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What Causes Migraines In Children

Migraine Headache In Children Medications

Migraine Headaches in Children

The drug treatments of migraine headache and associated symptoms can be divided into

  • analgesic ,
  • prophylactic therapies.

Analgesic and abortive therapy

Analgesic and abortive therapies are for the treatment of occasional severe headache attacks and related symptoms. Analgesic and abortive medications should not be used frequently because they may cause rebound headaches when children stop taking them. In general, the earlier in an attack the pain is treated, the less severe the pain becomes. The longer the wait before starting therapy, the more difficult the pain is to control. Established migraines are notoriously difficult to treat successfully.

Digestion temporarily slows or stops during migraine attacks, delaying absorption of oral medications. In addition to drug therapy approaches, other approaches to reducing the severity of many childhood migraines include avoiding sensory stimulation , applying ice packs, and resting in a quiet, dark room.

Preventive medications

Abortive drugs

The following drugs are used to treat quickly stop migraine headaches in mid attack. They have little preventive value.

The first group is the “triptans,” which specifically target serotonin. They are all chemically very similar, and their action is similar.

Analgesics Nsaids And Nonspecific Analgesics

Acetaminophen and ibuprofen are the most commonly used over-the-counter treatments for pain relief and antipyretics in children. For acute migraine treatment, acetaminophen is used in doses of 15 mg/kg, and ibuprofen in doses of 7.5 10 mg/kg. Both are effective and well tolerated, but ibuprofen is an overall better alternative for pain relief. Our experience with pediatric migraineurs has shown that when given at the beginning of the attack, a combination of acetaminophen and a caffeine compound relieves the headache faster and it diminishes its intensity with greater efficacy than either agent alone.

Ketorolac is another NSAID used mostly in the emergency department. At this time we only have one study regarding the use of ketorolac in pediatric patients suffering from migraine at the emergency room. It was used an intravenous formula, starting from 0.5 mg/kg to a maximum of 30 mg/dose. Ketorolac was effective in 55.2 % of the patients in one hour. An oral formula is also available for home treatment with a dosage of 0.75 mg/kg .

When administrated daily, these types of treatments can lead to analgesic-rebound headache. This problem is often under-recognized and very hard to treat. The patient enters a vicious circle, and headaches can become self-perpetuating. Analgesic rebound headache answers well to amitriptyline given for a short period of time with minimal sedation effects.

How Is Pediatric Migraine Diagnosed

To diagnose migraine, you can expect a doctor to conduct a physical examination and take a history. Young children might need help recalling their symptoms, how long they lasted, and what events happened before the migraine episode.

Writing down the circumstances around migraine episodes is important to track the frequency and duration. This is called a headache diary. It may be helpful to bring this information to the doctor.

Migraine cannot be diagnosed through blood tests or diagnostic scans, but a doctor might use these methods to rule out other conditions that share symptoms with migraine.

If a doctor diagnoses your child with migraine, ask for a written treatment plan. It can also be helpful to schedule a follow-up appointment to evaluate whether the treatment plan is working.

Lifestyle changes may help prevent your childs migraine episodes. These can include:

  • not skipping meals

Recommended Reading: Blinding Migraine

What Is A Headache In Children

A headache is pain or discomfort in one or more areas of the head or face. Headaches can happen once in a while. Or they may happen often.

Headaches are often divided into 2 groups, based on what causes them:

  • Primary headaches. These are not linked to another health condition. They are usually caused by tight muscles, widened blood vessels, changes in nerve signals, or swelling in parts of the brain.

  • Secondary headaches. These are a less common type of headache. They are caused by a problem in the brain, or another health condition or disease.

Types of primary headaches include:

  • Tension headache. These are the most common type of headache. Stress and mental or emotional conflict can trigger tension headaches.

  • Migraine. Migraines may start early in childhood. Researchers estimate that nearly 1 in 5 teens has migraine headaches. The average age they can start is 7 years old for boys and 10 years old for girls. There is often a family history of migraines. Some girls may have migraines that happen with their menstrual periods.

  • Cluster headaches. Cluster headaches usually occur in a series that may last weeks or months. This series of headaches may return every 1 to 2 years. These headaches are much rarer than tension headaches or migraines. They can start in children older than age 10. They are more common in teen boys.

What To Expect When Treatment Starts

What You Need to Know About Migraine in Children

Right away, start keeping a headache diary to help you track how well medication and therapy are working. Bring the diary to your child’s follow-up appointments so the doctor can check it and tweak the treatment program, if necessary.

If your child’s symptoms get worse or happen more often even with treatment, ask the doctor to refer you to a headache specialist.

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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

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

Medicines To Treat The Migraine And Tension Type Headaches

  • Ibuprofen and paracetamol are both safe to use in children to treat headache, unless advised otherwise by your doctor or pharmacist. Both should be used according to the instructions on the bottle or packet.

