Migraine in Children

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

familylineMigraine 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:
http://www.mayoclinic.org/diseases-conditions/headaches-in-children/basics/symptoms/con-20034478
http://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.

medsTake 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: http://jama.jamanetwork.com/article.aspx?articleid=1793774. And for help finding someone who can provide CBT, look here: http://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 http://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: (http://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. For more on sports concussions, see this section of our website: https://americanmigrainefoundation.org/understanding-migraine/sports-concussion/

What Triggers Migraine Attacks in Children

Migraine Fairy
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!