Headaches in children – Symptoms and 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. 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.

Aug. 06, 2021

Migraine in Children | American Migraine Foundation

Thank you to Marcy Yonker, MD, FAHS for her contribution to this spotlight!

Migraine and Children: It’s a Family Affair

Migraine headaches tend to run in the family.  Parents who have experienced their own severe headaches often don’t make the connection between them and the headache complaints of their children. However, an overwhelming majority (about 70%) of children and adolescents who experience migraines have an immediate family member who also has migraines or had them when they were children.

Many adults, though, don’t realize that their headache is actually a migraine. Only 48% of adults get a migraine diagnosis—so it’s very possible that Mom might not realize that realize the “regular” headache she gets before her period is a migraine.

Migraines are different from headaches and require different treatments. Migraines are a real disorder—not just a variation of a regular headache. They can be activated by changes in brain hormones, or interactions with the trigeminal nerve, a major pain pathway in the brain.

If you have a child who experiences bad headaches that you suspect might be migraines, think about your own headache history as a guide to your children’s complaints. If you see the connection, make an appointment with a migraine specialist for a proper diagnosis for your child. It may make all the difference.

For more information, check out these sites:
https://www.mayoclinic.org/diseases-conditions/headaches-in-children/basics/symptoms/con-20034478
https://pedsinreview.aappublications.org/content/33/12/562.extract#

Barriers to Getting Help

Young migraine sufferers endure the same obstacles to getting relief from their pain as older migraine sufferers. Many myths and beliefs persist in our culture that makes it difficult to get a proper diagnosis and treatment. Even those with migraine themselves tend to downplay the impact of the pain on their lives and families. In addition, those around them also set up barriers to help, either wittingly or not.

Doctors, too, often dismiss or ignore a child’s head pain. “Too many children who see a doctor for migraine or likely migraine are not getting any medication for their pain,” says Robert A. Nicholson, PhD, Director of Behavioral Medicine at Mercy Clinic Headache Center in St. Louis. “And too few are receiving care consistent with evidence based guidelines, and far too many are being prescribed an opiate.”

If you take your child to the doctor because you are concerned about migraine, don’t be reluctant to say so and to ask about medication or other forms of treatment.

Helping Your Child Manage Migraine

Get diagnosis and treatment

Have your child see a healthcare professional (a migraine specialist if possible) to determine if the headaches are migraines, their severity and frequency, and which treatment approaches are best.

• Acute treatment is used to stop the pain and prevent the migraine from getting worse.
• Preemptive treatment is used when your child’s migraine is triggered by a known activity such as exercise or specific foods.
• Preventive treatment is maintained for months or even years to reduce the frequency, severity, and duration of an attack and lessen the pain.
• Finally, there is complementary treatment which relies on non-medical approaches to reducing pain.

For more information about finding a migraine specialist, read this.

Take your meds

Some young people need to be reminded to take their medication. Make sure you understand from your doctor how and when the medication should be taken, and take a proactive role in being sure your child complies. If your child’s migraine attacks change (become more frequent or more severe, for instance) be sure to tell your doctor since a new treatment approach may be needed.

Live healthy

Your child’s migraine attacks can be brought on by many factors, big and small—not getting enough sleep (or getting too much), stressing out about life events like a big test, family troubles, illness or death of a loved one and even outside events like natural disasters and acts of terrorism. Try to stay alert to events in your child’s life and help guide him or her to maintain healthy habits.

Manage Stress

In addition to life events that can throw your child off the track and bring on a migraine, new research in stress management (also called cognitive behavior therapy) shows it has significant value in helping youngsters with chronic headache.

Relaxation techniques, biofeedback and other stress management tools do work in reducing the severity and disability related to migraines. Although young people (and their parents) may resist this approach, evidence is mounting that it’s well worth trying when migraines are debilitating.

To read more about stress management in kids with migraine, click here: https://jama.jamanetwork.com/article.aspx?articleid=1793774. And for help finding someone who can provide CBT, look here: https://www.aapb.org/i4a/pages/index.cfm?pageid=3297

Keep a migraine diary

Many people with migraine find that keeping a diary is a great tool for understanding why they get migraines and how to prevent them. With diary entries, they can track when they have an attack, how long it lasts, what they were doing before and during the attack, what foods they ate, and how bad they headache was.  Mobile phone apps may have more appeal for your youngster and may actually help kids comply better with medication regimens and track their migraines more closely. New apps are being developed every day and you can check out some of the best here https://www.healthline.com/health-slideshow/top-migraine-iphone-android-apps#11

Migraine Hurts Children’s School, Family and Social Life

The impact of migraine on a child’s quality of life has been well documented. Emotional issues and school performance are among the most common problems—they’re as troublesome for youngsters with chronic migraine to manage as for those who have cancer or arthritis. Kids often don’t tell others about their migraines, including teachers and other kids, which may make their behavior seem confusing or anti-social.

Here’s what to be alert to and keep you involved in minimizing the negative effects of migraine on your child’s quality of life:

School

• In school, missed classes, poor or failing grades and truancy can all be symptoms that your youngster with migraines may be struggling academically.
• Parents should get involved. Pay attention to your kid’s grades and class attendance. Tell teachers and school nurses about your child’s migraine condition. Parents can work with teachers, school nurses, and other health-related educators to raise awareness of the academic barriers that youngsters with migraine face. Teachers sometimes mistake a child who is having a migraine as “daydreaming” or disinterested, which might lead them to misperceive the child as lazy or having lower intelligence. Parents should also be aware of Chronic Health Form 504: (https://www.nhlbi.nih.gov/files/docs/public/lung/guidfam.pdf) which officially prohibits discrimination against kids with disabilities if they feel their child is disabled by migraines.

Friends

• With their peers, social ostracism or exclusion happen because other kids don’t seek them out socially because they may think that a migraine attack may prevent them from taking part in group activities.
• Parents should encourage their child to be open and honest with their friends about their migraines, which can often be a tall order for teenagers in particular. However there are many studies that show that migraine in adults and children is stigmatized by others and may result in bullying and shaming by those who don’t believe it is a real medical problem that causes real pain.

Sports

• Some kids will not participate in sports or exercise because it makes their migraines worse, a factor that may make it hard for them to fit in with their peers, manage their weight, or stay healthy and active.
• Parents should support their child’s decision to opt out or limit sports activities if migraines are frequent or severe. If kids can take part in these activities, parents could encourage children to do as much as they feel they can and to learn to monitor the impact of their activity on triggering a migraine.

Home Life

• At home, kids with migraine symptoms (such as sensitivity to light and sounds) are often irritable and may withdraw to their room due to pain. Other issues that can stress family relationships are parents having to miss work because their child has a migraine, or siblings having to “chill” because their brother or sister is sick with a migraine.
• For parents, family talks and openness about a sister’s or brother’s migraine may encourage understanding and reduce resentments among siblings. Parents who are docked pay because of a sick child, or feel that missing work may jeopardize their job should know they have some protection under the Family and Medical Leave Act: (https://www.dol.gov/whd/regs/compliance/whdfs28.pdf).

What Symptoms Should I Look For in My Kids?

Sometimes, a migraine can be hard to spot. No blood or bruises, no fever or chills, no broken bones—but inside the pain is immense.

Besides your child’s complaints about intense head pain, you should be alert to some other symptoms that may mean he or she has migraines.

Generally, migraine pain may be accompanied by nausea and vomiting, sensitivity to light, sounds or odors, and your child may want to lie down in a dark room. Also be alert about unusual depression or irritability in your child. People with chronic migraine, including children, are those who have migraine attacks at least 15 days per month.

If he or she has experienced vomiting after a head blow or injury in sports or play, be on the lookout for other evidence that he or she may have had a concussion.  Migraine is a major symptom of concussion but you might also observe that he or she has a dazed, stunned or confused look, inability to remember the hit or events just before or after hit, slow response to questions, insomnia or excessive sleeping, irritability, depression, and mood swings.

See a doctor as soon as possible and learn more about sports concussions from the American Migraine Foundation.

What Triggers Migraine Attacks in Children

Cartoon Credit: Linda Causey, 2011

• Just as with adults, migraines can be triggered by a range of factors.
• Lack of sleep. This is certainly one trigger, especially in teens who tend to get two to three hours less sleep than their younger brothers and sisters.  Too much sleep can also bring on a migraine.
• Diet. This means healthy eating but also not missing meals. Overall, the best diet is a healthy diet full of vegetables and fruits, and whole grains.
• Menstruation. There is evidence that teenage girls may get more severe migraines just before or during their periods.
• Dehydration. Encourage your child to drink water periodically during the day, even to get teacher permission during classes.
• Stress. It’s everywhere, even in grade school. Worries about tests, family problems, bullying and teasing all affect young people. Sometimes it’s hard to spot, so trying asking your child about these.

Helpful Articles for Headache in Kids

Back to School with Migraines
Children Get Headaches Too!
Complementary Therapies and Coping Tools for Children with Migraine
Headaches in Kids: What Parents Can Do to Help
Kids with Chronic Migraine Do Better in School and Live with Psychotherapy and Medicine
Migraine Variants in Children
Never Too Young for Chronic Headaches!
New Research on Connection Between Migraine and Colic
Pediatric Migraine: A Primer for Teachers and School Nurses
What is This Everyday Headache All About!

