Migraine Headache

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KEY POINTS

• A migraine headache can cause intense pain, nausea, vomiting, or changes in your vision just before or during the headache. Migraines can last for hours to days.
• Migraine headaches are usually treated with medicine for a current headache and sometimes, a second medicine for preventing further headaches.
• Have your child rest in a quiet, dimly lit room until the symptoms are gone. Put a cool, moist washcloth on the painful side of your child’s head. You might also try a heating pad set on the lowest setting. Experiment to learn which works better for your child.

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What is a migraine headache?

A migraine headache is a type of headache that can last for hours to days. It can cause intense pain as well as other symptoms. For example, you may have changes in your vision just before or during the headache, or you may feel sick to your stomach during the headache.

What is the cause?

The exact cause of migraines is not known. They may be related to a problem with the blood flow in the brain, or they may happen with changes in brain chemicals and hormones such as estrogen. You may find that your migraine headaches seem related to:

• Stress
• A change in your sleep habits
• Missing a meal
• Changes in the weather
• Loud noises
• Bright lights or glare
• Certain foods such as red wine, cheese, or chocolate
• MSG or food preservatives such as nitrates
• Some medicines

Migraines tend to run in families.

What are the symptoms?

Most children with migraines have warning symptoms before the migraine starts. Not every child has the same symptoms, but each child may have a pattern of symptoms. Symptoms that your child may have in the minutes, hours, or even a few days before a migraine include:

• Sensitivity to light, noise, or smells
• Feeling unusually tired
• Craving certain foods such as chocolate or not wanting to eat at all
• Feeling angry, irritable, or depressed
• Increased thirst and urination
• Changes in bowel movements, either constipation or diarrhea

Your child may also have vision changes about 30 minutes before your child’s head starts hurting. Your child may lose all or part of his or her vision for a brief time or see bright spots or zigzag patterns. Your child may also have tingling, numbness, or weakness. These warning symptoms are called migraine aura. Aura symptoms usually start gradually and go away within 20 minutes. Usually aura symptoms go away before the headache begins, but some children have aura symptoms at the same time as the headache. Aura symptoms are more common in adults than children.

Migraine symptoms usually last from 30 minutes to 2 days and may include:

• Throbbing or pounding headache, usually on one side of the head
• Pain that gets worse with physical activity
• Extreme sensitivity to light and noise
• Nausea or vomiting

After the headache goes away, your child may have some of these symptoms for a day or so:

• Feeling unusually tired or irritable, or feeling unusually refreshed and happy
• Muscle soreness and weakness
• Craving certain foods, or not wanting to eat at all

How is it diagnosed?

Your child’s healthcare provider will ask about your child’s symptoms and medical history and examine your child. There are no lab tests or X-rays for diagnosing migraine headaches.

It will help if you keep a record of:

• Date and time of each attack
• How long the headache lasted
• Type of pain such as dull, sharp, throbbing, or a feeling of pressure
• Location of pain
• Any symptoms before the headache began
• Anything that happened, including foods and drinks your child had, before the headache began. This should include checking the ingredients on the labels of packaged foods your child has eaten. Saving the labels of foods or drinks might be a good way to record this information.
• Use of cigarettes, caffeine, or alcohol, especially red wine, before the headache began. These are less likely to be migraine triggers for children, but you should ask if your child has used these products.
• The time your child went to bed and the time your child got up before the headache began

A headache diary can help your child’s healthcare provider know if your child has migraines, or if your child’s headaches are caused by tension, allergies, or other problems. Your child may have tests or scans to check for other possible causes of the symptoms.

How is it treated?

Medicines such as acetaminophen or ibuprofen can help treat milder migraines. Check with your healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a rare, serious illness called Reye syndrome.

• Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. Read the label and give as directed. Unless recommended by your healthcare provider, your child should not take NSAIDs for more than 10 days.
• Acetaminophen may cause liver damage or other problems. Read the label carefully and give your child the correct dose as directed. Do not give more doses than directed. To make sure you don’t give your child too much, check other medicines your child takes to see if they also contain acetaminophen. Unless recommended by your healthcare provider, your child should not take this medicine for more than 5 days.
• Your child's healthcare provider may prescribe medicine to treat headaches. Your child should take this medicine as soon as possible after a migraine begins. This means you and your child need to learn to recognize his or her warning symptoms.
• Your child’s provider may also prescribe a medicine to prevent your child’s migraine headaches. Your child may need to take preventive medicine for several weeks before you know if it is helpful.

How can I take care of myself?

When your child starts having signs of a migraine:

• As soon as possible after the symptoms start, give your child the medicine recommended or prescribed by your child’s healthcare provider. Treating the headache early can keep the pain from getting severe and shorten the time your child has the headache.
• Have your child rest in a quiet, dimly lit room until the symptoms are gone. The pain may go away with sleep.
• Put a cool, moist washcloth on the painful side of your child’s head.

Follow the full course of treatment prescribed by your healthcare provider. Ask your healthcare provider:

• How long it will take to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests. Contact your child’s healthcare provider if your child has new or worsening symptoms.

How can I help prevent migraine headaches?

Prevention is an important part of treatment. To help prevent migraine headaches:

Take note of the possible triggers of your child's headaches and help your child avoid these things in the future. Regular physical activity and keeping a routine for eating and sleeping may help keep your child from having a lot of migraines.

Talk to your child about the risks of smoking and using e-cigarettes, drinking alcohol, and using drugs.

Many children have fewer migraines as they get older.

For more information, contact:

• American Migraine Foundation
  856-423- 0043
  https://americanmigrainefoundation.org/
• National Headache Foundation
  888-643-5552
  https://www.headaches.org/