Do migraine headaches occur in children?

Pediatrics for Parents, Jan, 2005 by Donald Lewis

Yes!

Migraines are very common in children. About 5% of elementary school-aged children and 15% of high school adolescents experience migraine headaches.

Migraine attacks last one to seventy-two hours and are intense and pounding, often causing nausea and pain across the forehead or sides of the head. During the episode, light and sound aggravate the pain. Often the children will withdraw to a quiet, cool, dark place to rest. Typically, the child will look pale and not want to eat anything.

Most children will have only one or two migraine attacks per month, but some, particularly ten to fourteen-year-old boys, may have up to two or three per week.

There is a strong tendency for migraines to occur in families. Frequently, the parents of a child with migraines also suffer from intense headache attacks. Often, the parents' headaches have been blamed on stress or sinus problems, but they are also actually suffering from migraines.

The first step of treatment is accurate diagnosis and exclusion of other worrisome causes of headache. This can be accomplished by your child's doctor with a thorough medical history and physical examination. Headaches due to scary things like brain tumor--every parent's nightmare--can be discovered through this process of history, physical and neurological exam.

The next step is to establish the pattern of the child's headaches. The best way to do this is by keeping a headache diary. Write the date and time of day of the headache, the severity of the headache, the location of the head pain, symptoms other than headache, how long the headache lasts, any known cause or aggravating symptoms, and anything else either the parents or child think are important.

If the attacks occur infrequently, then the mainstay of treatment is the prompt use of pain medicine, within 30 minutes of the onset of the pain. Since the headaches often start at school, the medicine must be available to the student at school. Cooperation with the school nurse is essential so that the patient may have access to his pain medicine promptly. Hesitation leads to more pain!

Recently, we reviewed all the world's research that focused on treating attacks of migraine in children to find the best, most effective drugs. We found that the over-the-counter medicines ibuprofen and acetaminophen were the best medicines for children less than 12 years old. For teenagers, the nasal spray form of the prescription drug sumatriptan was the best available medicine.

For children and adolescents who average one or more migraine headaches per week, the treatment needs to be expanded to try to prevent the attacks from occurring. For these patients, it is essential to suggest some simple lifestyle modifications such as regular meals (stop skipping breakfast!), regular sleep (stop chaotic sleep patterns), moderation of caffeine intake (stop the lattes and sodas), regular exercise (get off the couch and turn off the video games), and search for triggers (stress, foods, activities). Sometimes, we will get the help of psychologists to teach behavioral therapies like biofeedback.

Once these lifestyle changes are in place, a variety of medications are used for a limited period of time to break the cycle of frequent headaches. Commonly used prescription medicines to prevent attacks of migraine include cyproheptadine (for young children less than ten to twelve years of age) and amitriptyline, valproic acid, gabapentin and topiramate for teenagers. These medicines are often needed daily for several months and usually through the entire school year so that the student's headaches are kept under control to limit school absences.

There is lot that can be done for children and adolescents who have migraine headaches. While no one can claim to cure migraine, a rational and tolerable regimen of lifestyle modifications coupled with the judicious use of pain medicines and preventive strategies can greatly reduce the burden produced by migraine.

If your child is suffering from frequent headaches, see your doctor and ask about these new pediatric migraine treatment guidelines.

Dr. Donald Lewis is professor and chairman of the Department of Pediatrics at the Children's Hospital of the King's Daughters in Norfolk, VA. He is a graduate of the United States Naval Academy and received his medical training at the Medical College of Virginia and his pediatric neurology training at the Children's Hospital of Philadelphia. His clinical and research interest for the past 15 year has been pediatric headache and migraine.