Headaches in Children | Johns Hopkins Medicine

What is a headache?

A headache is pain or discomfort in the head or face area. Headaches can be single or recurrent in nature, and localized to one or more areas of the head and face.

What causes a headache?

The exact cause of headaches is not completely understood. It is thought that many headaches are the result of tight muscles and dilated, or expanded, blood vessels in the head. Although migraine headaches were previously thought to be due to dilated blood vessels in the brain, newer theories suggest that changes in brain chemicals or electrical signaling may be involved. Other headaches may be caused by an alteration in the communication between parts of the nervous system that relay information about pain, coming from the area of the head, face, and neck. Lack of sleep and poor sleep quality are often the cause of chronic headaches. Occasionally, there is an actual problem in the brain, such as a tumor or malformation of the brain, although this is rare.

The way a child exhibits a headache may be related to many factors, such as genetics, hormones, stress, diet, medications, and dehydration. Recurrent headaches of any type can cause school problems, behavioral problems, and/or depression.

What are the different types of headaches?

There are many different ways to classify headaches. One method divides headaches into two categories:

Primary headaches

These are usually caused by tight muscles, dilated blood vessels, alterations in communication between parts of the nervous system, or inflammation of the structures in the brain and are not linked to another medical condition. Types of primary headaches include the following:

Migraines

Migraines may start early in childhood. It is estimated that nearly 20 percent of teens experience migraine headache. The average age of onset is 7 years of age for boys and 10 years of age for girls. There is often a family history of migraines. Some females may have migraines that correlate with their menstrual periods. While every child may experience symptoms differently, the following are the most common symptoms of a migraine:

• Pain on one or both sides of the head (some younger children may complain of pain all over)

• Pain may be throbbing or pounding in quality (although young children may not be able to describe their pain)

• Sensitivity to light or sound

• Nausea and/or vomiting

• Abdominal discomfort

• Sweating

• Child may become quiet or pale

• Some children have an aura before the migraine, such as a sense of flashing lights, a change in vision, or funny smells

Tension headaches

Tension headaches are the most common type of headache.  Stress and mental or emotional conflict are often factors in triggering pain related to tension headaches. While every child may experience symptoms differently, the following are the most common symptoms of a tension headache:

• Slow onset of the headache

• Head usually hurts on both sides

• Pain is dull or feels like a band around the head

• Pain may involve the posterior (back) part of the head or neck

• Pain is mild to moderate, but not severe

• Change in the child’s sleep habits

• Children with tension headaches typically do not experience nausea, vomiting, or light sensitivity.

Cluster headaches

Cluster headaches usually start in children older than 10 years of age, and are more common in adolescent males. They are much less frequent than migraine or tension headaches. Cluster headaches usually occur in a series that may last weeks or months, and this series of headaches may return every year or two. While every child may experience symptoms differently, the following are the most common symptoms of a cluster headache:

• Severe pain on one side of the head, usually behind one eye

• The eye that is affected may have a droopy lid, small pupil, or redness and swelling of the eyelid

• Runny nose or congestion

• Swelling of the forehead

Secondary headaches

These are from an organic cause in the brain (problems in the structure of the brain) due to another health condition or disease, and are the least common type of headaches.

What types of headache are associated with serious illness?

The child may have varying degrees of symptoms associated with the severity of the headache depending on the type of headache. Some headaches may be more serious. Symptoms that may suggest a more serious underlying cause of the headache may include the following:

• A very young child with a headache

• A child that is awakened by the pain of a headache

• Headaches that start very early in the morning

• Pain that is worsened by strain, such as a cough or a sneeze

• Recurrent episodes of vomiting without nausea or other signs of a stomach virus

• Sudden onset of pain and the “worst headache” ever

• Headache that is becoming more severe or continuous

• Personality changes that have occurred as the headache syndrome evolved

• Changes in vision

• Weakness in the arms or legs, or balance problems

• Seizures or epilepsy

The symptoms of a headache may resemble other conditions or medical problems. Always consult your child’s doctor for a diagnosis.

How are headaches diagnosed?

The full extent of the problem may not be completely understood immediately, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a headache is made with a careful history and physical examination and diagnostic tests. During the examination, the doctor obtains a complete medical history of the child and family.

Questions commonly asked during the examination may include the following:

• When do headaches occurs?

• What is the location of the headache?

• What do the headaches feel like?

• How long do the headaches last?

• Have there been changes in walking and behavior patterns, or personality?

• Do changes in positioning or sitting-up cause the headache?

• Is your child having trouble sleeping?

• Does your child have a history of emotional stress?

• Is there a history of trauma to your child’s head or face?

If the history is consistent with migraine or tension type headaches and the neurological exam is normal, no further diagnostic testing may be necessary.

Other diagnostic tests may include:

• Blood tests. These may include a complete blood count, levels or iron, levels of ferritin, and thyroid function tests.

• MRI. A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

• CT scan. A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

• Polysomnogram. This is a painless test that is usually done in a sleep lab. It involves recording breathing and muscle movements. A polysomnogram is generally done if there is a suggestion of a sleep disorder, such as sleep apnea or another sleep related problem.

Treatment for headaches

Specific treatment for headaches will be determined by your child’s doctor based on:

• Your child’s age, overall health, and medical history

• Extent of the headaches

• Type of headaches

• Your child’s tolerance for specific medications, procedures, or therapies

• Your opinion or preference

The ultimate goal of treatment is to stop the headache from occurring. Medical management relies on the proper identification of the type of headache and may include:

• Rest in a quiet, dark environment

• Medications, as recommended by your child’s doctor

• Stress management

• Avoid known triggers, such as certain foods and beverages, lack of sleep, and fasting

• Diet changes

• Exercise

Migraine headaches may require specific medication management including:

• Abortive medicines. Medicines, prescribed by your child’s doctor, that act on specific receptors in blood vessels in the head and can stop a headache in progress.

• Rescue medicines. Medicines purchased over-the-counter, such as analgesics (pain relievers), to stop the headache.

• Preventive medicines. Medicines, prescribed by your child’s doctor, that are taken daily to reduce the onset of severe migraine headaches.

Some headaches may require immediate medical attention including hospitalization for observation, diagnostic testing, or even surgery. Treatment is individualized depending on the extent of the underlying condition that is causing the child’s headache. The extent of the child’s recovery is individualized depending on the type of headache and other medical problems that may be present.

Toddler Migraine Symptoms and Treatment

Migraine headaches can affect just about anyone, from young children to the elderly. As some readers likely know, migraines differ from standard headaches because they are recurrent and tend to be more severe.

Migraines are also called acute recurrent headaches. Their pain levels are classified as moderate to severe, and they can last anywhere from 2 to 48 hours. On top of that, some people suffer from migraines two to four times a month.

That’s more than enough for anyone to handle, but when it’s your toddler who’s getting migraines this often, you might struggle to console the child.

At PAK Pediatrics, we understand that dealing with a toddler migraine not just once in a while, but every so often, can be a lot to handle. We are here to help. When you need pediatricians for your child’s sick visit, you can come see us at our Kingston or Pittston locations.

But first, let’s learn more about the different types of migraines, the symptoms of toddler migraines, and how we treat these conditions at PAK Pediatrics.

 

Different Types of Toddler Migraines and Their Symptoms

 

As we’ve said, migraines affect people of all ages, and the effects they have change with the circumstances.

Migraines affect about 3% of preschool-age children and 4% to 11% of elementary-school children. You should also know that migraine susceptibility can run in families.

Here are some common toddler migraine types and how they usually manifest.

Common Migraine without Aura

We’ll get into what aura is in a moment. For now, a common migraine usually presents in toddlers as head pain across the forehead, and children may indicate that they want to sleep. The classic toddler migraine often lasts shorter than an adult migraine, maybe about two hours or less.

Classic Migraine with Aura

The difference with this type of migraine is that aura occurs about 10 to 30 minutes before the migraine. Aura is a type of early-warning sign that a migraine is imminent. About 10% of children who get migraines experience auras.

Aura generally presents as visual phenomena that include blurred vision, flashing lights, or blind spots. A child’s aura could also encompass motor deficiencies and speech disruptions. The migraine follows the aura and then proceeds as normal.

Tension-Type Headache

Tension-type headaches are quite common both in children and adults. They are so named due to the pressure one feels in the head and neck. External factors such as stress can also cause a tension-type headache, rather than the condition always springing up on its own. Children may tell parents they don’t want to play as normal and would prefer to sleep. This could be a sign of a tension-type headache in toddlers.

Migraine Symptoms in Children Vs. Adults

Children can experience migraines differently from adults. Here are some of the common differentiators in toddler migraines:

• More children than adults experience abdominal migraines, which may bring about stomach or abdominal pain, nausea, and loss of appetite.

• Toddler migraines are usually shorter than adult migraines, going away after about two hours.

• Migraines in children are often bifrontal, meaning the pain occurs across the forehead. Migraines in older individuals tend to be more unilateral, or located in one place.

• Toddlers with migraines might indicate they want to go into a dark, quiet room. This could be their way of telling parents that they are experiencing light and sound sensitivities.

