potential applications that could revolutionize how we approach childhood headaches.

Interdisciplinary Approaches

There is growing recognition of the importance of multidisciplinary care in managing childhood headaches. What benefits can an interdisciplinary approach offer? Combining the expertise of neurologists, psychologists, nutritionists, and other specialists can provide comprehensive care that addresses all aspects of a child’s headache experience.

As research in childhood headaches continues to advance, it offers hope for improved diagnosis, treatment, and quality of life for affected children and their families. Staying informed about these developments can help parents and healthcare providers make the best decisions for managing childhood 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.

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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.