  • Triptans are an alternative to regular pain relief such as ibuprofen and paracetamol. There are different triptans which are available in various formats, such as tablets, melts, nasal spray and injection. Triptans can cause tingling sensations, warm flushes or tightness.

Also Check: Are Migraines A Sign Of Pregnancy

Migraine Headache In Children Medical Treatment

    Medical treatment of migraine headaches in children is based on the following: education of children and parents or caregivers about migraine triggers, creation of a plan of immediate treatment for the attacks, and consideration of preventive medicines or measures for children with frequent migraines.

    Education

    The doctor should also assure parents that the headache is not caused by a brain tumor or other life-threatening condition. A regular bedtime, strict meal schedules, and not overloading the child with too many activities are important. Helping the child recognize migraine triggers is helpful but often difficult. Ridding migraine triggers reduces the frequency of headaches in some children but does not completely stop occurrences.

    A headache diary can be used to record triggers and features of attacks. Triggering factors that occur up to 12 hours prior to an attack should be noted. Other important factors to include are as follows:

    • Date and time the attack began
    • Type and location of headache pain
    • Symptoms before the headache
    • All food and drink consumed prior to the attack
    • Bedtime, wake time, and quality of sleep prior to the attack
    • Menstrual periods
    • Medications taken and their side effects

    Unfortunately, even the most diligent person cannot always identify specific migraine triggers.

    Immediate treatment

    Prevention and Therapy

    How Are Headaches Diagnosed In A Child

    Kids Migraines- What a Pain!

    The healthcare provider will ask about your childs symptoms and health history. He or she may also ask about your familys health history. He or she will give your child a physical exam. The physical exam may include a neurological exam.

    Your child may be asked questions, such as:

    • When do headaches happen?

    • How long does the pain last?

    • Do changes in position such as sitting up cause the headache?

    You may be asked questions about your child, such as:

    • Does your child have changes in walking?

    • Does your child have changes in behavior or personality?

    • Is your child having trouble sleeping?

    • Does your child have a history of emotional stress?

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

    If a more serious condition is suspected ,your child may also have tests, such as:

    • MRI. This test uses large magnets and a computer to make detailed images of organs and tissues in the body.

    • CT scan. This test uses X-rays and a computer to make detailed images 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 standard X-rays.

    • Spinal tap . This test measures cerebrospinal fluid pressure. It may also be used to check for an infection in the CSF.

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    Migraine Headache In Children Causes And Symptoms

    The exact cause of migraine headaches is unknown. Some migraines are thought to be due a temporary deficiency of the brain chemical serotonin. Many of the drugs effective in treating migraines target this chemical. Some migraineurs know that their headaches are triggered by something they eat, drink, or a particular activity.

    The most common triggers include:

    Heres How To Treat Abdominal Migraines

    Itâs hard for doctors to treat a medical issue without a specific known cause. And while that might be frustrating for parents who see their children struggling with abdominal pain, there are ways to help diminish the discomfort. âWithout a clear understanding of the mechanism of disease, the treatment is limited to ruling out more sinister issues, and focusing on preventing episodes of AM,â explains Dr. Perelman. âThis includes typical interventions such as proper hydration, good sleep hygiene, and limiting stress.â You might even want to take your child to a therapist to help address other issues, particularly if the AM is stress-related. âAdminister cognitive-behavioral therapy to your child to relieve stress,â Dr. Victoria Glass, MD, a practicing physician with Farr Institute tells Romper. âThis may improve some symptoms before reaching the doctor’s office.â

    If the abdominal migraines might be due to something your kid is snacking on, a nutritionist will be included in your childâs medical team to eliminate anything that could irritate their tummy. âThere can also be certain food triggers: citrus, caffeine, cheese, chocolate, carbonated drinks, colorings and flavorings such as MSG,â says Dr. Scott, but advises that triggers can be different for each child. But if you can pinpoint a potential reason for the pain â whether itâs poor sleep, flashing lights, travel, or stress â those triggers should be avoided.

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    What Is An Abdominal Migraine

    Mostly common in children, abdominal migraine are episodic abdominal pains with various other migraine features. The child might complain of severe abdominal pains without any headache symptoms. This condition is largely misunderstood and under diagnosed due to lack of information and awareness.

    This condition is common in children with abdominal pain especially if there is a family history of migraine. Abdominal migraine is one of the most common causes of functional abdominal pain in children. Many sufferers will have headaches at other times too or go on to get more classical symptoms of migraine later. Some continue to get abdominal migraine symptoms into adulthood.

    Chronic and recurrent abdominal pain is a very distressing symptom that causes significant morbidity in affected children impairing their school performance and overall quality of life. Abdominal migraine is one of the most common causes of functional abdominal pain in children

    Symptoms Of Migraines In Children

    Common Types of Migraine Headaches and Symptoms: What Kind ...

