Headaches in children – Symptoms & causes

Overview

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

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

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

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Symptoms

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

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

Migraine

Migraines can cause:

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

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

Tension-type headache

Tension-type headaches can cause:

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

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

Cluster headache

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

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

Chronic daily headache

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

When to see a doctor

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

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

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

Causes

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

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

Risk factors

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

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

Prevention

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

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

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

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

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

Migraine Headaches in Children & Teens: Parent FAQs

​​​​​​​​​​Roughly 39 million people in the United States suffer from migraines. While they most often strike adults, many children also experience intense, throbbing headaches and other symptoms of migraines. Read on for helpful information about the signs, symptoms and causes of migraines and how to help children and teens dealing with them.

What is the difference between a migraine and a hea​dache?

Migraine pain usually is more severe. It often includes throbbing on one side of the head that often worsens with activity. Migraine headaches also tend to strike with other symptoms, such as nausea, vomiting, vision problems (seeing spots or flashing lights, for example), light and sound sensitivity, and tingling.

At what age can children get m​igraines?

Any child can get a migraine. About 10% of children age 5-15 and up to 28% of teens get them. Half of people who get migraines have their first attack before age of 12. Migraines have even been reported in children as young as 18 months!

What are some migraine causes, risk factors and ​triggers?

Family history. Migraines tend to run in fam​ilies. If one parent has migraines, there is roughly 50% chance that their child will too. If both parents have them, the chance is close to 90%.

Gender. Before
puberty, boys have more migraines than girls. That flips in the teen years and by age 17, as many as 8% of boys and 23% of girls have had a migraine. For adults, migraines are more common in women.

Stress & sleep. Irregular sleep schedules – getting too much or too little sleep – can be migraine triggers. So are changes in
stress levels.

Exercise. While exercise can sometimes trigger migraines,
regular exercise may help prevent or reduce the number of attacks.

Food & fluids. Skipping meals and eating certain foods and
additives can set off migraines. Common triggers include aged cheeses and meats, chocolate, citrus fruits, red and yellow food dyes,
monosodium glutamate (MSG), and the
artificial sweetener aspartame. Too much caffeine and spicy foods can also trigger migraines, but sometimes help headaches because they act as vasodilators and expand blood vessels. Not drinking enough water and other
beverages can cause dehydration, another migraine trigger.

Weather. Stormy weather with changes in barometric pressure, extreme heat or cold, bright sunlight and glare, high humidity or very dry air all can be triggers.

Are there differen​​t stages of migraines?

Migraines often develop in stages:

1. 
   Premonitory or warning phase: tiredness, stiff neck, mood changes (can last up to 24 hours).
2. 
   
   Aura: seeing spots, squiggly lines, dizziness, weakness, numbness and/or confusion. These symptoms, which don’t happen with all types of migraines, may last up to an hour.
3. 
   Headache or attack: severe, throbbing/pulsating pain with nausea, vomiting and light sensitivity.
4. 
   Resolution: sleep ends the headache pain for some children.
5. 
   Recovery: feeling tired (lasts hours to days).

How is a m​igraine diagnosed?

The
diagnosis of a migraine​ is usually based on a thorough medical history along with physical and neurological exams. Occasionally, tests like bloodwork, MRI or lumbar punctures may be recommended.

How are mig​​raines treated?

Lifestyle changes. Keeping healthy, regular routines can help prevent or reduce the frequency and severity of migraines:

• 
  Sleep hygiene. Children, especially those with migraines, should get 8-10 hours of sleep daily. If your child has trouble sleeping, your pediatrician may recommend tests to monitor for snoring or sleep disorders, which have been linked to migraines. Make sure TVs, cell phones, tablets and other
  media devices are turned off an hour before bedtime, since they can interfere with sleep.
• ​
  Healthy diet. Eat three regular meals each day at consistent times. Avoid heavily processed foods, which tend contain more migraine triggers like additives and artificial colors and sweeteners. Drink plenty of water and other healthy beverages to stay hydrated.

