Migraines in children

and Tanja Unterberger, medical editor Updated on

Sophie Matzik is a freelance writer for the medical team.

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Tanja Unterberger studied journalism and communication science in Vienna. In 2015 she started her work as a medical editor at in Austria. In addition to writing specialist texts, magazine articles and news, the journalist also has experience in podcasting and video production.

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Migraines in children usually take the form of headaches - but symptoms such as indifference, tiredness, paleness, dizziness, nausea or vomiting are also possible. About four to five percent of children are affected. Unlike in adults, migraines in children usually affect the entire head. Read here about the causes of migraines in children and what works against them!

In children, as in adults, it primarily manifests itself as a headache, but symptoms such as indifference, tiredness, paleness, nausea or vomiting are also possible. Unlike in adults, migraines in children usually affect the entire head. Read everything you need to know about migraines in children here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. G43R51

Brief overview

• Frequency: About four to five percent of all children
• Symptoms: severe headache, also: abdominal pain, nausea, vomiting, dizziness, paleness, loss of appetite, tiredness
• Causes: The causes are still unknown, the tendency is probably innate. Factors such as irregular bedtimes or meals, stress and pressure to perform promote migraine attacks
• Diagnosis: detailed anamnesis, physical examination e.g. for neurological abnormalities (vision problems / balance disorders), examination with imaging procedures such as MRI
• Treatment: Mainly supportive measures (e.g. heat applications, relaxation procedures, autogenic training, biofeedback). If necessary, medication (e.g. painkillers)
• Prognosis: Migraines in children are incurable, but can usually be treated well. In half of the children, the migraines disappear during puberty, in the rest it persists.
• Prevention: keep a migraine diary, eat a balanced diet, drink enough, exercise regularly, avoid stress, adapt everyday life to the weather, limit media consumption.

How common are migraines in children?

Four to five percent of all children suffer from migraines. Half of the attacks die away during puberty, while the rest of them persist into adulthood. Children whose mother and / or father have also had migraines are particularly likely to develop migraines. Girls and boys are affected equally often up to puberty. Among adolescents, migraines are more common in girls than in boys.

How is migraine manifested in children?

Sudden headache attacks that occur repeatedly or last for a long time are the most common symptom in children with migraines. Sometimes the headache also manifests itself as strong pressure on the head. The younger the child, the more likely it is that the headache is bilateral.

The migraine headache rarely affects only one half of the head. The most common pain is on the forehead, temples and around the eyes. Pain in the back of the head, on the other hand, is rather untypical for migraines in children.

Some children with migraines show other symptoms either in addition or exclusively.

• Sensitivity to light, noise and smells
• high temperature (from 37.5 degrees Celsius) or fever (from 38 degrees Celsius).
• Some children have abdominal pain (called "abdominal migraines" or abdominal migraines)
• Loss of appetite, nausea, vomiting.
• increased urination, they are
• thirst
• Racing heart.

Migraine attacks with aura perception

In addition to the symptoms already mentioned, children with migraines sometimes also experience neurological complaints - the so-called "aura". Typical signs of this are, for example, visual hallucinations such as bright colors and funny shapes that the child perceives. Visual disturbances, flashes of light or flickering patterns also occur. Doctors also speak of an "Alice in Wonderland Syndrome".

Other typical aura symptoms are abnormal sensations such as numbness or paralysis or tingling in the arms and legs. Some children also have trouble speaking.

How long does a migraine attack last in children?

In most cases, a migraine attack in children will pass in two to six hours. The attacks are therefore shorter than in adults. Occasionally, however, migraines in children can last 48 hours.

The symptoms of an aura in children are also temporary. They usually occur before the actual migraine headache begins. The aura perceptions usually subside quickly, they usually last for about half an hour to an hour. Permanent neurological damage is not to be feared.

How do you recognize migraines in children?

Small children in particular are not yet able to correctly interpret and express their sensations and body signals. Therefore, pay attention to whether your child behaves differently than usual. For example, many children stop playing, are pale or red in the face or would like to lie down and sleep.

