Migraines in children: signs, diagnosis, treatment

Migraines in children

Sophie Matzik is a freelance author for the NetDoktor medical editorial team.

This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical professionals.

Migraines in children Expresses itself primarily in the form of a headache, as in adults, but symptoms such as listlessness, fatigue, pallor, nausea or vomiting are also possible. Unlike in adults, migraines in children mostly affect the entire head. Read everything you need to know about migraines in children here.

How common is migraine in children?

About three to four percent of all children suffer from migraines. Migraines are particularly common in children in whom the mother and / or father are also migraines. Before puberty, about as many girls and boys are affected by migraines. In half of the children the migraine disappears during puberty, in the rest it persists. Then girls are more affected by migraines than boys.

Migraines in children: symptoms

Migraines in children are often overlooked. On the one hand, this is because young children cannot yet adequately express their complaints. On the other hand, the symptoms are often atypical, since the headache in children is sometimes only slight or completely absent. Instead, children with migraines increasingly suffer from accompanying symptoms such as abdominal pain, rapid heartbeat, reddening of the skin, increased body temperature, dizziness, thirst, urge to urinate, nausea and vomiting.

Migraine attacks in children are usually one to six hours shorter than in adults. In addition, migraine headache in children rarely affects one half of the head. The younger the child, the more likely the headache is bilateral. The pain is most often localized in the forehead, temples and around the eyes. Pain in the occipital area, on the other hand, is very atypical for a migraine in children and should be diagnosed particularly urgently.

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Luise Heine has been an editor at Netdoktor.de since 2012. The graduate biologist studied in Regensburg and Brisbane (Australia) and gained experience as a journalist in television, in the Ratgeber publishing house and in a print magazine. In addition to her work at NetDoktor.de, she also writes for children, for example at the Stuttgart children’s newspaper, and has her own breakfast blog "Cake for breakfast".

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Aura symptoms

In addition to the headache and the above-mentioned accompanying complaints, the occurrence of neurological abnormalities (“aura”) is also possible with migraines in children. Typical aura phenomena in children are optical hallucinations such as bright colors and funny shapes, but also visual disturbances such as flashes of light and flickering in front of the eyes. Medicines also speak of one "Alice in Wonderland syndrome". Other typical aura symptoms of migraines in children are sensations (e.g. numbness, tingling in the arms or legs), paralysis and speech disorders.

All of these aura phenomena of migraines in children are temporary. They usually occur before the actual migraine headache begins. They usually last for about half an hour to an hour. With the onset of the headache, they subside and no neurological damage remains after the migraine attack.

How to notice migraines in children?

In most cases, children do not report the migraine themselves. Small children in particular cannot really express what they feel. Therefore, pay particular attention to changes in your child’s behavior. Many stop playing, turn pale or red in the face or would like to lie down and sleep. Other children become restless and irritable or complain of abdominal pain. School children are suddenly unable to concentrate and have problems doing their homework.

Migraines in children: causes

As with adults, the cause of migraines in children is still not fully understood. Doctors suspect an inherited disposition, as migraines occur frequently in many families. In addition, each affected person probably comes indiv >

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

Trigger: physical stress

Excessive physical exertion often causes headaches in children. On the one hand, this may be due to insufficient fluid intake during exertion. On the other hand, too low blood sugar can also be crucial for headaches and migraines in children. Children are particularly sensitive to low blood sugar levels. Therefore, it should always be ensured that children are best to eat a carbohydrate-rich meal (e.g. pasta) two to three hours before exercising.

During sports, children need to drink water regularly to replace the fluid lost through sweating. If a child often complains of a headache after exercising, training with endurance sports such as swimming, running or cycling makes sense. This way, the body is gently used to the physical stress.

Trigger: irregular sleeping habits

Sleeping habits also have a major impact on the development of migraines in children. Both too little and too much sleep can lead to migraine attacks. The need for sleep in children is age-dependent and also individually different. While it is usually 13 to 18 hours in infants up to the first year of life, at least twelve 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.

Very often the sleep rhythm gets mixed up on the weekend when the children go to bed late and sleep longer. Especially in children with migraines, care should be taken to ensure that the sleep pattern is as regular as possible, with constant sleep and wake-up times throughout the week. This can prevent migraine attacks in children.

Trigger: Mental stress

Psychological stress can also promote migraines in children. These include, for example, overstimulation due to the use of electronic devices, lack of physical exercise, family conflicts and entitlement to benefits at school.

