According to the National Headache Foundation, approximately 5 percent of children experience a migraine by the age of 10. Nevertheless, pediatric migraine continues to remain an underrecognized disorder, largely because the criteria used to diagnose a migraine in adults doesn’t necessarily fit with migraines in children.
By examining some of the primary unique features of a pediatric migraine—ones that differ from adult migraines—you can better understand the condition so your child can get a proper diagnosis and relief.
The misconception that a migraine is a predominantly female disorder has hindered the diagnosis of migraines in males, especially considering the fact that prior to puberty, boys are more likely than girls to experience migraines.
While an increased sensitivity to light and sound are common symptoms associated with adult migraines, children may not experience these sensitivities with their migraines until later in life. If a child does experience light or sound sensitivity, they may have a hard time describing it. Instead, your child may put on sunglasses or earplugs or retreat to a dark, quiet room.
Other associated symptoms unique to a pediatric migraine include osmophobia (sensitivity to odors), vertigo, and/or abdominal pain.
In addition, according to a study in Neurology, about 70 percent of children experience autonomic (involuntary) symptoms with their migraines—in adults, autonomic symptoms are more commonly seen in cluster headaches or sinus headaches than migraines. There are a variety of autonomic symptoms your child may experience.
Examples of Autonomic Symptoms
- Forehead and facial sweating and/or flushing
- Eye redness or tearing
- Runny nose and/or congestion
- Swelling around the eye
- Drooping eyelid
Symptoms that occur during the four phases of a migraine attack differ between children and adults.
Before a migraine (called the premonitory or pre-headache phase), both children and adults commonly experience mood changes such as irritability. However, a child may also become pale or develop shadows under his or eyes. In contrast to children, adults tend to report more gastrointestinal changes like diarrhea or constipation, as well as muscle stiffness, fatigue, and yawning.
During the aura phase, a child may experience but have difficulty recognizing or reporting visual disturbances such as zig-zag lines, bright spots, or flashing lights. In fact, some research suggests that some children report feeling embarrassed to report the unusual neurological disturbances of an aura.
During the headache phase, a child (especially a toddler or preschooler) may have difficulty acknowledging or describing his or her pain. Though a child may not verbalize it, the throbbing pain of a pediatric migraine is moderate to severe, unlike the mild pain of a tension-type headache.
Watch out for behavioral or emotional disturbances in your child. For example, instead of telling you her head hurts, your child may stop eating or playing, cry a lot, or have temper tantrums.
Of course, these behavior changes are not diagnostic of a migraine—however, they may be a sign of a pediatric migraine if there are accompanying signs such as vomiting or pain that worsens with physical activity.
The post-headache phase, also called the postdrome, refers to the symptoms a person experiences after the migraine headache resolves. While adults tend to report fatigue, weakness, mood changes, stiff neck, difficulties concentrating, and/or dizziness, children most commonly report the following:
- vision changes.
- food cravings.
- numbness and tingling sensations.
- eye pain.
Duration and Location
Generally speaking, migraines last a significantly less amount of time in children than adults. Moreover, the location of the headache is also different in children. While adults classically experience a migraine on one side of their head, children often feel the pain on both sides of their heads or across their foreheads.
There are migraine variants mostly unique to children, such as cyclic vomiting syndrome, paroxysmal vertigo, or abdominal migraine. These disorders can be tricky to diagnose, as a headache is either only a minor or nonexistent part of the disorder.
For instance, in the case of an abdominal migraine, a child experiences soreness in their belly button area, nausea, vomiting, paleness, and/or a loss of appetite. In fact, headaches often do not occur at all or are only a mild symptom. Thus, before diagnosing abdominal migraine, a child needs to have a full gastrointestinal evaluation to rule out other potential causes of chronic abdominal pain.
In the past, treatment for a pediatric migraine mainly consisted of simple behavioral measures like sleep, fluids, and applying a cold compress. If medication was utilized, acetaminophen (Tylenol) or ibuprofen was recommended.
Now, treatment for pediatric migraines is becoming more thoughtful. Besides the traditional behavioral and pharmacological measures, pediatric headache specialists are encouraging more sophisticated interventions, ones that adult migraineurs use, like relaxation therapy, biofeedback, and school education and action plans (so a child can go rest in a dark, quiet room during school hours).
Preventive strategies are being emphasized for children with migraines, such as not overscheduling activities, maintaining a regular sleep schedule, and minimizing or eliminating caffeine intake.
Additionally, aside from Tylenol and ibuprofen, children (mostly adolescents) now have more drug options when it comes to easing their migraines, such as triptans, a combination triptan/nonsteroidal anti-inflammatory called Treximent (sumatriptan/naproxen sodium), and a preventive medication called Topamax (topiramate).
A Word From Tips For Healthy Living
Recognizing that a pediatric migraine is unique from an adult migraine has been an important milestone within the migraine community. Not only are children now being properly diagnosed, but they are getting the relief they deserve. Children are also learning how to manage their migraines at an early age, which for many, will be a lifelong condition.