Treatments for Toddler Migraines

Migraines in your toddler are certainly something to mention in a standard well-child visit, but if your child is experiencing significant pain from migraines, don’t wait to contact PAK Pediatrics.

The general treatment for childhood migraines starts with the pediatrician doing a physical exam of the child and checking his or her neurological function (such as movement coordination).

Extreme cases might require your child to have more advanced testing, such as MRIs or CT scans. But often, migraines can be treated at home. You should ensure your child gets enough rest and good nutrition. Our nutrition services in Kingston, PA, can help here.

You can also give your toddler over-the-counter pain relievers, such as Tylenol, when migraine symptoms occur. If taken at a migraine’s onset, most of the symptoms should be relieved.

Let PAK Pediatrics Help with Your Toddler’s Migraine

No matter what your child’s migraine symptoms are, or how long they last, migraines are not fun for anyone. If your toddler has been suffering from migraines, come see us at PAK Pediatrics. Our locations in Kingston and Pittston, PA, would be happy to schedule an appointment with you.

Make your appointment today.

Migraine headaches can affect just about anyone, from young children to the elderly. As some readers likely know, migraines differ from standard headaches because they are recurrent and tend to be more severe.

Posted: 4/14/2021 by
Lseo

Migraine Headaches (for Parents) – Nemours KidsHealth

What Are Migraines?

A migraine is a type of headache that recurs (keeps coming back). The pain is often throbbing and can happen on one or both sides of the head.

Migraines also cause other symptoms. People with migraines can feel dizzy or sick to their stomachs. They may be sensitive to light, noise, or smells.

Migraines can be disabling, and kids and teens with migraines often need to skip school, sports, work, or other activities until they feel better.

Who Gets Migraines?

Up to 10% of U.S. teens and young adults get migraines. And after age 12, during and after puberty, migraines affect girls twice as often as boys.

Experts believe that the likelihood of getting migraines runs in the family. Kids who have a parent who gets migraines have a greater chance of having them than kids without that family history.

What Causes Migraines?

The exact cause of migraines isn’t known. Scientists think that they happen because some neurons (nerves in the brain) stop working properly and send the wrong signals. This may affect the nerve system that regulates pain.

Whatever the cause, experts do agree that different things trigger (set off) migraines in people who have them.

Common migraine triggers include:

• stress
• changes in hormone levels, such as from periods or birth control pill use
• skipping meals
• dehydration
• too much caffeine or withdrawal from caffeine (suddenly having less caffeine than usual)
• some foods (alcohol, cheese, citrus fruits, pizza, chocolate, ice cream, etc.)
• sudden changes in sleep patterns
• smoking
• weather changes

What Happens During a Migraine?

Every migraine begins differently. Sometimes kids and teens get a warning that a migraine is on its way. A few hours or even days before the actual headache, they might feel funny or “not right. They might crave different foods, or feel thirsty, irritable, tired, or even full of energy. This is called a “premonition.”

Some kids get auras. These are neurological symptoms that start just before the headache and last up to an hour. An aura is different in every person, but it often affects vision. For example, a person might:

• have blurred vision
• see spots, colored balls, jagged lines, or bright flashing lights
• smell a certain odor
• feel tingling in a part of their face

Once the headache starts, light, smell, or sound may bother kids with migraines or make them feel worse. Sometimes, if they try to continue with their usual routine, they may become nauseated and vomit. Often the pain begins only on one side of the head, but it might eventually affect both sides. Trying to do physical activities can make the pain worse.

Most migraines last from 30 minutes to several hours; some can last a couple of days.

How Are Migraines Diagnosed?

Your doctor will ask a lot of questions to see what might be causing the symptoms, and will examine your child, paying particular attention to the neurological exam. He or she may ask your child to keep a headache diary to help figure out what triggers the headaches. That information will help the doctor figure out the best treatment.

Sometimes, doctors may order blood tests or imaging tests, such as a CAT scan or MRI of the brain, to rule out medical problems that might cause migraines.

How Are Migraines Treated?

Migraine headaches and their triggers can vary a lot. Treatment can depend on how severe the headaches are, how often they happen, and what symptoms a child gets with them.

Usually it helps to lie down in a cool, dark, quiet room. The doctor may prescribe pain relief medicine or medicines that help with nausea and vomiting. Some kids and teens need preventive medicines that are taken every day to reduce the number and severity of their migraines.

Some doctors teach a technique called biofeedback to their patients with migraines. This helps them learn to relax and use the brain to gain control over certain body functions (like heart rate and muscle stress) that cause tension and pain. If a migraine begins slowly, some people can use biofeedback to remain calm and stop the attack.

Adding other non-medicine therapies to the treatment plan, such as acupuncture or herbs, helps some people with migraines. But ask your health care provider about these before trying them. This is especially true of herbal treatments because they can affect more traditional methods of treatment.

Can Migraines Be Prevented?

Not all migraines can be prevented. But learning what triggers migraines and trying to avoid them can help. Have your child take a break from activities that might start a migraine, such as using the computer for a long time. If some foods are triggers, help your child skip them. Some people find that cutting back on caffeine or drinking a lot of water can help prevent migraines.

Make a plan for all the things your child has to do — especially during stressful times — so he or she doesn’t feel overwhelmed when things pile up. Regular exercise also can reduce stress and make your child feel better.

The more you and your child understand about migraine headaches, the better prepared you can be to fight them.

Kids Health Information : Migraine headache

Migraine headaches (migraines) are a type of severe headache, which is often felt on one side of the head. Some children get migraines every now and then, while others get them more than once a week.

Migraines tend to run in the family and about half of children who get migraines will continue to have them when they are adults. In teenagers and adults, migraines are more frequent in females, but in children they happen equally between boys and girls.

While they can be painful and disruptive at the time, migraines are not usually a serious problem, and they are not life-threatening. Treatment involves controlling your child’s symptoms and preventing further migraines.

Signs and symptoms of migraines

Toddlers and young children may experience headache with nausea/vomiting and they may go pale quite suddenly.

Older children and teenagers experience more adult-like migraines. The symptoms commonly include a headache, which lasts six to 12 hours, and may be:

• severe
• dull or throbbing
• all over the head, or worse on the sides of the head
• on only one side of the head.

Your child may also:

• lose their appetite, have nausea (feel sick) or vomit
• feel tired
• have stomach pain.

Some children experience an aura (visual or sensory changes that happen just before the headache starts). These can be quite distressing for children, as they may see spots or zig-zag lines; be sensitive to light, sound or smell; develop tingling of the lips; or lose part of their vision. An
aura typically lasts for a few minutes before disappearing when the headache begins.

Some children may experience certain rare features of migraine, such as dizziness or fainting (basilar migraine), tingling around the face and arms (hemiplegic migraine), or they may be suddenly confused and disorientated (acute confusional migraine). However, these symptoms may be
signs of a more serious condition, such as stroke. If your child has a headache and suddenly develops any of these symptoms, call an ambulance immediately.

Regardless of your child’s age, migraines usually get better or go away altogether with sleep.

What causes migraines?

It’s not exactly clear what causes migraines, but they are likely to happen when blood vessels of the head and neck spasm or constrict (become narrow). Minutes to hours later, the blood vessels dilate (get larger). When they dilate, they fill with blood, which causes more
pressure in the skull and a headache develops.

Many things can trigger (start) migraine headaches, including:

• being tired
• bright lights, including phone, tablet or TV screens
• loud noises
• relaxation after physical or mental stress (e.g. after exercise or extended periods of study)
• muscle tension over a long time
• smoking, or breathing in second-hand tobacco smoke
• missing meals
• drinking alcohol
• caffeine (found in coffee, many energy drinks and some medicines)
• menstruation
• using oral contraceptives (the Pill)
• heat.

For a few children, migraines can be triggered by certain foods, such as:

• food with the amino acid tyramine (e.g. aged cheese, smoked fish, chicken livers, figs, some beans)
• chocolate
• nuts or peanut butter
• fruits (especially avocado, banana, citrus fruit)
• onions
• dairy products (milk, yoghurt, cheese)
• baked goods
• meats with nitrates (e.g. bacon, hot dogs, salami, cured meats)
• foods containing monosodium glutamate (MSG)
• any processed, fermented, pickled, or marinated food.

When to see a doctor

If your child experiences frequent or severe headaches, see your GP.

There are no specific tests to diagnose migraine, but doctors can usually make the diagnosis after considering the description of your child’s headaches, and examining your child. In a very small number of children, tests may be done to rule out other causes of headache, but
most children do not need any tests.

You should also take your child to see the GP if:

• you are worried about their headaches or they are getting worse
• your child’s headache lasts for more than two days
• the headaches begin to disrupt your child’s school, home or social life
• they are having a headache more than once a week
• your child is under three years of age and experiencing headaches
• the headaches are waking your child up from sleep or they are worse in the morning.

Take your child to the nearest doctor or hospital emergency department if your child’s headache is associated with:

• neck stiffness, vomiting or high fevers
• increasing confusion, behaviour change or loss of balance
• a head injury.

There is no cure for children who experience regular migraines. However, children who get very frequent migraine headaches may be prescribed preventative medication (prophylaxis) to reduce the frequency of the headaches. Your child’s doctor will discuss what treatment is appropriate with
you.

