Migraine in children

How common is migraine in children?

About three to four percent of all children suffer from migraine. Migraine is particularly common in children whose mother and / or father are also migraineurs. Before puberty, about as many girls as boys are affected by migraine. In half of the children, the migraine disappears at puberty, the rest it remains. Then girls are more likely to be affected by migraine than boys.

Migraine in children: symptoms

Migraine in children is often overlooked. This is partly due to the fact that small children can not adequately express their complaints. On the other hand, the symptoms are often atypical, as the headache in children is sometimes low or completely absent. Instead, children with migraine increasingly suffer from concomitant symptoms such as abdominal pain, palpitations, redness of the skin, increased body temperature, dizziness, thirst, urgency, nausea and vomiting.

The attacks of a migraine in children are usually one to six hours shorter than in adults. In addition, migraine headache rarely affects a half of the head in children. The younger the child, the sooner the headache is bilateral. Most commonly, the pain is localized in the forehead, temples and eye area. Pain in the occipital region, on the other hand, is very atypical for migraine in children and should be clarified especially urgently.

Aura symptoms

In addition to the headache and the already mentioned concomitant symptoms, the occurrence of neurological abnormalities (“aura”) is also possible in children with migraine. Typical auric phenomena in children are visual hallucinations such as bright colors and funny shapes, but also visual disturbances such as flashes of light and flickering in front of the eyes. Doctors also speak of an “Alice in Wonderland Syndrome”. Other typical aura symptoms of migraine in children include abnormal sensations (such as numbness, tingling in the arms or legs), paralysis and speech disorders.

All of these aura phenomena of migraine in children are only temporary. They usually occur before the actual migraine headaches begin. They usually last about half an hour to one hour. With the onset of headache, they diminish and no neurological damage persists after the migraine attack.

How do you notice migraine in children?

In most cases, children do not report migraine themselves. Especially small children can not really express what they feel. Therefore, pay particular attention to behavioral changes in your child. Many people stop playing, grow pale or red in the face or like to lie down and sleep. Other children become restless and irritable or complain of abdominal pain. School children suddenly can not concentrate anymore and have problems doing their homework.

Migraine in children: causes

As with adults, migraine in children has not yet fully understood what triggers it. Doctors suspect a hereditary predisposition, as migraine occurs frequently in many families. In addition, each individual trigger factors are likely to be added (trigger = English for “trigger”).

The trigger factors are basically similar to those of adults, but there are some differences. Stress is the most important trigger of migraine in children, but children are usually even more sensitive to influences that would not cause migraines in adults. The typical trigger factors of migraine in children are:

Trigger: Physical stress

Excessive physical exertion often causes headaches in children. On the one hand, this may be due to inadequate fluid intake during the effort. On the other hand, too low blood sugar can be crucial for headaches and migraines in children. Children are particularly sensitive to low blood sugar levels. Care should therefore be taken to ensure that children eat a carbohydrate-rich meal (for example, pasta) two to three hours before exercise.

During exercise, children must drink water regularly to replace the fluid lost from sweating. If a child frequently complains of headaches after exercise, training with endurance sports such as swimming, running or cycling makes sense. Thus, the body is gently used to the physical stress.

Trigger: Irregular sleep habits

Sleep habits also have a major influence on the development of migraine in children. Both too little and too much sleep can lead to migraine attacks. The need for sleep in children is age-dependent and individually different. While infants up to the age of 13 are usually 13 to 18 hours, at least 12 hours a day are recommended for children from one to four years. Older children and adolescents should sleep about nine to twelve hours a night.

Sleep patterns often get mixed up on weekends when children go to bed too late and sleep longer. Especially in children with migraine should therefore be paid to a regular sleep pattern as possible with consistent sleeping and getting up during the entire week. This can prevent migraine attacks in children.

Trigger: mental stress

Mental stress can also promote migraine in children. These include, for example, sensory overload through the use of electronic devices, lack of physical activity, family conflicts and achievement demands in school.