Acute medications. Your child’s doctor may recommend or prescribe medications that can help during a migraine attack. These work best when taken at the first sign of an attack. Keep in mind that
medication overuse headaches may start if these are used daily or frequently. Examples of medicines that can help during a migraine include:

• Analgesic pain medicines such as
  acetaminophen and products that combine ​acetaminophen, aspirin and caffeine, and nons​teroidal anti-inflammatory medicines such as
  ibuprofen and naproxen.
• 
  Triptans, a category of drugs called selective serotonin receptor agonists. Evidence shows that combination sumatriptan/naproxen tablets and zolmitriptan nasal spray can stop headache pain within two hours.

Preventive medications. There are some medications that when taken daily can help reduce the severity and/or frequency of migraines. These tend to be “off-label,” meaning they are not approved by the U.S. Food and Drug Administration for migraines. Their risks and benefits should be discussed with your doctor. Options include:

• Cardiovascular drugs: propranolol
• Antidepressants drugs: amitriptyline

• Anti-seizure drugs: topiramate
• Antihistamines: cyproheptadine

Are there any alternative therapies​​ shown to help migraines?

There are some alternative or
natural and non-pharmaceutical approaches to migraine treatment that may help. These include:

Cognitive behavioral therapy (CBT), which focuses on coping skills, positive thinking, sticking to healthy habits, and relaxation techniques to help ease migraine pain. Research also has found that CBT combined with migraine medications is more helpful in treating migraines that medication alone.

Herbs, vitamins and minerals. Certain extracts and supplements may help with migraines, although some should be avoided for safety reasons. Talk with your child’s doctor before using any herbal or vitamin supplements. Common supplements include:

• Feverfew: this plant contains parthenolide, which some small studies suggest may help prevent migraines in some people. However, the evidence remains mixed.
• Riboflavin (vitamin B-2), coenzyme Q10 and magnesium supplements may decrease the frequency of migraines.
• Butterbur extract: plant containing petasins is
  NOT recommended because of long-term liver disease risk.

How can I help my child avoid missing s​​chool from migraines?

Children who suffer from migraines are
absent from school twice as often as other students. Talk with your child’s teachers and school nurse about ways to help avoid missed class time. A letter from the doctor explaining your child’s diagnosis and the medications they take when they feel a migraine coming on can help the conversation. Helpful
accommodations may include making sure your child has ready access to water and snacks, for example.

Additional Inf​​ormation:

• 
  Headaches: When to Call the Pediatrician
• 
  Natural Therapies for Children with Chronic Headaches
• 
  Fever and Pain Medicine: How Much To Give Your Child
• 
  American Academy of Neurology Practice Guideline Update: Acute and Preventive Treatment of Migraine in Children and Adolescents (Summary for Patients and their Families) ​
• 
  Migraine Trainer, an app developed for teens by the National Institute of Neurological Disorders and Stroke​

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Migraine in children – treatment in Moscow, classification, causes

Migraine is a chronic high-intensity headache that manifests itself in the form of attacks at different intervals. The disease can occur not only in adults, but also in children. Statistics note that it is observed in 5-8% of preschool children and in about 60-80% of adolescents. Often parents ignore such symptoms, explaining them by fatigue, however, when a migraine appears, it is recommended to consult a doctor without delay, since the treatment of migraine in Moscow is successful when contacting experienced specialists.

How to distinguish a migraine from other pain

Headache in patients of any age can be primary or secondary.

• Primary have no connection with disorders of brain structures.
• Secondary arise as a consequence of the disease. These are, for example, diseases such as cysts, tumors, osteochondrosis, infections

Migraine is a disease of the first group, that is, the structures of the brain in this case are not disturbed, but its functions can be changed.

Disease classification

The International Headache Society has created a universal classification, on the basis of which neurologists distinguish the following types of the disease:

• No aura. The headache in this case is severe, but visual and other changes in this case are not observed. The pain syndrome usually increases and is characterized by a pulsating character, and stiffness of the forehead, head and temples is observed. The pain may be made worse by bright lights or loud noises.
• With an aura The pain of a throbbing nature is complemented by other symptoms. Among them, for example, nausea, distortion of vision and smell, slowing down of speech. It is this option that is typical for adolescents, usually a migraine of this type is observed in children over 14 years old.
• With numbness of the body. The sensitivity of certain parts of the body decreases, there is a feeling of stiffness in the back and limbs. Possible slurred speech.
• It is accompanied by partial paralysis of the muscles of the eyes. The patient feels a split in the eyes, the disease is characterized by twitching eyelids, a change in the size of the pupils.
• Accompanied by basilar disorders. Such pains are typical for adolescents during puberty, especially for girls at the beginning of the menstrual cycle. The pain is accompanied by nausea, dizziness, and sometimes loss of consciousness.
• Retinal, accompanied by visual disturbances, in some cases blindness is possible. For children, this form of migraine is usually not characteristic.