Care at home

There are a number of ways to help your child while they are having a migraine:

• Be understanding about their distress.
• Give pain medication right at the start of the headache – before it builds up to becoming severe. Your doctor may have prescribed specific medications to take in the event of a migraine, or you can use pain relievers such as paracetamol or ibuprofen. See our fact sheet
  Pain relief for children.
• Offer fluids or a small amount of food if they can tolerate it.
• Encourage the child to sleep or rest in a cool, dark, quiet room – sleep is the best reliever of migraine headaches. 

The following may help to control your child’s symptoms and prevent further migraines.

• Anything that has triggered a migraine in the past should be avoided if possible.
• Regular meals and sleep patterns are very important.
• Alternative therapies, including relaxation techniques, can help some children.

When your child first starts getting migraines, a headache diary can help to work out the triggers. The headache diary should include:

• when the headache started and what seemed to trigger it
• how long it lasted
• which part of the head hurt
• how bad it was on a scale of 1 (mild) to 10 (severe)
• if anything helped to soothe the headache
• the time of going to bed the night before
• if there were any other symptoms 
• if school was missed because of the headache.

Key points to remember

• Migraine headache is very painful, but it is not usually a serious problem.
• There is no cure for migraine – treatment is about controlling symptoms and preventing further headaches.
• Anything that has triggered a migraine in the past should be avoided if possible.
• Good pain management at the onset of headache can prevent the build-up of headache and help in relatively quicker relief.
• Children with frequent migraines may be prescribed a preventative medication.

For more information

Common questions our doctors are asked

Does my child need a scan of their brain?

Most children do not need any tests. Usually a migraine can
be diagnosed based on the history of the episodes. If there are any concerns on
examination or unusual features in your child’s history, your doctor may
arrange a scan of your child’s brain to exclude other potential causes of
severe headache.

I used to give my teenager medication with codeine to help
his migraines. What is a good alternative to codeine?

Codeine is no longer recommended as a pain relief medicine
because it is an opioid drug  that has
been shown to offer very little additional benefit compared to similar
medicines without codeine, while being associated with potential side effects.
For bad headaches, you can give both ibuprofen and paracetamol at the same
time. If nothing provides relief, see your GP to discuss other options – there
are medications specifically formulated to help with migraines.  

What is an abdominal migraine?

Some children experience migraines in their
stomach instead of their heads – they may have pain in the middle of their
abdomen, and some of the other signs of migraine, such as nausea and tiredness.
They are well between attacks. You should discuss these symptoms with your GP.
Abdominal migraines are thought to have similar risk factors and triggers to
migraine headaches, and similar treatment is suggested, e.g. rest, sleep, pain
relief medication.

Developed by The Royal Children’s Hospital Neurology department. We acknowledge the input of RCH consumers and carers.

Reviewed May 2018.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit

www.rchfoundation.org.au.

Learning the Different Migraine Headache Symptoms in Children

Like adults, it’s not uncommon for children to develop different types of headaches, such as stress-related headaches or migraine, but they usually aren’t serious. It’s also possible for children to have chronic daily headaches.

The cause of headaches in children is wide and varied. It can be caused by anxiety, infection, minor head trauma, or even high levels of stress. Over-the-counter pain relief medications and lifestyle changes can usually treat headaches in children, but you should still know when the symptoms are no longer normal. That’s why it is important to pay close attention to the symptoms of your child’s headache. Do not hesitate to consult with a pediatrician if the symptoms persist, get worse or occur more frequently.

Migraine Symptoms in Children

Children and adults are afflicted with the same types of headaches, but they may exhibit different symptoms. For example, migraines can last for at least four hours in adults, whereas it is less than four hours in children.

It may be more challenging to identify what type of headache a child is suffering from, especially younger children who are still unable to describe the symptoms. However, certain symptoms are more likely to fall under certain headache categories. For example, children experiencing migraine may show some of these symptoms.

• Pounding, throbbing, or pulsating headache
• Vomiting
• Nausea
• Abdominal pain
• Pain that gets worse with exertion
• Extreme sensitivity to sound and light

Infants are not immune to migraines. Very young children who can’t tell you what’s wrong may cry while holding their head, indicating severe pain.

What are the Different Causes and Trigger of Migraine in Children?

Several factors may cause a child to develop a headache, which include:

• Head trauma
• Infection and illness
• Stress and anxiety
• Genetics
• Certain foods and beverages
• Too much sun exposure
• Excessive physical activity
• Loud noises
• Change in sleep patterns

When to See a Doctor?

Most headaches in children are not serious, but do not hesitate to take your child to a doctor if any of these symptoms occur together with a headache:

• Vomiting
• Visual changes
• Muscle weakness
• Symptoms that awaken your child at night
• A change in your child’s personality
• Fever
• Neck pain or stiffness
• Headaches coming from the back of the head

Although headaches in children are normal and usually nothing to worry about, it’s still a good idea to keep a close eye on their symptoms. Be ready to take them to a pediatrician if things take a turn for the worse. One of the friendly and compassionate pediatricians at Pediatrix in Phoenix will be more than happy to look after and care for your child.

90,000 Children’s migraine

Migraine headaches in children: guidelines for teachers and school health personnel.

Children get headaches too! Headache occurs at any age, even in children between the ages of two and three. The number of severe headaches peaks during adolescence. Headache symptoms in children are not at all the same as in adults. As a result, children are often left without a correct diagnosis for many years, until the headache “symptoms” into a more adult picture.Migraine headache in adults with loss of performance that lasts up to 3 days, as well as nausea, vomiting, and / or sensitivity to light and sound. Since children with severe headaches may not always be able to describe how they are feeling, this description of the symptoms will be important for parents to take action in time. With close observation and in-depth interviewing, you can get an idea of ​​your child’s headache, which will help in making a correct diagnosis. Differences in headaches in children.The episodic headaches that children experience can actually be migraines with or without an aura.

There are some notable differences when comparing the clinical symptoms of migraine between children and adults: 1. Headaches can be shorter, lasting as little as an hour or two. 2. Attacks do not happen as often. They can only happen once a month, or every few months. 3. The pain is most often localized in the forehead on both sides, which is one-sided. As children and adolescents get older, the pain tends to become one-sided.4. Young children may develop other migraine syndromes even before they complain of headaches. The two most common are cyclic vomiting syndrome and abdominal migraine.

* Cyclic vomiting syndrome is defined as regular, predictable bouts of vomiting over several weeks. These bouts of vomiting can be very severe and lead to dehydration.

* Abdominal migraine is similar to a common migraine, only instead of headache, children complain of abdominal pain.The pain is vague or cramping around the navel.

Since occasional abdominal pain or vomiting can occur due to gastrointestinal problems, parents should take this into account and consult a gastroenterologist to assess their child’s condition before starting migraine therapy.

5. Children may not be able to report on many of the common symptoms commonly associated with migraines, such as sensitivity to light or sound. They may also complain about trouble concentrating.(These symptoms can be suspected by the child’s behavior during a headache attack.)

Helping Your Child If your child has episodic headaches, it is important that the doctor diagnoses it correctly as soon as possible. After clarifying the diagnosis, your child will be prescribed effective therapy to relieve a headache attack and, if necessary, preventive treatment. Ideally, therapy should stop the headache, or at least reduce it within 2 hours, and prophylactic treatment will reduce the incidence of the headache by 50% or more.If the therapy is not effective, then you need to show the child to a pediatric neurologist or a headache specialist (cephalgologist).

ADDITIONAL THERAPY FOR CHILDREN SUFFERING WITH MIGRAINE.

Currently, there are only two approved drugs for the relief of migraine attacks in children. Most parents need to use additional ways to help their children with migraines.

There are many methods available to alleviate your baby’s suffering:

Cold use – cold compresses placed on the head and relieve headaches.For very young children, you can use bags in the shape of animals or other interesting shapes. For older children, cold compresses should be applied to the hands.

Acupuncture is a minimally invasive procedure that does not have any serious adverse reactions, however, it is important to select a well trained professional to administer the sessions.

Managing Nausea:

• Recent research has shown that wrist bands with sea salt can help regulate nausea.

• Lemon, lime, or ginger with soda and salty crackers can help calm the stomach.

• You can also use mints.

• Many adults find ginger or peppermint tea to be a sedative. If your kids don’t like a hot drink, make tea and add ice to it.

Sun and light protection. If you are at home, close the blinds and curtains in the nursery to keep the light out. When you are away from home and cannot change the environment, you need to wear sunglasses or a sleep mask on your child to protect him from irritating sunlight.

Minimization of noise. It is desirable that during a migraine attack, it is calm and quiet around. Tuck him in your bedroom and leave him alone if possible. Minimize the spread of noise in the child’s room or use ear plugs.

Temperature control. Most children with migraines prefer to wait out the attack in a cold room, so try to ventilate and cool the room as much as possible.

Aromatherapy.Using high quality oils that contain soothing aromas such as lavender, mint, or tangerine can be incredibly beneficial and safe. If you choose to use pure essential oils for aromatherapy, remember that, with the exception of lavender, oils should never be applied undiluted to the skin, as they can cause skin irritation or burns. Dilute them before use. Coconut oil is a good choice because it doesn’t smell of its own and can be easily disposed of if it gets on your clothes or bedding.