All of these psychologically stressing factors can not only lead to psychic abnormalities, but are also considered a very important factor in the development of migraine in children. For example, parents should be careful to limit the daily media consumption of their children to a reasonable level and in particular to keep aggressive and incriminating content away from their children.

Trigger: Weather

A common trigger of migraine in children and adults are temperature changes and high humidity. You can not change the weather, but at least you have the option to adjust your behavior on critical days. If, for example, a change of weather is imminent or it is particularly warm and humid, you should generally plan more rest periods in your everyday life. This can sometimes help prevent migraine attacks.

Trigger: physical stimuli
In particular, the physical stimuli include noise and changes in the light. Noise has been shown to cause a particularly severe stress response in humans. Noise is not only caused by construction sites or road traffic, but can also be caused, for example, by overly loud music (especially headphones). Such noise can trigger migraines in children and adults.

Children are also very sensitive to changing light conditions. For example, a desk placed directly in front of a window may be inconvenient. Occupational physicians recommend placing a desk at right angles to a window instead. Even flickering flashlights in discos can lead to migraines in adolescents.

Trigger: Chemical irritants

Children are often very sensitive to chemical irritants, as they are often found in the home and school environment. Typical headache-inducing substances are for example:

• Exhaust gases from cars
• Paints and adhesives
• Perfume and deodorants
• Residual toxins (wood preservatives or solvents in furniture or floors)
• cigarette smoke

Trigger: food

In general, children react more sensitively than adults to different foods. Why some foods cause a migraine is not clear. Certain ingredients may be the reason. For example, the so-called biogenic amines tyramine and histamine are believed to promote migraine – but there are still lack of evidence proofs. The following foods are discussed as possible triggers of migraine in children:

• Cow’s milk, eggs, cheese
• Chocolate, cocoa-containing products
• caffeine
• gluten-containing cereals
• tomatoes
• citrus fruits
• greasy food such as sausages, ham, salami, pork

Migraine in children: diagnosis

If you suspect migraine in your child, the pediatrician or family doctor is the right person to contact. The diagnosis of migraine in children is usually not so easy: Small children can usually not adequately express their pain and discomfort. In some cases, migraine starts in children even before language acquisition.

To clarify a possible migraine in children, the doctor will first conduct a detailed conversation to record the medical history (anamnesis) with the parents. Especially for small children, it is about the parents describing what they noticed with their child. Also, friends, relatives or carers in the school or kindergarten may provide information on behavioral problems. Somewhat larger children are included in the medical history themselves. The attending physician will ask questions like:

• Can you show where it hurts you?
• Since when does it hurt?
• Do you have such a thing often or is this your first time?
• Where does it still hurt, except in the stomach? (Children tend to project pain generally into the abdomen.)
• Have you noticed if the pain always occurs after a certain situation?

After the anamnesis interview, the doctor will examine the child. In doing so, he pays attention to whether neurological abnormalities such as problems with the eyes, the sense of balance, the motor skills or the sensitivity show. He also examines whether the child’s mental and physical development matches his age.

In some cases further investigation may be needed to rule out other causes of headache. These include, for example, imaging examinations of the skull (such as magnetic resonance imaging or magnetic resonance imaging, MRI).

Perform a headache calendar

It makes sense to keep a headache calendar with your child and bring it with you to every doctor’s visit. In this calendar, you should specify exactly when the headaches occur, how strong they are, how long they last and whether they are accompanied by other complaints (nausea, vomiting, abdominal pain, etc.).

This detailed information makes it easier for the attending physician to recognize migraine in children and to exclude other diseases. In addition, a headache calendar can also help you at home to recognize and avoid the individual headache trigger factors in your child.

Migraine in children: treatment

The treatment of migraine in children is different from that in adults. First, non-drug treatment in children has been shown to be significantly more effective in children than in adults. Therefore, they should always take precedence over the use of medication.

