What is Migraine Headache in Childhood (Migraine)?
Migraines and other headache disorders are among the top reasons for illness around the world. In particular, migraines are the most common type of constant headaches in children and teenagers. Approximately one in ten children suffer from migraines, which can lead to poor school performance and negatively affect their quality of life.
In fact, almost 18% of children in the emergency room suffer from migraines. However, migraines in children are different from those in adults. They are often accompanied by other symptoms, not just headaches – like frequent vomiting and stomach migraines, which is often mistaken for a stomach disorder.
Diagnosing migraines in children and teenagers involves getting a thorough headache history, including details like the location, quality, severity, and duration of the pain. But some migraines can be more complex, causing symptoms such as unsteady movement, weakness on one side of the body, or altered consciousness, which adds to the concerns of healthcare providers. Sometimes, the cause of the migraine may not be clear, such as those triggered by an injury.
To treat migraines, doctors often recommend over-the-counter painkillers and medications approved by the US Food and Drug Administration. Preventing migraines may involve changes in lifestyle, different behavioral approaches, and medication with fewer side effects. Numerous studies support the use of ibuprofen, acetaminophen, and certain prescription medications for handling migraines in children. However, none of these treatments are effective against migraine-associated nausea or vomiting. Some medications can help with sensitivity to sound and light caused by migraines. The best advice is to treat migraines early, choose the best method of medication administration based on the characteristics of the migraine, and get advice on lifestyle changes to avoid triggers and prevent overuse of medication.
What Causes Migraine Headache in Childhood (Migraine)?
Migraine is a type of headache that’s quite common and can seriously affect people’s lives. Women experience migraines more often than men, with about 18% of women and 6% of men having them. There are many things that can trigger a migraine, such as stress, being very tired, certain foods, alcohol, drugs, smoking, changes in the weather, and strong smells. Scientists are discovering more about what causes migraines, and this knowledge is helping develop better treatments and ways to prevent migraines.
Children can get migraines too, and this often happens because they have a gene making them more likely to get migraines, and something in their environment or body triggers it. These triggers could be certain medications, foods, stress, or hitting puberty. Many children who have migraines also have family members who have them. Although there’s evidence to suggest genes play a role, it’s not entirely proven yet. But, for certain types of migraines, like hemiplegic migraine, it’s clear that specific gene mutations cause them.
Migraines are usually something that’s passed down in families. Research has found that children who have a parent with migraines usually start getting migraines at a younger age than their parent did. Having a parent with migraines not only increases a child’s risk of having more severe migraines but also influences other areas of their life. However, if a child’s parent also suffers from migraines, they are likely to get treatment earlier and more intensively.
Risk Factors and Frequency for Migraine Headache in Childhood (Migraine)
Migraines are a common headache disorder among children. These typically happen to between 5% to 40% of children, but this number can go up to 80% when they transition to adult neurological care. Children of any sex can get migraines, but after puberty, it’s more common in girls. As children grow older, the tendency to experience migraines also increases.
- Migraines happen to 5% to 40% of children, sometimes increasing to 80% as they grow into adulthood.
- Before puberty, migraines occur equally in boys and girls. After puberty, girls are more likely to have migraines.
- In Germany, studies show that migraines become more common as children get older, reaching around 1% per year around the age of 10 for both sexes, 3.49% per year in girls, and 1.72% per year in boys by age 19.
- In East Asia, migraines are common and can greatly affect the quality of life of kids with the condition. Studies suggest that there’s a need for more awareness, diagnosis, and effective management of migraines in these countries.
- Migraine can affect even children under seven years old, with the condition found in up to 4% of the general population. Early detection and treatment are vital, especially considering the influence of prenatal and perinatal factors on the onset of migraines.
- There is no link between being born prematurely and the risk of migraines. Parental migraines, lower socioeconomic position, maternal hypertensive disorder, and maternal smoking during pregnancy are predictors of a child having migraines.
- Migraines can often coexist with epilepsy, another common chronic childhood neurological disorder. This suggests that they might share similar genetic and pathophysiological mechanisms. Anti-epileptic drugs can be used as preventive treatment for migraines in children.