Balanced nutrition and adherence to drinking regime. It is important that your child gets enough fluids to prevent dehydration. In addition to plain water, you can dilute the fruit juice with water for a change. Using electrolyte drinks may seem like a good idea, but they often contain substances that trigger migraine attacks, so it is very important to be thoughtful and understand whether this is right for your child or not. Food should be something simple, such as chicken broth and a few crackers, if your child is able to eat anything at the time of the attack.

The author of the article is a neurologist, cephalgologist Toropova A.A.

The fastest and most effective way to get rid of a child’s migraine is – botulinum therapy .

90,000 Medicines for the emergency treatment of migraines in children and adolescents

Relevance and Review Question

Migraine is a painful and debilitating disorder that often occurs in children (under 12 years old) and adolescents (12 to 17 years old).Common symptoms during a migraine attack include headache, nausea, vomiting, and increased sensitivity to light and sound. There are many types of migraine treatments, of which the most common are paracetamol (also known as acetaminophen), ibuprofen and other anti-inflammatory drugs, and triptans. Not all triptans are approved for use in children and adolescents, and this [approval / approval] information varies from country to country.

Research characteristics

In our review, we looked at 27 randomized controlled trials of drugs versus placebo to find out which treatments were effective in relieving pain two hours after treatment. We also wanted to know what side effects these treatments might cause. A total of 7,630 children received medications in the studies. The evidence is current to February 2016.Each study included 13 to 888 participants. Their average age was 12.9 years, ranging from 8.2 to 14.7 years. Nineteen studies were funded by a drug manufacturer.

Key Findings

Ibuprofen has been shown to be effective in treating migraine in children, but the evidence is limited to only two small clinical trials. Ibuprofen is an affordable and inexpensive medication that makes it an excellent choice for migraine headaches.Paracetamol has not been shown to be effective in relieving pain in children, but we found only one small study. Triptans are a type of medicine designed specifically for the treatment of migraines, and they often have a more pronounced effect on pain relief in children and adolescents. Triptans studied in children include rizatriptan and sumatriptan, while almotriptan, eletriptan, naratriptan, risatriptan, sumatriptan, and zolmitriptan have been studied in adolescents. The combination of sumatriptan and naproxen sodium is also effective in treating migraines in adolescents.In general, there is a risk that triptan medicines may cause unwanted side effects such as taste disturbances, nasal symptoms, dizziness, tiredness / fatigue, loss of energy, nausea or vomiting. These studies did not report any serious side effects.

Quality of evidence

Overall, the quality of the evidence presented in this review was moderate for triptans, but low for paracetamol and ibuprofen, as we found very few studies.Additional research needs to consider the effects of each type of migraine treatment in children and adolescents separately.

Migraine in children

GBU RO OKB im. ON. Semashko “

Department of medical rehabilitation for children with dysfunction of the central nervous system

neurologist Sushchevskaya Julia Alexandrovna

Migraine … This word alone recalls the description of the procurator Pontius Pilate in the novel” The Master and Margarita “by M.A. Bulgakova: “Oh gods, gods, why are you punishing me? Yes, no doubt about it! It is she, she again, the invincible, terrible disease of hemicrania, in which half my head hurts. There is no money from her, there is no salvation … ”. Others will see a typical picture from an advertisement: a woman or a girl, with a suffering expression on her face, taking a magic pill – and the pain goes away immediately.

However, migraine occurs not only in adults, it is quite common in children, which frightens parents very much.

To begin with, let’s find out and what kind of disease is migraine and how does it differ from other types of headaches?

It should be said that all headaches, both in adults and in children, are divided into 2 large groups: primary and secondary. Primary headaches are not associated with the presence of any violation of the structure of the brain, secondary headaches, on the contrary, occur with organic pathology of the brain (tumors, strokes, cysts), neck (osteochondrosis of the cervical spine), systemic diseases and infections (ARVI, influenza , meningitis, etc.NS.). Migraine belongs to the first group, which means that there is no disturbance in the structure of the brain (but not its function!) With this disease.

Migraine is characterized by a hereditary predisposition – that is, if there is a migraine in parents and other relatives, its likelihood in a child increases. This disease is caused by an incorrect reaction of receptors in the vessels and cells of the brain, their interaction, in response to various types of environmental stimuli and stress. The irritants, or triggers, are individual for each child with migraine, but the main groups can be distinguished:

• psychological (stress, strong emotions, sudden changes in mood)
• hormonal (menstruation and ovulation in girls)
• environmental factors (bright light , weather change)
• food (certain foods, drinks)
• medicinal (nitroglycerin, hormones)
• other factors (fatigue, lack of sleep / oversleeping, hunger, air travel, fever).

When a child with a hereditary predisposition is exposed to any of the listed factors or their complex, a migraine attack may develop.

What are the symptoms of a migraine in a child?

Migraine pain is localized in the frontotemporal region, near the orbits, less often in the parietal region. Children 10-12 years old, adolescents and adults are characterized by pain in one half of the head, and the side can change from attack to attack. In younger children, bilateral headache is possible.Migraine attacks can begin at any time of the day, but more often the onset of the attack is noted in the afternoon or evening. High-intensity migraine headache, “intolerable”, typically throbbing, but in children it can also be pressing, bursting or breaking.

In addition to headache, migraine attacks are characterized by fear of light, sounds, nausea and, less often, vomiting; sometimes an attack may be accompanied by abdominal pain. After vomiting, as a rule, there is a relief of the general condition, and the child usually falls asleep.After sleep, the attack usually stops completely. In the interictal period, children with migraine are practically healthy.

Often, 20-60 minutes before an attack, a child develops a so-called aura: “flies” or flashes of light, a luminous line or spot in front of the eyes, loss of visual fields on one side; less often – one-sided weakness or discomfort: tingling, crawling “chills” (this phenomenon is called paresthesia) in the extremities, speech disorders. The changes that occur during the aura period are completely reversible and disappear with the development of a direct migraine attack.Sometimes the aura can “cut off” and not turn into an attack.

The average duration of attacks in most children with migraine without aura is 2-3 hours, in most children with migraine with aura, the attacks are much shorter, up to 1 hour.

What to do if you suspect your child is having a migraine attack?

First of all, you need to make sure that he does not have an infectious disease – measure body temperature, examine the skin and mucous membranes for a rash, pustules.

The child should be put to bed, dim the lights in the room, remove sources of noise, calm down, and try to calm down the parents themselves. You can put a cold compress on your forehead, it is easy to massage your temples. In severe nausea, vomiting can be induced artificially. If, within 30-40 minutes of rest, the headache has not weakened or did not go away at all, and also with a high intensity of pain, it is possible to give the child pain relievers that are allowed at a given age in an appropriate dosage (but after vomiting!) – as a rule, these are ibuprofen preparations and paracetamol.

If there is no effect from the above measures, it is possible to call an ambulance.

If the attack has passed, you should consult a neurologist yourself as soon as possible. You should remember as many details of the attack as possible and what preceded it for several hours. For the classic form of migraine, you may not need any additional examinations. In case of doubt, the doctor will prescribe an examination for the child, as well as, in any case, preventive treatment with special drugs.

In addition, children, due to the developing nervous system, also respond very well to non-drug treatment: psychotherapy, acupuncture, physiotherapy.

What measures should be taken to prevent seizures?

In addition to following your doctor’s prescriptions exactly, you should avoid factors that trigger your child’s migraine. There should be a calm emotional environment in the family and children’s team, a full night’s sleep and daytime rest.It is necessary to limit the visual load in the form of games on a computer, tablet and smartphone, watching TV up to 1-1.5 hours a day. If a child attends sports sections, then this must be done reasonably, under close supervision. The optimal duration of exercise is 20-30 minutes per day. Avoid or limit a number of foods that can provoke a migraine attack: salty and spicy foods, foods with glutamate as a preservative, tomatoes, kiwi, long-aged cheeses, sausages, chocolate, some nuts, soda, tea, coffee.For adolescents, it is necessary to explain the harm of smoking and drinking alcohol.

Procurator Pontius Pilate in Bulgakov’s novel did not have knowledge that could help him in the fight against migraines, so we can only sympathize with him. And in the modern world it is in our power to help a patient with migraine, knowing its causes and having in our arsenal modern methods of treatment: to reduce the frequency and intensity of attacks, to “control” migraines, which will help your child to live without being different from other children.

How to help a child during a migraine attack?

Do children have migraines?

Yes, it happens! More than half of adults indicate that their first migraine attack occurred in childhood – before the age of 15. However, in many children, migraines can begin even at the age of less than 5 years. Therefore, in fact, migraines in children are much more common than commonly believed.

Migraine in children is generally the same as in adults.However, in children, pain is more often bilateral. If your child has intermittent vomiting or abdominal pain that cannot be explained, this could be the onset of migraine . Be sure to mention such symptoms at your doctor’s appointment.

Does your child have a headache?

If your child complains of a headache, try to calm him or her, say that “it will all be over soon.” But if this happens for the first time, or if the headache is different from the usual (for example, more severe), start looking for its cause.You should never just think that your child is complaining of a headache in order to get attention or to get an opportunity not to do something. Seeing your distrust and irritation, the child feels stress and it is more difficult for him to cope with the pain. A new headache cannot be ignored. You know your child better than his teacher or friends. A headache can be very frightening for him, and in some cases (although very rarely) dangerous to his health.