Other children are restless and irritable. Some complain of stomach ache or screw up their eyes in bright light. Schoolchildren often suddenly have problems concentrating and doing their homework. You should also think of a migraine if you have a headache that wakes your child out of sleep at night.

Migraines in children often manifest themselves differently than in adults. Therefore, pay close attention to your child's behavior and, if necessary, have a doctor clarify any symptoms that arise.

What are the causes of migraines in children?

It is not yet fully understood what causes migraines in children. However, medical professionals suspect that migraines are hereditary as they occur in many families. Certain trigger factors also seem to favor migraine attacks in children.

The child's brain reacts to many stimuli and events with a migraine attack more frequently than that of adults. They are therefore more often exposed to triggering factors in everyday life. The most important trigger factors of migraines in children include, for example:

Low blood sugar and dehydration

If children exert too much physical effort, they often develop headaches. One of the reasons for this is that they are not drinking enough or their blood sugar is too low. Children in particular are particularly sensitive to low blood sugar levels. Migraine attacks often become noticeable if, for example, the child has not had breakfast in the morning.

Irregular sleep

Both too little and too much sleep can lead to a migraine attack. The sleep rhythm is very often mixed up at the weekend when the children go to bed too late and sleep longer, which makes migraine attacks more likely. Conversely, an attack makes it difficult to fall asleep.

stress

Mental stress and stress also promote migraines in children. These include, for example, overstimulation from electronic devices such as computers, smartphones or televisions. Too much media consumption before going to bed has a particularly negative effect.

A lack of physical activity, family conflicts and high performance demands in school as well as bullying are just as frequent triggers for migraine attacks. The anticipation of a birthday party or a cold can also cause stress and promote migraines in children.

weather

Children in particular are sensitive to certain weather conditions. A sudden change in temperature (usually a rise in temperature) and high humidity often trigger migraines in children. However, a direct connection between the weather and migraines has not yet been scientifically proven.

Noise and light

In particular, noise and changes in light cause migraines in children. Noise in particular triggers a great deal of stress. This not only applies to loud noises at construction sites or in traffic, but also to music that is set too loud (especially with headphones).

Children also react very sensitively to changed lighting conditions, for example when the desk is placed in front of a window. Occupational health professionals recommend placing a desk at right angles to the window instead. Flickering flashlights in clubs can also trigger migraines in some teenagers.

Chemical irritants

Children are often very sensitive to chemical irritants. Typical substances that trigger headaches are, for example:

• Car exhaust
• Dyes and adhesives (e.g. for handicrafts)
• Perfumes and deodorants
• Residential toxins (e.g. wood preservatives or solvents in furniture or floors)
• Cigarette smoke

food

Certain foods are also suspected of causing migraines. An intolerance to certain ingredients such as the proteins tyramine and histamine is a possible reason. However, there is still a lack of scientific evidence. The following foods are discussed as possible triggers of migraines in children:

• Cow's milk, eggs, cheese
• Chocolate, products containing cocoa
• caffeine
• Grains containing gluten (e.g. wheat, rye, spelled, barley, oats)
• tomatoes
• Citrus fruits (e.g. lemons, oranges)
• fatty food such as sausage, ham, salami, pork

According to the current state of knowledge, it is not necessary to generally avoid certain foods in the case of migraines. According to nutritionists, a special migraine diet does not make sense.

Migraines in children: diagnostics

Since small children are usually not yet able to express themselves appropriately, diagnosing a child's migraine is often difficult. In many cases, doctors therefore diagnose migraines relatively late. Therefore, if you suspect your child has migraines, see a doctor as soon as possible.

The pediatrician or family doctor is the first point of contact. If necessary or for further examinations, the doctor will refer you to a neurologist or pediatric neurologist.

If your child experiences sudden headaches more often, lasts longer or gets worse, see a doctor as soon as possible!

Talk to the doctor

First, the doctor conducts a detailed discussion (anamnesis) with the parents. In doing so, he records the child's medical history. Especially with young children, it is important that the parents describe the symptoms they have noticed in their child. Doctors recommend, among other things, friends, relatives or supervisors at school or kindergarten to ask questions about this.

Small children are often not yet able to express their pain and discomfort appropriately. As a result, it is often difficult for doctors to diagnose migraines in children.