- Children with ADHD and their mothers are more likely to have migraines. Insecure parental attachment might exacerbate anxiety in children with migraines.
- Allergic disorders like allergic rhinitis and allergic rhinoconjunctivitis are also common in children with migraines and can increase the disability caused by headaches.
- In a study conducted among 96 patients with sarcoidosis, 29% had migraines. In this group, only being female was predictive of having migraines.
Signs and Symptoms of Migraine Headache in Childhood (Migraine)
In children, the most frequent sign of a migraine is a headache. To diagnose a migraine, doctors need to take a thorough history and conduct a detailed physical examination. The child must have had at least five attacks that meet migraine criteria. This includes:
- Headaches lasting at least an hour to 72 hours
- Unilateral (one-sided) headache
- Pulsating pain
- Moderate to severe pain intensity
- Pain that gets worse with physical activity
- At least one of the following: nausea, vomiting, sensitivity to light (photophobia), or sensitivity to sound (phonophobia)
Migraines can be a little different in children compared to adults. For example, children’s migraines are often in the front of the head, not the sides or back, and may affect both sides of the head instead of just one.
Medical examinations should include blood pressure checks, feeling the head for sinus tenderness, and checking for signs of a stiff neck. Doctors should also examine the back of the eye (a funduscopic examination) for signs of increased pressure inside the skull, and test the child’s field of vision. Head size should be measured, and the skin should be checked for signs that might indicate conditions linked to headaches and brain tumors like neurofibromatosis or tuberous sclerosis.
Vomiting is more common in children with migraines. Some research suggests that very young children might have recurring vomiting before they start getting migraine headaches and other migraine symptoms. This is why it is important that both child and parents complete the standard International Headache Society questionnaire, to help the doctor diagnose the condition correctly.
Testing for Migraine Headache in Childhood (Migraine)
Diagnosing migraines in children is mostly based on their symptoms, but lab tests and brain scans might be necessary in some situations.
Reasons for Lab Tests
* Kids who suffer from sickle cell disease can get headaches when their hemoglobin (Hgb) is low. A blood test may be needed for these children.
* If a headache is suspected to be caused by inflammation or a condition affecting the mitochondria, a luminary puncture (a test where a needle is inserted into the spinal canal) may be done. However, doctors need to be careful because this test can sometimes make the headache worse by lowering the pressure inside the skull.
* An EEG (a test that records brain activity) can be done if a doctor suspects the child is having seizures. It’s quite common for children with migraines to have abnormal EEG results: between 10% to 75% have abnormalities, with 20% to 30% experiencing sudden, brief increases in brainwave activity.
When a Brain Scan might be Needed for Kids with Migraines
* If children have any loss of neurological function, like seizures, impaired vision, altered consciousness, or decreased motor skills.
* If an infant or a toddler has an unusually large head.
* If an eye exam reveals problems, like cuts in the visual field, eyes that don’t move together, or abnormalities at the back of the eye.
* If the child’s headaches are always located on one side of the head.
* If the headaches persist for many days and don’t improve with treatment.
Treatment Options for Migraine Headache in Childhood (Migraine)
If a child is unable to go about their daily activities, like attending school or playing, due to migraines, it’s crucial to get effective treatment. Research indicates that the most effective method for treating migraines in children is a multi-faceted approach that includes medicines like NSAIDs (drugs that reduce pain and inflammation) or ‘triptans’ (medicines specifically used for migraines), in combination with self-management techniques and therapies such as biofeedback, relaxation and cognitive-behavioral therapy.
Treatment can include non-medical methods such as ensuring good sleep patterns, managing stress, regular exercise, and avoiding known migraine triggers. Medical treatments could include different classes of drugs – beta-blockers, calcium channel antagonists, serotonin antagonists, antidepressants, and antiepileptics.
One drug, Amitriptyline, has been found to be effective for preventing migraines. Additionally, certain dietary supplements, known as nutraceuticals, have shown promise, with fewer side effects. For example, Coenzyme Q10 has been found to be particularly effective, especially with prolonged use, though Amitriptyline works faster.