How to tell if a child has a migraine?

Children with headaches most often have mood disorders, they experience nausea, headache, often one-sided.Sometimes the attack may be preceded by an aura. … Be prepared to provide your doctor with the following information:

• How long does the headache last?
• How often does this happen?
• Have you noticed what causes seizures?
• Where is the pain localized and what is its nature?
• Are there any accompanying symptoms (eg, increased sensitivity to light, nausea)?
• How can the seizure be stopped?

If headaches are frequent, start keeping a diary.If you have the results of any examinations of your child, take them with you to the appointment with the pediatric neurologist .

How to treat migraines in children?

Please note that children cannot be treated in the same way as adults. Most drugs (both pain relievers and those intended for the prevention of migraines) have not been tested in children, and some of them are generally prohibited. So please be careful. For example, children under 12 should not be given aspirin.Instead, paracetamol (acetaminophen, panadol) or ibuprofen (nurofen, moment) is used to relieve pain. To reduce nausea, metoclopramide (cerucal, raglan) can be taken. Never give your children any medication just because you usually use it! For the treatment of migraine in your child, all recommendations and prescriptions must be issued by a doctor. Discuss any medications you are giving or planning to give to your child with the pediatrician or Pediatric Neurologist .

Inform the teachers at the school and the school nurse that your child is suffering from migraines.This will help him avoid misunderstandings from staff and other students. Also, if you remember, medications to relieve a migraine attack work best when taken early in the attack. If your child’s migraine attacks are usually intense, accompanied by nausea or vomiting, then he needs to take medication. And it is easier to do this if the teacher or nurse promptly prompts him to take the medicine. Sometimes your child just needs to relax in a dark, quiet room, and for this you need to enlist the support of the school nurse.Do not draw too much of your child’s attention to the headache, do not make him a disabled person. Try not to create a situation in which it becomes clear to the child that he is receiving your undivided attention and may not do unwanted activities (do not do homework, do not help you around the house), only if he has a headache. Tell him that the headache is safe and will soon pass, that he needs to take medication or lie down in silence for a while, and soon he will be able to play and do his usual activities again.

So, during a migraine attack in a child:

• Try to avoid taking medications.
• Arrange for your child to rest in a dark, quiet room.
• Give the child something to eat and drink.
• Give half or whole tablet of paracetamol or ibuprofen as needed. These drugs are also available in suspension form.
• If the attack still unfolds and severe nausea appears, you can take Cerucal.
• Combined analgesics (Pentalgin, Kaffetin) are approved for use in children over 12 years old
• The only triptan that is approved for use in children is Imigran in the form of a spray.
• If you have to give your child pain relievers more than twice a week, discuss migraine prevention with your pediatrician.
• In children, attacks become more frequent under the influence of the same provocateurs as in adults. Therefore, in the case of frequent seizures, try to identify the triggers for seizures in your child.

Following the following guidelines for living with migraines can be of great help to your child:

1. Do your best to get your child’s sleep patterns in place – it is advisable for your child to go to bed and get up at about the same time every day, including weekends.
2. Provide your child with the opportunity to go in for sports, fitness, gymnastics, as this reduces stress, anxiety, improves mood and allows you to control weight (all of these factors are risk factors for increased migraine attacks).
3. The child should eat regularly and not skip meals because a decrease in blood glucose levels can lead to the development of a migraine attack. Try to arrange for your child to eat more fresh foods that are free of preservatives and chemical additives.
4. Try to reduce the amount of caffeine your child is getting. It is advisable not to exceed one cup of carbonated drinks per day.
5. Make sure your child drinks enough, especially during the summer.
6. If migraine attacks are still frequent, focus on non-drug approaches. Children can find biofeedback and relaxation techniques very helpful.

If necessary, magnesium supplements can be taken to reduce migraine attacks. If the pain is frequent and the child has to take pain relievers more than 10 days a month, see a doctor in order to cope with this situation in time. Some drugs to relieve migraine, which are used in adults, are approved for use in children.As a parent, you have a very important role to play – to educate yourself and teach your child how to manage his migraine. Migraine is a benign condition and should not be a major problem for your child.

A pediatric neurologist (pediatric neuropathologist) receives an appointment at our clinic

90,000 symptoms, causes and treatment, what is aura, abdominal and retinal migraines

Viktoriya Zorina

Saves her daughter from migraine

Author’s profile

My 12 year old daughter has been suffering from migraine attacks for two years now.

Despite her young age, her daughter suffers in an adult way: with an aura, sometimes nausea and problems with peripheral vision.

I will tell you how we cope with childhood migraines, which doctor to go to and what to do during attacks.

See your doctor

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Causes and types of migraine in children

Migraine is a disease with severe headache attacks lasting from 4 to 72 hours. Adults usually have a headache on one side, and children often have bilateral headaches. It can be throbbing and aggravated by exertion, accompanied by nausea and sensitivity to light, sounds, or smells.

Primary headaches in children and adolescents N.I. Pirogova PDF, 2.62 MB

Migraine in children – article for patients on Uptodate

Classification of migraine in children – Uptodate

The exact reasons why children develop migraines are unknown. It is now believed that there is a genetic predisposition to it.

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The first migraine attack can occur even in the earliest childhood.According to various sources, about 2.5% of children under the age of 7 have migraines; by the age of 10, this figure increases to 5%. At the same time, chronic migraine with attacks of at least 15 days a month is observed in about 1-2% of adolescents. In general, migraine attacks are unpleasant, but usually have no long-term consequences and do not lead to health problems.

Childhood migraines can be with or without aura. Aura is a temporary condition that usually occurs before the onset of pain, 5-60 minutes before it.Most often, this is a visual impairment in the form of stripes or spots in front of the eyes, but it can manifest itself as numbness in the limbs or problems with speech.

Symptoms of a child’s migraine: how it differs from an adult

Sergey Zaitsev

child neurologist, candidate of medical sciences, medical center “Neuro-Med”

Attacks of a child’s migraine often proceed differently than in adults. In adults, classic migraine is more common: attacks of acute severe pain with nausea and vomiting, sometimes with an aura, pain is felt on one side in the temporomandibular region, this is called hemicrania.Descriptions of such classic seizures can be found in the literature.

Children often have bilateral pain, and not in the temporal region, but in the forehead, crown, and occiput. Moreover, they, like adults, do not have seizures, but may be accompanied by nausea and vomiting. Another of the classic signs is intolerance to bright lights and sounds. Mood changes often, problems with mental performance appear.

At the same time, seizures in children, compared with adults, are usually shorter, often less intense and may be atypical – for example, autonomic symptoms occur: the child turns pale, dizzy, circles under the eyes, stuffy nose or ears.

In adults and adolescence, migraine is more common in girls and women, and in children under 10 years of age, migraine, especially the classic one with aura, is more common in boys.

How did a daughter get her first migraine attacks

In September 2019, a daughter, who was 10.5 years old, first complained of a headache. She explained that it hurts only on one side. The pain was not related to stress: the daughter is doing well at school, but does not consider her studies to be an important enough cause for worry.In addition, the school year began just two weeks before the first attack. An hour later, the daughter vomited, and then everything went away.

Headaches in children – Uptodate

Pathopsychology, clinical features and diagnosis of migraine in children – Uptodate

Two days later, the situation was repeated, but the attack began with an aura – darkening in the eyes and asterisks, as the daughter described this condition. This time we tried to stop the pain with the Ibuklin Junior pill, and my head stopped hurting about half an hour earlier.

Ibuclin Junior contains 100 mg of ibuprofen and 125 mg of paracetamol, the price in pharmacies starts from 90 R. Source: Sbermegamarket

One episode could be ignored, but a repetition required a doctor’s attention. Having decided that the migraine was associated with rapid growth and the onset of puberty, we still turned to the pediatrician at the OMC clinic for a referral to a neurologist. The pediatrician confirmed my assumption and gave me a referral.

The neurologist turned out to be a young professional who questioned my daughter in detail about her symptoms, state of health and possible causes of migraine.I liked that he did not seek confirmation from me and took seriously the questioning and examination of the child. He also approved the use of Ibuklin Junior tablets according to the instructions, since they help, and asked to come to an appointment if the situation recurs. The doctor did not prescribe any additional examination, since he did not see any alarming symptoms.

A neurologist suggested that migraine attacks are associated with hormonal changes in the body. Judging by the further development of events, it is: we did not find other reasons that could provoke migraines.

Symptoms and causes of migraine – Mayo Clinic blog

Diagnostics of children’s migraine

Sergey Zaitsev

Pediatric neurologist, Candidate of Medical Sciences, Medical Center “Neuro-Med”

Children most often have tension headaches and migraines – these are the most common primary headaches. That is, pain that occurs on its own and is an independent disease, in contrast to secondary headaches, which will be a symptom of another underlying disease.

Tension headache in children is diagnosed successfully, but the diagnosis of migraine is often difficult. To begin with, the child cannot always accurately describe his feelings. Usually children just complain that their head hurts, but it is rather difficult to understand where and how. In addition, children often have atypical migraine attacks.