The doctor usually asks slightly older children directly. Among other things, he asks questions such as:

• Can you show where it hurts you
• Since when does it hurt?
• Do you have something like this often or is this the first time?
• Where else does it hurt except in the stomach? (Children tend to describe pain, like stomach ache, that they are already familiar with)
• Did you notice if the pain always occurs in a certain situation? (e.g. when playing or doing sports, after an argument)

Physical examination

After the interview, the doctor examines the child. To do this, he scans the child's head, arms and legs, among other things, and examines it for neurological abnormalities: does it see flashes of light? Does it have a shaky gait? Do your arms or legs feel numb? In addition, he determines whether the mental and physical development of the child corresponds to his age.

Misaligned teeth or jaws, visual difficulties, tense muscles or blockages can also lead to severe headaches. Therefore, more research is often needed to rule out other causes of the headache. This includes, for example, imaging examinations of the skull such as magnetic resonance imaging (MRI).

Keep a headache journal

For the diagnosis, it makes sense if you and your child keep a headache diary and bring this with you to every visit to the doctor. In this calendar, for example, enter exactly when the headache occurs, how severe it is, how long it lasts and whether it is accompanied by other complaints (e.g. nausea, vomiting, abdominal pain, etc.).

These detailed information make it easier for the attending physician to recognize migraines in your child and to rule out other diseases.In addition, a headache diary helps you at home to determine the triggering factors for the headache in your child and to avoid them in advance.

Migraines in children: what helps?

Therapy for migraines in children differs from that in adults. Doctors recommend treating migraines in children initially only with supportive measures without medication.

Experience has shown that these are significantly more effective in children than in adults. If the symptoms cannot be relieved sufficiently in this way or if the child is in severe pain, doctors will also prescribe medication if necessary. However, children receive different preparations than adults.

Treatment without medication

Relaxation methods: Children with migraines are usually helped by simple relaxation methods such as Jacobson's muscle relaxation. The affected children learn to tense certain muscle areas and then relax again.

Autogenic training is also suitable, in which the children repeat thought formulas (e.g. "My arm is getting very heavy") and thereby relax. With both methods, however, it is important that the children do the exercises regularly - preferably daily.

Physical therapy: Physical therapy with heat applications or massages of the neck, neck, head and face as well as acupuncture can help children against severe headaches.

Biofeedback: According to the German Society for Neurology, so-called biofeedback in particular should be very effective, especially for children and adolescents. Various body functions can be measured using electrodes on the skin, for example tension or relaxation of the head muscles or the widening and narrowing of the arteries in the brain. These are made visible by sound and light signals. In this way, patients learn to deliberately and specifically influence these functions.

In this way they can weaken an acute migraine attack and prevent migraine attacks (prophylaxis).

According to the German Migraine and Headache Society (DMKG), procedures without medication in children are usually as efficient as medication.

Home remedies

Parents often feel helpless when their child has a migraine attack. Even simple measures and home remedies are often very effective:

Even the smallest of activities, such as running around or watching TV, usually exacerbates migraines in children. In the event of an acute migraine attack, it is especially important that the children get rest. It is best to bring your child into a well-tempered and darkened room. You should also shield it from disruptive stimuli and sources of noise such as radio or television. Also make sure that your child drinks enough water.

A few hours of sleep, a cool towel on the forehead or a neck massage with peppermint oil (do not use on babies and toddlers!) In most cases ensure that headaches and migraines in children improve quickly.

Small children with migraines in particular fall asleep while playing. In this case, it is best to let it go back to sleep. Sleep is good for your child and they may wake up without a headache.

Medication for a migraine attack

For children and adolescents who have an acute migraine attack, doctors primarily recommend pain relievers such as ibuprofen or paracetamol. Acetylsalicylic acid (e.g. aspirin) is also approved for use against migraines in children aged 12 and over. These drugs are available as tablets, powders, or suppositories.

If taken early, migraine attacks can sometimes be stopped. However, since migraine attacks are usually shorter in children than in adults, the drugs often only take effect when the attack is over. However, there are also children who are in very severe pain and who often need urgent medication. Your doctor will therefore explain to you whether and in what dose your child should take painkillers.