It is worth pointing out a few additional facts about the aura. Its characteristic symptoms usually appear before the onset of the pain attack itself – about 30 minutes or an hour. These are visual disturbances of a different nature – for example, glare or flashes that occur before the eyes. Sometimes at the same time numbness of the limbs is felt, speech slows down.

Causes of migraine in children

Very often, migraine is inherited: if the parents suffered from it, it is highly likely that the child will also have it. The source of the disease is an incorrect reaction that occurs in the brain receptors as a response to stress or environmental factors. This disorder may not manifest itself until triggers occur. The main causes of migraine that become triggers for the onset of a severe headache:

• Psychological – most often stress.
• Food – sometimes pain occurs as a reaction to the use of certain foods.
• Medications – especially often migraine causes the use of hormonal drugs.
• External factors such as weather changes.

The trigger can also be lack of sleep, overwork, jet lag, SARS and other diseases with fever.

The causes of migraine also depend on the age of the patient. The most common conditions under the age of 12:

• weather changes;
• difficulty sleeping;
• high physical activity, provoking an overload of the vestibular apparatus;
• congenital vascular pathologies;
• stress;
• bright lights, noise, strong odors;
• immunity weakening:
• infectious diseases.

The appearance of migraine in children over 12 years old is caused by several other factors, among them:

• hormonal changes;
• eating disorders;
• difficulties in relationships with peers;
• addiction to drugs;
• conflicts in the family;
• difficulties in study and personal life;
• sleep disorders;
• high physical activity;
• lack of vitamins;
• allergic reaction to drugs.

How do you know if it’s a migraine?

Migraine in children is not uncommon, and it is the most common type of headache in childhood. During an attack, the pain is localized in the forehead, in the area of ​​the temples, less often in the region of the crown. In babies, an attack is manifested by a decrease in activity, they cry loudly, especially from bright lights and loud sounds. Even without crying, the eyes may turn red. If a child cannot explain his condition in words, not only crying will help to suspect a migraine, but also the fact that the baby rubs his temples or eyes. How to understand that it is a migraine? At a younger age, the disease can be distinguished due to some periodic syndromes, including:

• Vomit. The pain is accompanied by bouts of nausea and vomiting. They occur regularly, while in between attacks there are no similar and other symptoms that would suggest a gastrointestinal disorder. The urge to vomit during attacks can be frequent – every 2-4 hours, per hour the number of urges can reach five pieces. Additionally, the baby feels increased sensitivity to light and loud sounds.
• Paroxysmal dizziness. A syndrome in which the head begins to spin even with a slight tilt or turn, and dizziness is also accompanied by vomiting and nausea.
• Abdominal migraine. The term refers to a condition that is characterized by abdominal pain lasting up to three days. No other disorders of the gastrointestinal tract were observed.

In children older than 10 years, as in adults, the manifestations are different:

• pain occurs, as a rule, only on one side of the head;
• an attack most often begins in the evening or afternoon, but in general, the likelihood of an attack and the intensity of pain do not depend on the time of day;
• pain has a high intensity, can be characterized by children as unbearable;
• photophobia occurs;
• an attack may be accompanied by nausea, abdominal pain often appears;
• in case of vomiting after it, the condition improves;
• feeling of constriction in the temporal or frontal region.

The attack stops completely after sleep. The symptoms described above do not occur until the next attack. The pain characteristic of this disease is usually severe, throbbing.

What should I do if my child has a migraine attack?

During an attack, it is important, first of all, to make sure that the baby is not sick – to check if there is a rash on the skin, if the temperature has risen. Parenting steps:

• put the baby to bed;
• eliminate external stimuli – sound, light;
• make a light massage of the temples;
• make a cool compress on the forehead;
• induce vomiting if the pain is accompanied by nausea.