The second difference in the treatment of migraine in children compared to adults is that some other medicines are used. Typical migraine medications such as acetylsalicylic acid or metoclopramide should not be used in children. Under no circumstances should parents who suffer from migraine themselves simply administer their medication to their child! Otherwise, it can lead to life-threatening consequences, especially due to incorrect dosage! The migraine medication must select a doctor specifically for a child and also calculate the correct dosage.

In general, a migraine in children is usually best treated with a combination of non-drug and drug treatments.

Migraine in children: non-drug measures

Non-drug therapy for migraine in children and adults includes, for example, physical therapy (such as heat applications), relaxation procedures, autogenic training and so-called biofeedback. These procedures are suitable in part both for the acute migraine attack as well as for the prevention (prophylaxis) of further migraine attacks. According to the German Migraine and Headache Society (DMKG), the non-drug procedures are quite as efficient as a pure drug prophylaxis. In particular, the biofeedback method seems to be very effective especially in children and adolescents.

Parents often feel helpless when they have a migraine attack. Even very simple measures can be very effective:

In an acute migraine attack children should get especially quiet. Bring your child into a darkened room. Noise sources such as radio or television should be completely avoided as this can increase the headache. A few hours of sleep, a cool towel on the forehead or a neck massage with peppermint oil (not in infants and toddlers!) In most cases ensure that headaches and migraines in children quickly disappear.

Especially small children can just fall asleep while playing. Sleep is good for your child and it may wake up without a headache. On the other hand, even the smallest activities, such as running around or watching television, can increase migraine in children.

Migraine in children: medication in the attack

For migraine in children, the same applies to adults: in acute attacks, the sooner they are used, the better. This means that the drugs should be taken at the first migraine signs. Then a migraine attack can sometimes be stopped.

The treatment of acute migraine attacks is started with a so-called antiemetic. It not only combats the frequently occurring nausea, it also increases the effectiveness of the painkillers given afterwards. In children, the prescription drug domperidone is used as an antiemetic (as a tablet or suppository). The doctor usually determines the correct dose based on the weight of the child. The dosage must be very carefully chosen and strictly adhered to: too high a dose can cause serious side effects.

As the next step, a painkiller is administered about 15 minutes after the antiemetic. For children and adolescents, ibuprofen or acetaminophen is recommended. On the other hand, acetylsalicylic acid, which is commonly used in adults, is absolutely taboo: in children and adolescents, taking it can lead to a life-threatening Reye syndrome.

Flunarizine and topiramate has been approved by the FDA for teenagers with migraine. There is evidence of efficacy for propranolol; valproic acid is not effective in children and adolescents. Studies suggest that botulinum toxinA may be effective in adolescents.

If the migraine in children does not improve with the mentioned painkillers, active substances from the group of triptans or (less frequently) ergotamines are also available. However, these should be used with caution in migraine in children and may usually be given only from the age of twelve. In smaller children, they can be prescribed in very severe cases by a headache specialist. These medications are available as tablets, suppositories or partial nasal spray.

Migraine in children: medicines for prevention

In contrast to the drug treatment of acute migraine attacks, the drugs must be taken permanently to prevent another attack. This also explains why it is not uncommon for problems, as the adverse drug reactions usually burden children even more than adults. Therefore, medicines for the prevention of migraine in children are only used if non-pharmacological procedures and in particular behavioral therapy measures do not adequately help.

Betablockers are used as well as adults (for propranolol there is evidence of efficacy). Valproic acid is not effective in children and adolescents. Studies suggest that botulinum toxinA may be effective in adolescents.) Parents should be advised by the doctor about the possible side effects of the medication.

Migraine in children: prognosis

Migraine in children is not uncommon. In many cases, however, the signs are not recognized early enough and taken seriously. A therapy often starts late. Then often have problems at school or in the family arise.

The prognosis for migraine in children is often good. In about half of the cases, migraine continues in children in adulthood. In the other half, the migraine attacks disappear with puberty. Often they will come back later. Finally, only about a quarter of all children with migraine remain permanently without migraine even in adulthood.

Crucial for a favorable prognosis is how well it succeeds to avoid trigger factors. For example, persistent stress worsens the prognosis of Migraine in children clear.