    Children may exhibit the symptoms of migraines differently. However, the following are the most common symptoms of migraine in children .

    • Pain in one or both sides of the head or even all over the head.
    • Throbbing, pounding, or pulsating headache
    • Sensitivity to light or sound
    • Nausea with or without vomiting
    • Abdominal discomfort
    • Sweating
    • Child becomes quiet or pale
    • Experiencing an aura before the migraine, such as seeing flashing lights or experiencing vision changes or funny smells.

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    Heres What You Need To Be Aware Of When It Comes To Abdominal Migraines

    While they can be unpleasant , abdominal migraines do go away. And for the most part, they arenât dangerous, either. Still, in some instances, you might need to seek medical attention right away, particularly âif the pain is severe, accompanied by fever, loss of appetite, inability to pass urine, passage of bloody or black stool, this should prompt a visit for urgent evaluation,â Dr. Perelman advises.

    Abdominal migraines might be a precursor to further migraines in the future. âAMs eventually resolve with age and time,â says Dr. Scott. âHowever, a high percentage of these children will later develop migraine headaches.â If there is a family history of migraines, you might want to speak to your childâs pediatrician as well as a pediatric oncologist to find out what the next steps should be.

    Although it sucks to see your little sweetie in pain, just keep in mind that eventually, abdominal migraines will go away â permanently. But if you ever have any questions about the severity of the condition , you should trust your own gut and talk to your childâs pediatrician to seek out the answers you need.

    Studies cited:

    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.

    Recommended Reading: How Common Are Visual Migraines

    What Types Of Headaches Can Kids Get

    Kids can get the same types of headaches as adults, including:

    • Migraines, which cause moderate to severe pain and often nausea and vomiting
    • Tension headaches, which may be related to tight muscles and increased stress
    • Cluster headaches or frequent episodes of intense pain around an eye that can occur over many days
    • Chronic daily headaches that occur on at least 15 days of the month

    Its important to know how to recognize the different types of headaches, says Tonia Sabo, M.D., Pediatric Neurologist at the Childrens Health Headache Clinic, Medical Director of the Neuro-Concussion program and Associate Professor at UT Southwestern. Knowing what type of headache your child is suffering from, and what is causing that headache, can help you treat it and prevent it from occurring in the future.

    To help prevent migraines and headaches, Dr. Sabo encourages you to get to know your childs headache triggers.

    Prevention Of Migraine In Children

    Headaches and Children

    The identification of triggers plays a pivotal role in preventing migraines. Maintain a headache diary for your child, where you can enter the possible triggers of every migraine episode. Write down details, such as when the headache started, the painâs location, severity and duration, and effective medicines. Also, write down the amount of sleep your child got, meals, fluid intake, physical activity level, any factors that may have contributed to stress, changes in the weather, etc. .

    The following lifestyle modifications can help prevent migraine attacks in children .

    • Ensure eight to ten hours of sleep daily.
    • If the child has trouble sleeping, the pediatrician may recommend tests to monitor snoring or other sleep disorders predisposing them to migraine attacks.
    • Turn screens off an hour before bedtime.
    • Ensure regular meals thrice a day at the same time.
    • Avoid heavily processed meals that may be loaded with additives, preservatives, artificial colors, or sweeteners.
    • Ensure that the child consumes ample fluids to prevent dehydration.

    Inform your childâs school and teachers about their condition, and ensure they are equipped with the necessary medicines and knowledge to care for the child. Younger children may feel afraid during an episode of intense pain. Thus, it is essential for the parent to stay calm and reassure the child in these scenarios. Contact your childâs doctor if you notice any new, unusual symptoms.

    References:

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    Diagnosis And Treatment Of A Headache And Stomach Ache In A Child

    Your doctor will take a health history and perform a physical exam. If the pain in your childs head is getting worse, your doctor will perform a neurological exam to check for issues in the brain. If the history is consistent with migraine or tension headaches and the neurological exam is normal, no further diagnostic testing may be necessary.

    Imaging tests such as an MRI and CT scan will be done. They will take pictures of the inside of the head or abdomen to assess for any potential problems in the brain or stomach. A polysomnogram may also be done if your doctor suspects your child has a sleep disorder such as sleep apnea or another sleep-related problem.

    When serious conditions have been ruled out, you can treat the pain at home by giving your child over-the-counter pain medications such as acetaminophen and ibuprofen. Aspirin should not be used to help treat pain in your child, and ibuprofen should only be used if your child is over the age of 6 months unless your doctor says otherwise.

    Other home treatments for abdominal pain often depend on other symptoms that are present with the pain such as diarrhea and nausea. Try the following if your child has mild abdominal pain without other symptoms:

    • Have your child rest. Most symptoms will get better or go away in 30 minutes.
    • Have your child sip clear fluids such as water, broth, tea, or fruit juice diluted with water.
    • Have your child try to pass a stool.

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