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What causes migraine in children?
February 15, 2021

Around 3–10% of children experience migraine. The prevalence increases with age until puberty, when about half of these children or young teens stop having migraine episodes.

Alternately, if migraine symptoms begin during adolescence, the person is more likely to continue experiencing the condition into adulthood.

Before puberty, migraine is just as likely to affect males as females. After puberty, females are more likely to experience it.

Symptoms of migraine in children

Children with migraine experience many of the same symptoms as adults. These can include:

  • a headache that lasts 2–72 hours
  • a headache on one side of the head
  • moderate to severe pain
  • pain that gets worse with physical activity
  • sensitivity to light or sound
  • nausea or vomiting
  • aura, sensory disturbances such as flashing lights in the field of vision that may be the first symptom

According to the United Kingdom’s National Migraine Centre, children are more likely to experience pain in multiple locations, or across the entire head, compared with adults.

Also, episodes in children may be shorter than those in adults.

It can be difficult to diagnose migraine in young children, who may be unable to describe their symptoms. Another challenge involves the subjectivity of pain intensity — children and their parents or caregivers may have little or nothing to use for comparison. For these reasons, doctors rarely diagnose migraine in children under 2 years old.

Finally, it is worth noting that for some people with migraine, a headache is absent or a minor symptom.

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What causes migraine in children?

Researchers do not know why some children experience migraine while others do not. However, many children with migraine have family members with the condition, suggesting that there is a genetic component.

Experts do know that certain genetic mutations predispose children to some types of migraine. For example, if a child has hemiplegic migraine, a type that causes temporary weakness and paralysis, they may have a mutation in any of the following genes:

  • CACNA1A
  • ATP1A2
  • SCN1A

Research into the causes of other types of migraine is ongoing.

People with migraine often find that certain foods, situations, or environmental factors triggers migraine episodes. Identifying these triggers can often help prevent the episodes.

However, identifying the triggers can take time. It is also worth noting that several triggers often overlap to contribute to the development of a migraine episode.

It can help to keep a record of a child’s migraine symptoms and any possible causes. We give specific ideas about what to note down in the “Home care” section below.

Common triggers to consider include:

  • Changes in sleep patterns: A child may have an episode if they sleep too much or too little. It may help to establish and maintain a regular sleep schedule.
  • Dehydration: Ensuring that a child drinks enough water, particularly after physical activity, may help reduce migraine symptoms.
  • Foods and drinks: Specific foods may trigger symptoms and so may eating too little. Take note of what a child has eaten on days when they have symptoms and check for a pattern.
  • Stress: Stress and overstimulation can contribute to migraine. If a child frequently feels stressed and anxious, they may benefit from having a quiet space where they can calm down. Mindfulness activities for children may also help.
  • Environmental triggers: These might include weather changes, secondhand smoke, and bright lights, including those on computer or phone screens, for example.

Not all migraine triggers are avoidable, but avoiding them whenever possible may reduce the frequency of episodes.

Medical treatments

If a child is experiencing migraine symptoms, a doctor might recommend an appropriate dosage of an over-the-counter (OTC) medication, such as:

  • acetaminophen (Tylenol) every 4–6 hours
  • ibuprofen (Advil) every 6–8 hours
  • naproxen (Aleve) every 8–12 hours

However — these drugs and dosages are not always suitable for children. Check with a doctor or pharmacist before administering any OTC medication to a child.

If a child experiences frequent or severe migraine episodes, a doctor may also prescribe a drug from a family of medications called triptans. These work specifically to prevent migraine episodes.

The Food and Drug Administration (FDA) have approved sumatriptan (Imitrex) and rizatriptan (Maxalt) for use in children.

If a child does not respond well to triptans, the doctor may prescribe:

  • beta-blockers
  • amitriptyline (Elavil) or nortriptyline (Pamelor)
  • antiepileptic medications

Some children may also respond to relaxation training or biofeedback.

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Home care

In addition to administering medication and helping to prevent exposure to triggers, caregivers and children can use other strategies to help manage migraine symptoms:

During an episode

When migraine symptoms occur, try:

  • moving the child to a quiet, darkened room
  • applying cool or warm compresses to their head
  • offering them an eye mask to block out any light, if they have sensitivity to light
  • massaging any tense or sore muscles
  • encouraging the child to sleep, if this helps with their symptoms

Anyone keeping a symptom diary should take note of:

  • the time and date that the symptoms occurred
  • the length and severity of the episode
  • whether any treatments or strategies helped
  • any possible triggers

Preparation

Being prepared for migraine episodes may help limit their effects. A person might:

  • Make one or more migraine kits, including items such as medication, hot or cold packs, an eye mask, water, and a symptom diary.
  • Learn about potential triggers and identify specific ones.
  • Help identify any warning signs that symptoms are arising.
  • Inform schools, daycare centers, and other caregivers about the child’s experiences and what to do if a migraine episode occurs.

It is worth keeping in mind that administering pain medication as soon as possible may help stop the progression of the migraine episode.

Emotional support

It can be difficult to assess the extent of a child’s migraine symptoms. Depending on their age, they may not understand their condition or may be afraid of it.

During an episode, it is important to be reassuring and calm. Afterward, it may help to teach the child about the condition or have a doctor explain it to them.

Understanding what migraine is and that each episode eventually ends may alleviate some fears. It may also help for the child to take a proactive role in managing the condition, for example, by keeping or helping with a symptom diary.

When to seek help

Contact a doctor about a child’s migraine symptoms. They may prescribe medication to reduce the severity and frequency of episodes. It is also important that they rule out other possible causes of the symptoms.

Some migraine symptoms resemble those of more serious health issues. Seek emergency medical care if a child experiences:

  • a sudden, severe headache with no other migraine symptoms
  • a headache with the worst pain that they ever experienced
  • a headache after a head injury
  • a headache and any of the following:
    • a stiff neck
    • confusion
    • a seizure
    • loss of consciousness

Speak with a doctor right away if a child has migraine symptoms alongside:

  • changes in vision, balance, or coordination
  • excessive vomiting
  • persistent pain
  • a recent change in personality or behavior

Any of the above may indicate a different underlying condition.

Summary

In children, migraine is not uncommon, and the symptoms can occur from a young age. Taking OTC pain medication as soon as symptoms develop may stop or limit their effects. A doctor may instead prescribe targeted migraine medications.

It is important to receive medical attention for any migraine symptoms. A doctor needs to be sure of the cause because some symptoms resemble those of other health issues.

In addition to prescribing medication, the doctor can provide guidance about identifying triggers and managing episodes.

 

 

Source:  https://www.medicalnewstoday.com/articles/migraines-in-children#prevalence 

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