Migraine is the third most common disease in the world, with one billion afflicted globally. This includes children. Dr. Christine Lay, AMF Vice-Chair, and pediatric neurologists Dr. Amy Gelfand and Dr. Kaitlin Greene sat down for our “Migraine in Children” webinar. They answered pressing questions about treating and helping children manage migraine. This article is meant to serve as a resource for you when talking to your doctor about your child’s migraine.
Q: How prevalent is migraine in children?
A: Migraine is very prevalent in children. By age 10, one in 20 children will suffer from migraine. Before puberty, boys and girls are equally likely to be affected. As they go through their teenage years, the prevalence rate increases to what we see in adults, with 18% of girls getting migraine and 6% in boys.
Q: How does migraine present in a young child?
A: For the most part, it looks like an adult migraine attack. However, there are a few differences. Adults often describe pain on one side while it is more common for children to experience pain on both sides or in the front. Children may also experience light and/or sound sensitivity during an attack in addition to nausea or vomiting.
Additionally, children, especially young children, may not have the verbal skills to describe what they are feeling. It is important for adults to pay attention to key behaviors to help identify migraine. For example, if your child wants to be left in a dark, quiet room, this might suggest light or sound sensitivity, and decreased appetite may be a sign of nausea. Keeping a diary can help to better understand the frequency of attacks and identify if there are days, times, or situations when migraine is more likely to occur.
Q: What is going on in the brain that might lead to a child presenting with migraine symptoms?
A: We do not fully understand what can initiate a migraine attack. However, there is some information that can offer insight. Research has indicated that migraine attacks may start in the hypothalamus, the part of the brain that regulates sleep-wake cycles, appetite, and mood. Migraine is also fundamentally a genetic disorder, which means that children who live with migraine may already have a predisposition to the disease. It is encouraged for parents to dig into their family history of migraine.
Q: What should I tell my child when they’re experiencing intense pain from a migraine attack?
A: First, it is important to recognize that your child is experiencing a migraine attack. Reassure them that nothing dangerous or worrisome is causing the pain. Talking to your child about what they are experiencing can also help them understand what is going on from their perspective.
In older children, such as teenagers, you can inform them that there is a ‘filter’ to their brain that is not working at that moment. Let them know that their brain is unable to ‘filter’ out external stimuli—lights, sounds, and so on—and is causing sensory overload.
Q: What is the relationship between epilepsy and migraine?
A: Migraine with aura and epilepsy are two disorders of episodic hyperexcitability of the brain. Hyperexcitability is when the brain becomes overstimulated with electrical waves in patterns. It can lead to a seizure (for epilepsy) or cortical spreading depression (for migraine aura).
Q: Is it possible for an adolescent with epilepsy to become migraine-free?
A: It is certainly possible with effective treatment. Epilepsy should not prevent an adolescent from responding to migraine treatment.
Q: I think my child has migraine. What should I do?
A: Always talk to your doctor. Observe clues and behavior that would indicate your child is having a migraine attack or about to have one. This includes sensory sensitivity, appetite difficulty and so on. Keep a log on how frequent the symptoms and/or attacks occur and what kind of stimuli (such as lights, sounds, etc.) could be affecting your child. Checking your family history for migraine is also a good source of clues that you can mention to your doctor.
Q: What is the connection between migraine and infant colic?
A: Infant colic is excessive crying in an otherwise healthy and well-fed infant. Colic affects between 5-20% of babies on average. Research has shown that babies who are colic are more likely to have migraine in childhood. Mothers who also have migraine are most likely to have colicky babies.
Infants’ brains are already sensitive to sensory experiences. As such, infants with migraine have extra sensitivity to external stimuli. Additionally, colicky crying tends to happen in the evening. This is likely because babies have experienced external sensory stimuli all day and have an opportunity to express their pain and discomfort through inconsolable crying when the day winds down.
It is important for parents to remember that colic infants are not a result of bad parenting. It could very well be an indication of migraine, which will be more manageable as their child gets older.
Q: Does my child have abdominal migraine? What does it look like when it happens?
A: As children age from infancy to toddlerhood, they may experience episodes of sudden dizziness, looking pale or unsteadiness on their feet. As they get older, they may experience recurrent attacks of dizziness or vertigo. These are indications of migraine.
By around elementary school age, some children experience recurring attacks of long-lasting stomachaches that range from moderate to severe pain. It is a stomachache that stays, unlike regular stomachaches. There is usually a dull pain in the general belly button area. Some other symptoms include changes in appetite, nausea or vomiting.
It is important to note that abdominal migraine usually requires more investigation. As such, be sure to look into your family history for migraine and speak with your doctor.
Q: What is cyclic vomiting syndrome and how does it relate to migraine?
A: If your child has an episodic pattern of throwing up, this is called cyclic vomiting syndrome. It is unknown if cyclic vomiting syndrome is linked to migraine, but it is still worth noting and bringing up to your doctor if you suspect your child suffers from migraine.
Q: What are some behavior or lifestyle changes that can help my child with their migraine symptoms and attacks?
A: There are many ways you can help manage migraine symptoms and attacks:
- Reduce sensory overload. If your child is suffering from a migraine attack, take them to a dark or quiet room and let them rest in there until their attack passes.
- Sleep. This is often very helpful for anyone with migraine.
- Hydration. Keeping hydrated can also help.
- Regular meals and exercise. Maintaining a routine of adequate meals and exercise can help reduce the symptoms of migraine and headaches in general.
Be mindful. It is important for both children and parents to be aware of their symptoms and patterns. Parents should also teach their children to remain calm and centered to avoid exasperating symptoms.
Q: Can I use supplements or medication for my child’s migraine?
A: Studies have shown that supplements could help with migraine. Ask your doctor about supplements like melatonin, riboflavin (or Vitamin B2), coenzyme q10 (Coq10), and magnesium.
Medications can help with migraine. Consult your doctor to determine which ones will work best for your child. If your child is prescribed medication, continue to keep track of symptoms, side effects, and results. Also, consider neuromodulation devices, but keep in mind that most insurance policies do not cover those.
Q: I’ve tried everything, but no treatment has worked. What should I do?
A: There is always something else to try. Migraine is unique to each individual and can change as children age from childhood to adolescence to adulthood. Work with your doctor to figure out the best plan for your child, continue to record symptoms and triggers, and console your child about their experiences.