Migraines are the most important and frequent type of headache in children, affecting more than one in twelve kids — yet only 20 percent of children with migraines are ever properly diagnosed and treated (Headache, May 1997).
While there is still some controversy among doctors about what causes migraines, many doctors think migraines are caused by an inherited extra-sensitivity of certain blood vessels to the nerve and chemical signals that normally cause these vessels to dilate or constrict (especially to serotonin, norepinephrine, and substance P). When these over-exuberant blood vessels expand and contract, the resulting changes in pressure produce pain (Pediatric Annals, September 1995).
Your child may have migraines if he or she has at least five headaches (in which the child is well between episodes) accompanied by at least 3 of the following symptoms:
- Abdominal pain
- Nausea or vomiting
- Throbbing headache
- Specific location of pain
- Associated “aura” – a funny sensation just before a headache, which may be a change in any of the five senses (vision, hearing, taste, smell or touch).
- Relief with sleep (headaches that awaken children, or early morning headaches, are probably not migraines – -they might be signs of a brain tumor)
- Family history of migraines
There are several types of migraines, including migraines with auras, migraines without auras, abdominal migraines, and cyclical vomiting.
Before puberty, migraines are more common in boys than in girls (the reverse is true afterwards).
Most kids do not have an aura (changes in vision or tingling hands or feet), but most do have a throbbing or pounding headache, often at both temples, accompanied by nausea and vomiting.
The headaches typically last for one to three hours — but they can last for 24 hours.
Kids are often sensitive to light, sounds, or smells during a migraine episode
A number of foods have been shown to be the triggers for some individuals. The most common of these are nuts, chocolate, cola drinks, hot dogs and luncheon meats (probably the nitrates and nitrites), pepperoni and sausage (thought, perhaps, to be the spices), kippers, and MSG. Both alcohol and birth control pills are associated with migraines, but there are better reasons than headaches to avoid these in young children. Caffeine has also been associated with migraines, giving children yet another reason to avoid coffee, tea, and some sodas.
Bright flashing lights can also trigger migraines.
Children who get migraines are more likely to get them when they are over-tired or have gone too long without eating. In addition to fatigue and hunger, other known triggers are sun exposure, excessive physical exertion, motion sickness, loud noises, head bumps, stress, and anxiety.
Exciting new drugs have been developed for adults with migraines. These have not yet been approved for use in children, but thankfully kids are much more responsive than adults to available, gentle medicines.
Ibuprofen (Motrin or Advil) is more than twice as effective as acetaminophen (Tylenol) at stopping a migraine — but acetaminophen starts working twice as fast. I recommend giving a child a dose of both ibuprofen and acetaminophen when the headache starts, and then having him rest in a quiet, darkened room.
Pediatric neurologists are starting to study drugs commonly used by adults with migraines, to find out if they are same and useful for children with migraines. These include both oral medications and nasal sprays. (Pediatric Neurology 2003 and Pediatrics 2005) Therefore, for children with migraines that are very frequent, or are interfering with school, then a continuous, daily medication might be prescribed to prevent the migraines. Options for this include propranolol, phenytoin, phenobarbital, amitriptyline, cryoheptadine, and methysergide.
I prefer teaching children either self-hypnosis or biofeedback to control their headaches. These techniques can be mastered by most kids in second grade or above. They have been shown to be even more effective than propranolol at preventing migraines (Nelson Testbook of Pediatrics, Saunders, 2000) — and without side effects!