If the condition does not improve within 40 minutes, pain medication can be given. Their use is also advisable at the beginning of an attack, with a high intensity of pain. This should be done only after vomiting, paying attention to the recommended dosage according to age. If all of the above measures did not help, you need to call an ambulance.

After eliminating the attack, you need to contact a neurologist. At the same time, it is important to remember all the details of the disease, as well as external factors that caused migraine. An experienced doctor diagnoses the disease from the first consultation, and in controversial situations will prescribe additional examinations.

Diagnostics

The task of a neurologist is not only to establish a diagnosis, but also to find the main trigger that provokes pain. Usually, a survey of the baby and parents is enough to make a diagnosis; in case of doubt, additional studies are prescribed. Especially often they are required if the child is small and cannot independently describe his condition and what he feels. The following studies may be ordered:

• Ultrasound of vessels and arteries to study blood flow.
• MRI and CT to assess the work of the central nervous system.
• Encephalography, which allows you to determine nerve impulses and evaluate the activity of neurons.

If necessary, a blood test can be prescribed, as well as a consultation of specialists – a gastroenterologist, an ophthalmologist, a neurosurgeon.

Migraine treatment

Indications for treatment – the appointment of a specialist, self-treatment in this case is recommended to be avoided! The main goal of therapy is to reduce the number of seizures. Doctors prefer to choose preventive methods, minimizing the number of drugs prescribed to the child. For this purpose, triggers are identified that stimulate the development of pain syndrome in order to exclude them from the child’s life. If this does not help, safe drugs are selected, the intake of which is usually prescribed by the course.

Indications for treatment and treatment to the doctor are as follows:

• Frequent seizures (more than two per month).
• Low effectiveness of painkillers.
• Prolonged attacks with high intensity of pain.
• Intolerance to drugs used to eliminate an attack.
• The presence of an aura.

In addition, it is very important to exclude factors that are triggers. A few general recommendations:

• Ensuring a calm environment both at home, in the family, and in the team that the child visits.
• Normalization of the daily routine with proper rest and sleep.
• Limiting visual load, which increases when playing games on a smartphone or computer.
• Control of physical activity. It should be present in the daily routine, but not more than 30 minutes daily.
• Limiting daily TV viewing.
• Reducing the consumption of foods that can provoke an attack. These are, for example, spicy dishes, too salty, canned food, kiwi, chocolate, nuts, tomatoes, coffee, soda, tea.
• Eliminate the impact on the child’s life of alcohol and smoking.

In addition, it is important to teach the child to recognize an attack and talk about it to parents. Toddlers often do not notice the approaching pain during an exciting game, talking about it only when nausea and vomiting appear. There is also the opposite situation: children perceive any headache as a migraine, even if it is not. It is important to teach the child to distinguish migraine from other types of pain and to inform parents in a timely manner about the onset of an attack.

Our Center offers effective migraine treatment in Moscow, which is possible thanks to the use of advanced methods and the experience of our neurologists. We will help reduce the frequency of the principles, reduce their intensity and teach you how to control migraine, which will help the child live calmly, without fear of a headache.

Migraine in children. What is migraine in children?

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

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

ICD-10

G43.0 G43.1

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

General information

The peak incidence occurs in adolescence, when the frequency of migraine is about 15%. Girls get sick 3 times more often than boys. In schoolchildren of primary and secondary grades, the condition occurs in 5% of cases, and among preschoolers, about 2.5% suffer from migraine. There is evidence that the disease can begin in infancy and early childhood, and its equivalents are infantile intestinal colic. In modern pediatrics, doctors often face a chronic process – 1-2% of adolescents over 12 years of age are diagnosed with chronic migraine.

Migraine in children

Causes

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

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

Pathogenesis

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

Classification

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

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

Symptoms of migraine in children

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

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

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

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

Complications

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

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

Diagnostics

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

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

Treatment of migraine in children

Non-drug therapy

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

Conservative therapy

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

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

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

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

Experimental treatment

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

Prognosis and prevention

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

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

Sources

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