There may still be difficulty in assessing the intensity of headache in children. Adults easily rate their feelings on a scale from 0 to 10, children have to offer visual images, such as pictures, emoticons.Here it is important to be guided by the story of adult close people: how the behavior and well-being of the child changes, how much mood and working capacity are disturbed. By these signs, you can also determine the strength of the headache.

If there are classic seizures and there were more than 4-5 of them, the diagnosis is made clinically, that is, according to the results of the medical history and physical examination. Additional research is usually not needed.

In other situations, if secondary headaches are suspected, it is usually necessary to exclude other causes.Then additional studies are prescribed.

For example, if there is a suspicion of a tumor, an MRI scan of the brain is done, and if for vascular pathology – an examination of the vessels of the neck and head. In cases where there is information about injuries or some past infections, an additional examination is also sometimes prescribed.

Very rarely, but it happens that video EEG monitoring may be required: there are epileptic headaches with vomiting, nausea, arising in the occipital region, mainly at night.Then exclusion or confirmation of epilepsy is necessary.

Treatment of migraine in children and adolescents

You should immediately consult a doctor if the pain begins after a head injury, appears in the morning, that is, the child wakes up from pain, or is accompanied by neck stiffness, fever, fainting and impaired coordination of movements. In such cases, the headache may be caused by another cause – not a migraine, but something more serious.

Our doctor found no particular reason for concern, but advised to call an ambulance if the attack does not go away for more than 15-20 minutes and is accompanied by vomiting, visual impairment or coordination, numbness or weakness in the limbs.And also turn to him again if the attacks recur, or go for examination if they become more severe.

For the treatment of childhood migraines, pain relievers are prescribed, which must be taken during attacks. As a rule, these are the usual analgesics from the pharmacy: paracetamol and ibuprofen, which are sold without a prescription. They should not be taken more than 14 days a month, otherwise abusal headaches will appear, that is, pain caused by the medicine itself. It is also worth reading the instructions if you need to relieve an attack with medicine from your home medicine cabinet before consulting a doctor.Not all drugs are suitable for children – for example, aspirin is contraindicated before age 15 due to the risk of complications such as Reye’s syndrome.

If conventional pain relievers do not work, your doctor will prescribe a prescription drug called triptans. These drugs are designed to treat migraines. They should not be drunk more than 9 times a month.

Still need to exclude triggers – what can provoke an attack. In children, this may include skipping meals, stress, lack of sleep, certain foods, such as nuts or coffee.

At the first visit, the neurologist gave us written recommendations on what can and should not be done for migraines, in addition, he allowed the use of triptans – prescription drugs for the treatment of migraines, if conventional painkillers stop helping.

During an attack of pain, the doctor advised the following scheme:

1. Take “Ibuklin Junior” or “Nurofen” in age doses.
2. If painkillers do not help, drink “Sumatriptan” – according to the instructions it is possible only from the age of 18, but triptans are also prescribed abroad for young children.The dosage here is determined only by the doctor; you cannot take such drugs on your own.
3. For nausea, add Cerucal or Domperidone.

He also advised to exclude some foods and drinks: cola, coffee, hot spices, some cheeses, chocolate with additives, bananas, nuts, legumes, tomatoes. These foods can trigger migraine headaches. However, allowed dark bitter chocolate and green tea. In addition, he advised to avoid psycho-emotional stress before bedtime.

The neurologist recommended limiting psycho-emotional stress, and in case of a severe attack, call an ambulance. I did not make a diagnosis of migraine: I think, because the attack was a single one, Sumatriptan was named after the active substance, other trade names are Sumamigren, Rapimed, Amigrenin, the price is from 77 R. Source: Lekas

Peculiarities of treatment and prevention of child migraine

Sergey Zaitsev

pediatric neurologist, candidate of medical sciences, medical center “Neuro-Med”

When migraine attacks appear, you need to consult a neurologist – you definitely need to fight this disease.Even rare seizures can cause psychoemotional disorders and reduced adaptive capacity.

Migraine is not as harmless as previously thought. At the time of an attack, vascular disorders occur, brain cells are affected. It can affect quality of life and cognitive function. If the pain is frequent and severe, accompanied by obvious neurological symptoms, it means that the disease is unfavorable, preventive control of seizures is needed.

It is important to quickly distinguish migraine from other types of headache and correctly diagnose, since in this disease special, specific treatment can be successful.

In general, childhood migraines are treated in the same way as adults. Usually, the doctor prescribes analgesics, that is, drugs that relieve pain attacks. If the attacks are short and infrequent, this is sufficient.

If the attacks are severe and frequent, it is necessary to prescribe special means and preventive therapy. Abroad, both adults and children use approximately the same drugs.

For example, triptans for relieving seizures are included in all foreign treatment protocols for childhood migraines.We do not have such recommendations, and the instructions for such drugs indicate that they are allowed from the age of 18, although in other countries they are successfully prescribed to children of younger age.

Similarly with the means for the prevention of migraine: a wide arsenal of medicines in our country is available only to adults, and children and adolescents do not have the opportunity to officially use the latest highly effective drugs.

On the other hand, non-drug methods and regimen recommendations work very well for children.An excellent result can be achieved if the child is provided with sufficient sleep, systemic physical activity, limiting the time for watching videos, removing excessive intellectual and emotional stress.

As a rule, children do not have such a strong dependence of migraine attacks on food triggers as in adults. If adults are advised to immediately exclude certain foods, then children often keep a food diary and analyze which product can provoke an attack. Usually these are foods with a high tyramine content: dried, dried, smoked and pickled products, aged cheeses, nuts, chocolate, as well as foods with a lot of food additives: flavor enhancers, flavorings, preservatives, and the like.

How did repeated migraine attacks proceed

Almost a year later, in August 2020, my daughter fainted in the bathroom, and the next day she had a migraine. As before, nothing influenced the onset of seizures: there was no stress, the sleep and dietary regime did not change. We again went to the doctors, the pediatrician routinely wrote out a referral to a neurologist, as well as blood, urine and ECG tests. Everything was in order there.

This time the neurologist prescribed additional examinations for my daughter, since she had fainting before the attack: an ophthalmologist’s consultation, an electroencephalogram, an ultrasound examination of the neck arteries.She passed all of them free of charge under the compulsory medical insurance, no deviations from the norm were found.

The main result of the visit to the doctors was the final visit to the neurologist. He reviewed the results of the examinations, repeated past recommendations and recommended to come for an examination if loss of consciousness or migraine recurs within three months. However, this did not happen.

In May 2021, my daughter had migraines with aura again. The first time Ibuklin Junior didn’t help her, and I gave her half a triptan tablet.This helped to relieve the attack.

The next day everything happened again. New symptoms were added: loss of peripheral, that is, lateral, vision, numbness of the legs and arms on the side of the migraine. While we were thinking whether to call an ambulance, the pill worked and everything went away.

Two days later, she had a third attack, not as difficult as the second, and we again went to the clinic. The neurologist examined his daughter for a long time and suggested not only visiting an ophthalmologist, but also doing an MRI of the brain to exclude a stroke.

He issued a referral to the Morozovskaya hospital, but there it was possible to get an MRI scan free of charge only after a month. I was able to enroll there for a fee the next morning because someone canceled the appointment.

Examination and management of children with headache – Uptodate

MRI of the brain with arteriography – an assessment of the condition of the arteries – cost 8300 R. In Moscow, you can find cheaper options, but I decided that it would be better to do the examination in a children’s hospital, and not in a private medical center.Fortunately, according to the results of the study, nothing unusual was found. The daughter, who was clearly nervous about what was happening, perked up after reading the conclusion, and so did I.

After the examinations, we returned to the neurologist, who wrote the final report and sent me home.

Since then, my daughter has had one short migraine attack with aura in July. There were no vision problems or numbness in the limbs. Considering that it is impossible to recover from migraines, all that remains is to cope with the attacks with the help of pills.I hope that these attacks will go away along with the completion of hormonal changes.

The conclusion based on the results of the MRI of the brain sounded encouraging At the neurologist’s appointment, according to the results of the examinations, the diagnosis was made “migraine with aura”

How much did I spend on the treatment of migraine in a child

Thanks to the fact that I was lucky to find a good neurologist in the city polyclinic, I saved a lot of money: five paid appointments would cost me about 10,500-72,175 rubles, depending on the clinic’s requests.For example, an appointment with a neurologist at the Family Doctor costs 2100-3500 RUR, at Dokdeti – 4000-6000 RUR, at the GMS Clinic – 6696 R, and at EMC – 14 435 R.

For two years we spent 9960 R

on migraine treatment

MRI of the brain with arteriography

8300 R

Maxalt Max, Spanish “Rizatriptan”

1550 R

“Ibuklin Junior”

110 R

Save

1. Migraine is a disease with severe headache attacks that last from 4 to 72 hours.It can be one-sided, less often bilateral, accompanied by an aura, nausea, sensitivity to light, sounds, odors.
2. Children also have migraines. If a child complains of pain on one side, it is most likely her. At the same time, children often have atypical migraine attacks – for example, when the head hurts from both sides.
3. There are usually no long-term consequences for migraine attacks, but they can and should be alleviated.
4. Migraine cannot be completely cured; you can only alleviate the condition with painkillers in an age-related dosage.Only a doctor should prescribe treatment.
5. Sometimes migraine has symptoms similar to those of a stroke or a tumor. To exclude other diagnoses, you need to undergo an additional examination.