More consistent treatments, known as prophylaxis, might be needed if migraines result in the child missing school frequently, having a reduced quality of life, needing frequent emergency room visits, or having to take painkillers often. Multiple drugs like propranolol, topiramate, flunarizine, and cyproheptadine could be used in prophylaxis, with palpitations being the most common side-effect.
Studies have found that combining triptans with NSAIDs can improve effectiveness. Different forms of triptan such as Imitriptan and rizatriptan are effective as pills, while sumatriptan and zolmitriptan also come as nasal sprays. They can be considered for severe migraines.
Additionally, the migraine management strategy may include educating patients about potential triggers, advising them on good sleep and diet habits, and recommending analgesics for temporary headaches. Analgesics include common painkillers like ibuprofen or acetaminophen. They work by reducing the body’s sensitivity to pain.
In more severe cases, adding a type of medication called a triptan might be necessary. These medicines are FDA-approved for use in children and have been clinically found to be effective and well-tolerated. They work by reducing the swelling of blood vessels in the brain that triggers migraines.
For persistent migraines, also known as status migrainosus, stronger medications, like valproate sodium, metoclopramide, or prochlorperazine, may need to be administered directly into the bloodstream or muscle. Prochlorperazine was found to be more effective than metoclopramide in preventing a revisit to the hospital.
Research is also ongoing into the efficacy of alternative therapies for migraines, including natural remedies. For example, melatonin, a hormone that regulates the sleep-wake cycle, has been shown to be effective in managing migraines in adults and is safe for use in children. Meanwhile, the ketogenic diet (a high-fat, low-carb diet) is being studied for its potential in preventing migraines, by altering brain metabolism.
It’s important to understand that tackling migraines is a multi-pronged process and getting the right combination of treatments can greatly improve a child’s quality of life.
What else can Migraine Headache in Childhood (Migraine) be?
Children experiencing headaches, similar to migraines, may actually be experiencing different health conditions such as:
- Continual day-to-day headaches
- Brain tumors
- Abnormal blood vessel formation
- Excess fluid in the brain (hydrocephalus)
- Head injuries or trauma
- Diseases related to the mitochondria
- Cluster headaches (intense headaches that occur in groups or “clusters”)
Some kids might start showing symptoms of a condition known as “pseudotumor cerebri” or “idiopathic intracranial hypertension”, which is hard to distinguish from migraines because their symptoms are very similar. In fact, children’s headaches are strongly associated with both migraines and non-migrainous headaches. The main difference with pseudotumor symptoms and migraines is the presence of double vision in the former.
What to expect with Migraine Headache in Childhood (Migraine)
Early onset migraines may lead to a less favorable outcome in later life. However, very few studies have followed up on this issue, especially over a longer period. The most comprehensive study covers children under 6 who suffer from migraines. Some studies hint that getting migraines at a very young age might mean the migraines persist into later life. Some features of the migraines may change over time, and if the migraines persist, a symptom called “allodynia” (an increase in pain sensitivity) may increase.
Some studies revealed that children and teenagers might experience allodynia within the first six months of having migraines. Unlike in adults though, in children, this symptom isn’t tied to how often they have migraines or how long they’ve had them. Instead, it’s significantly linked to migraines with a visual disturbance known as aura, being female, waking up with pain, and potentially, genetics.
According to one study, a quarter of patients stopped experiencing migraines by the age of 25. Another found that about 80% of patients reported a significant reduction in migraines by the age of 10. One specific study reported a significant link between migraines and the risk of stroke in women aged 15 to 45 who smoked or were on birth control pills.
Possible Complications When Diagnosed with Migraine Headache in Childhood (Migraine)
It’s quite rare, but in some cases, a migraine that’s complicated by lasting neurological symptoms can lead to permanent neurological deficits. Some of these instances might actually be due to undiagnosed metabolic diseases.
Preventing Migraine Headache in Childhood (Migraine)
It’s very important to consult with a healthcare professional if you’re experiencing symptoms like headaches. This is to ensure that headaches aren’t being caused by other health conditions. Research has suggested that losing weight can help reduce migraines, especially in children who are overweight. Additionally, if there’s a risk of a specific type of migraine called ‘hemiplegic migraine’, which can be detected before birth, getting genetic counseling is highly recommended.