The doctor can also move the antiemetic domperidone as tablets or suppositories to children aged 12 and over. This medication not only fights nausea, but most of all it enhances the effects of pain relievers. However, children should not take this drug without medical advice!

If the mentioned drugs do not improve the migraines in children, there are also active ingredients from the group of triptans available. These have a vasoconstricting, anti-inflammatory and analgesic effect. These include, for example, the remedies sumatriptan and zolmitriptan in the form of nasal sprays. As a rule, however, the doctor only uses these drugs in adolescents from the age of twelve.

Many medications for migraines (e.g. metoclopramide or steroids) that help adults can cause serious damage to children! Therefore, do not give your child any medication that you are taking yourself!

Drugs for prevention

According to the German Society for Neurology, it has not yet been conclusively proven whether drugs to prevent migraines in children are actually effective.

Studies indicate that the beta blocker propanolol and the calcium channel blocker flunarizine can help children and adolescents with migraines. Other studies also show that botulinum toxin A (better known as botox) prevents migraine attacks in adolescents. However, due to a lack of data, these active ingredients have not yet been approved for use in children with migraines.

Migraines in children: prognosis

In about half of the children, the migraines disappear during puberty, in the rest it persists. Most of the time, however, migraines in children can be treated well. The following applies: Ultimately, the decisive factor for a favorable prognosis is how well you succeed in avoiding triggering factors such as stress.

Since young children are often unable to express their symptoms properly, it is often difficult to make a diagnosis early. Therapy therefore often starts late, which for many children is associated with stress in everyday life, at school or in the family. It is all the more important to consult a doctor at the first signs of a migraine.

How do you prevent migraines in children?

Migraine attacks in children cannot be completely avoided. However, there are some steps you can take to prevent it. The primary aim is to avoid possible triggers.

Keeping a migraine diary: Keeping a migraine diary can help to find out which triggers are responsible for the migraines in your child. In this way, triggering factors can be identified and avoided in advance.

Eating a balanced diet: Make sure that your child has a balanced diet and eats regularly. Children should not skip meals. A constant blood sugar level without large fluctuations has been shown to prevent migraine attacks. Regular meals with complex carbohydrates from whole grain products, potatoes, fruits and vegetables are ideal for this.

Drink enough: It is important that your child drinks enough fluids (especially during exercise) and drinks water regularly. In this way you will prevent dehydration and thus headaches.

However, drinks containing caffeine and teine ​​(e.g. cola drinks) are not suitable for children! These may make the migraine attacks longer or cause the attacks to occur more frequently.

Regular exercise: If your child often complains of headaches after exercise, it makes sense to exercise with endurance sports such as swimming, running or cycling. In this way, your child's body gets used to the physical strain, which usually makes the headache go away. Regular exercise outdoors is also ideal as a counterbalance to your child's stressful everyday school life.

Get enough sleep: Especially with children with migraines, it is important to ensure that they sleep as regularly as possible with constant sleeping and getting up times. Children’s need for sleep varies from person to person. While younger children usually need more sleep, older children and adolescents usually need a few hours less sleep.

Limit media consumption: Children who frequently use smartphones, computers or TVs are more likely to suffer from migraines. Therefore, make sure to limit your children's daily media consumption to a reasonable level and, in particular, to keep aggressive and stressful content away from your children.

Avoiding stress: Mental stress often triggers a migraine attack in children. Therefore, try to keep psychologically stressful situations such as arguments within the family away from your child. Also make sure that your child has a balance (e.g. outdoor exercise) to the stressful everyday school life and that you do not put any pressure on your child to perform.

Adapt behavior to the weather: You cannot change the weather, but at least you can adapt your child's behavior on critical days. For example, if the weather is about to change or if it is particularly warm and humid, you should plan more breaks (e.g. nap) in everyday life for your child. This, too, can sometimes prevent migraines.

Avoid irritants: some substances cause headaches. Therefore, avoid exposing your child to irritants such as exhaust fumes, dyes and fragrances. You should also refrain from smoking in the presence of your child.

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