Migraine in a Child: How to Treat a Child’s Headache | Child health | Health

Sometimes it is quite light and does not cause significant changes in the child’s behavior. However, children can often experience severe, paroxysmal headaches that are accompanied by nausea, marked changes in daily activity, and require frequent use of pain relievers.

About the causes and methods of treating headaches in children, Alexey Vladimirovich Sergeev, neurologist, Ph.D., “University Headache Clinic” , spoke about.

Maya Milich, AiF.ru: Why do children have a headache?

Alexey Sergeev: According to the reasons, all headaches can be divided into two large groups: primary and secondary.

Primary headaches are independent neurological diseases, the main manifestation of which is headache.In childhood, the most common primary headaches are migraines and tension headaches. They are the cause of headaches in 96% of all cases.

Secondary headaches are symptoms of infection or organic pathology. About 60% of all secondary headaches in children are due to fever in acute respiratory infections and inflammation of the paranasal sinuses. The manifestation of a serious neurological pathology: brain tumors, hydrocephalus, subarachnoid hemorrhage, meningitis – headache can occur quite rarely.

MM, AiF.ru: How to determine if a child has a headache and how much it hurts?

A. S .: To do this, you need to carefully analyze how the child’s behavior changes with headaches, for this there is even a special questionnaire.

With moderate to severe headache, the child stops all activity, seeks to close his eyes and stay in a darkened room. Often, before and during a headache attack, children experience pallor, increased sweating, “dark circles” under the eyes.

MM, AiF.ru: What causes headaches in children?

A.S .: As a rule, provocateurs of headache (migraine) in children are:

• stress,

• irregular nutrition,

• sleep disturbance,

• unhealthy diet, fast food.

MM, AiF.ru: What can be done if a child has a headache?

A. S .: If the headache does not go away on its own within 30-40 minutes during relaxation or rest (the child can lie down or fall asleep for a short time) and the intensity of the pain increases, it is necessary to use painkillers.But they must be in the correct age dosage. Do not use drugs containing acetylsalicylic acid, since they are rare at the age of 15 years, but they can lead to rather serious complications. If pain relievers do not help, you need to see a specialist.

Important! For the correct diagnosis, the doctor needs to understand in as much detail as possible the complaints of the child (if possible due to age) and / or parents. It is on the basis of complaints and on examination that a diagnosis can be made, and if a secondary nature of pain is suspected, an adequate search for the causes can be carried out.Often this is forgotten not only by parents, but also by doctors, who prescribe a lot of tests and procedures that are unnecessary and tedious for the child. It is still possible to meet a child with classic migraine at the reception, the diagnosis of which is made only clinically, with a huge folder of absolutely useless studies.

The most important questions when a child complains about a headache, the answers to which should be prepared by parents before an appointment with a doctor:

• How long have the headaches been observed (days, months, years)?

• How often does the headache hurt (how many times a week, month or year)?

• How bad is the headache?

• What can make a headache worse or easier?

• Under what circumstances does a headache occur (at school, at home, after physical exertion, when the weather changes, against the background of hunger, etc.)?etc.)?

• What other complaints accompany the headache (fear of light, sound, nausea, vomiting, dizziness, etc.)?

• Where is the headache localized (forehead, temple, back of the head or the whole head hurts)?

• How does the head hurt (presses, throbs, bursts, squeezes, etc.)?

Before visiting the doctor, it is advisable to make a list of medications that the child takes (if any), as well as a list of all the questions you are interested in.

In case of frequent headache (once a week or more), it is necessary to consult a specialist for a course of prophylaxis, which should include both drug and non-drug approaches.

Among non-drug methods, the effectiveness of biofeedback can be noted. This is training using special programs, during which the child learns to independently reduce muscle and psycho-emotional tension, which leads to a significant reduction in headaches.

MM, AiF.ru: How to understand that you urgently need to see a doctor?

A. S .: There are several basic situations for urgent contact.

The first is the appearance of a sudden severe headache, which may be accompanied by concomitant symptoms (nausea, vomiting, dizziness, etc.).etc.).

Second – increased frequency and intensification of episodes of pain (in situations where the child has headaches for a long time, but they begin to progress).

Third – pain of occipital localization.

Fourth – recurring headaches in children under 7 years of age.

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90,000 Migraine in children – causes, symptoms, diagnosis and treatment

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

General

The incidence peaks in adolescence, when the incidence of migraine is about 15%. Girls get sick 3 times more often than boys. Among schoolchildren of junior and middle 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 infant intestinal colic is its equivalents. In modern pediatrics, doctors are often faced with the chronization of the process – 1-2% of adolescents over 12 years old are diagnosed with chronic migraine.

Migraine in children

Causes

Migraine is a polyetiological disease, which makes it difficult to identify specific provoking factors. Hereditary predisposition is believed to play a large role, as the disorder often affects multiple family members. Autoimmune pathologies, viral and bacterial infections can act as a predisposing factor. The onset of a pain attack in children is associated with the influence of triggers, which are:

• Psychoemotional factors .Migraine develops with stress, severe mental strain, and an unfavorable psychological climate in the family. In adolescents, it is usually provoked by preparation for exams and admission.
• Food . The provocative role of chocolate, some types of hard cheeses, products with spicy and extractive substances has been proven. During adolescence, a headache attack can be triggered by drinking alcohol.
• Exogenous stimuli .The risk of migraine paroxysm increases with exposure to bright flashing lights, harsh odors, loud noises. For some children, pain occurs when climatic conditions change.
• Hormonal changes . In 60% of adolescent girls, the rhythm of the onset 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 cephalalgia 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. Painful sensations arise under the influence of certain triggers and are caused by dilatation of cerebral vessels. The vasoactive substances glyceryl trinitrate and calcitonin-gene-linked peptide play a role in the development of an attack.

Classification

In assessing symptoms and medical history, experts are guided by the recommendations of the International Headache Society, which were revised in 2004.Migraine is classified as primary cephalalgia (not of organic origin) and is divided into several categories:

• Migraine without aura. 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 onset 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 vertigo in children.
• Retinal migraine. The disease is characterized by a combination of cephalalgia with visual impairment or temporary blindness on the affected side. A rare option in pediatrics.

Symptoms of migraine in children

A migraine attack begins with a prodromal phase that lasts from 2 hours to several days.Symptoms of this period are nonspecific, so parents do not always notice and interpret them correctly. The child becomes restless and irritable, his mood changes quickly for no apparent reason. Babies have digestive upsets, decreased or increased appetite. Difficulty falling asleep and frequent nocturnal awakenings are noted.

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

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

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

Complications

If the disease is not treated with anti-relapse, the risk of developing migraine status increases. Moreover, all the symptoms last more than 3 days, which is extremely difficult for the child to tolerate. Even more dangerous is migraine cerebral infarction, which begins with a typical migraine attack with an aura and is subsequently complemented by persistent neurological deficits. Such 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 often occurs in girls aged 13-17 years. When the disorder is chronic, specific symptoms bother the child for more than 15 days a month for at least the last 3 months. Chronic migraine is difficult to treat, and it often causes psycho-emotional and neurological disorders.

Diagnostics

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

• MRI of the brain. Neuroimaging is indicated to rule out organic lesions in the nerve tissue that provoke 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 state of the cerebral vessels.In young children, MRI is replaced by neurosonography.
• EEG. If symptoms are supplemented by twitching of individual muscles or full-fledged convulsions, an electroencephalogram is performed to check the threshold for convulsive cerebral readiness. The study noted dysfunction of the median structures of the brain, separate foci of increased excitability. The data obtained make it possible to differentiate 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 to determine the activity of the cellular and humoral defense links.
• Serological tests . In many children, the chronicity of the disease is associated with a persistent viral infection. Antibodies to the herpesvirus group, which are most often associated with headaches, are detected routinely.According to the testimony, a test is made for the presence of antibodies to borrelia to exclude Lyme disease.

Treatment of migraine in children

Non-drug therapy

Pediatric neurologists recommend first adjusting the lifestyle: reasonably correlate physical and mental activity, avoid stress and family conflicts, ensure a full night’s sleep. Reduce the number of caffeinated beverages, spicy foods, chocolate and nuts in the diet, since these foods provoke migraine attacks.If necessary, prescribe psychotherapeutic correction, exercise therapy and relaxing massage.

Conservative therapy

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

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

Prophylactic treatment of migraine is recommended for increased frequency of cephalgia in children up to 2-3 times a month, the duration of headaches over 24-48 hours without interruption.The indications for anti-relapse therapy include the high intensity of the pain syndrome, which significantly disrupts the child’s daily activity, 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, at 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

A new group of drugs has been developed in the USA and Europe – monoclonal antibodies to calcitonin-related 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 for the prevention of relapses and chronicity of the process.

Forecast and prevention

It is impossible to completely get rid of migraine, but in 25-30% of children, after reaching adulthood, the attacks disappear. For the rest, treatment with non-drug methods and anti-relapse therapy significantly reduces the frequency of headaches and improves the quality of life.