All these psychologically stressful factors can not only lead to psychological abnormalities, but are also considered to be a very important factor influencing the development of migraines in children. For example, parents should therefore take care to limit their children’s daily media consumption to a reasonable level and, in particular, to keep aggressive and stressful content away from their children.

Trigger: weather

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

Trigger: physical stimuli
The physical stimuli include in particular noise and changes in light. Noise has been shown to trigger a particularly strong stress reaction in humans. Noise is not only generated on construction sites or by road traffic, but can also be caused, for example, by music that is set too loud (especially with headphones). Such noise pollution can trigger migraines in children and adults.

Children also react very sensitively to changing lighting conditions. For example, a desk placed directly in front of a window can be unfavorable. Occupational physicians recommend placing a desk at right angles to a window instead. Flickering flashing lights in discotheques can also lead to migraines in adolescents.

Trigger: chemical irritant

Children often react very sensitively to chemical irritants, as can often be found in the home and school environment. Typical substances that cause headache include:

  • Exhaust fumes from cars
  • Dyes and adhesives
  • Perfume and deodorants
  • Living poisons (wood preservatives or solvents in furniture or floors)
  • cigarette smoke

Trigger: food

In general, children are more sensitive to different foods than adults. Why some foods trigger a migraine is not certain. Certain ingredients may be the reason. For example, the so-called biogenic amines tyramine and histamine are thought to promote migraines – but there is still no evidence of effectiveness. The following foods are discussed as possible triggers of migraines in children:

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

Migraines in children: diagnosis

If you suspect migraines in your child, the pediatrician or family doctor is the right contact. The diagnosis of migraines in children is usually not so easy: Small children are usually unable to adequately express their pain and discomfort. In some cases, migraines in children even begin before language learning.

To clarify a possible migraine in children, the doctor will first have a detailed conversation with the parents to record the medical history (anamnesis). With small children in particular, it is important that the parents describe what they noticed in their child. Friends, relatives or caregivers at school or kindergarten can also provide information on behavioral problems, if necessary. Slightly larger children are included in the medical history themselves. The attending doctor will ask questions such as:

  • Can you show where it hurts you?
  • How long has it hurt??
  • Do you have something like this more often or is this the first time?
  • Where does it hurt except in the stomach? (Children generally tend to project pain into the abdomen.)
  • Did you notice whether the pain always occurs after a certain situation?

After the medical history interview, the doctor will examine the child. He pays attention to whether there are any neurological abnormalities such as problems with the eyes, balance, motor skills or sensitivity. He also examines whether the child’s mental and physical development corresponds to his age.

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

Keep a headache calendar

It makes sense if you keep a headache calendar with your child and bring it with you to every doctor’s visit. In this calendar you should record exactly when the headache occurs, how severe it is, how long it lasts and whether it is accompanied by other symptoms (nausea, vomiting, abdominal pain, etc.).

This detailed information makes it easier for the treating doctor to recognize migraines in children and to rule out other diseases. A headache calendar can also help you at home to identify and avoid the individual trigger factors for headaches in your child.

Read more about the investigations

Find out here which examinations can be useful for this disease:

Migraines in children: treatment

The treatment of migraines in children is different from that in adults. First, experience has shown that non-drug treatment methods are 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 migraines in children from that in adults is that other medications are sometimes used. Typical migraine medications such as acetylsalicylic acid or metoclopramide should not be used in children. Under no circumstances should parents who suffer from migraines themselves simply give their medication to their child! Otherwise, life-threatening consequences can occur, especially due to an incorrect dosage! A doctor must select the migraine medication specifically for a child and also calculate the correct dosage.

Generally speaking, a migraine in children is usually best treated with a combination of non-drug and drug measures.

Migraines in children: non-drug measures

The non-drug therapy of migraines in children and adults includes, for example, physical therapy (such as heat applications), relaxation procedures, autogenic training and so-called biofeedback. These procedures are partly suitable for acute migraine attacks 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. The biofeedback process in particular seems to be very effective, especially for children and adolescents.

Parents often feel helpless when their child has a migraine attack. Very simple measures can be very effective:

In the case of an acute migraine attack, children should above all get rest. Take your child to a darkened room. Noise sources such as radio or television should be avoided entirely, as this can intensify the headache. A few hours of sleep, a cool towel on the forehead or a neck massage with peppermint oil (not for infants and toddlers!) In most cases ensure that headaches and migraines quickly disappear in children.

Small children in particular can easily fall asleep while playing. Sleep is good for your child and they may wake up without a headache. Even the smallest of activities, such as walking around or watching TV, can increase migraines in children.

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