By Susy Jeng, MD, FAAP & Eliza Gordon-Lipkin, MD, FAAP
Roughly 42 million people in the United States suffer from migraines. While they most often strike adults, many children also experience intense, throbbing headaches and other symptoms of migraines. Read on for helpful information about the signs, symptoms and causes of migraines. We will also discuss ways to help children and teens dealing with them.
What is the difference between a migraine and a headache?
Migraine pain usually is more severe. It typically includes throbbing on one or both sides of the head that worsens with activity. Often, this pain is helped by sleep. Migraine headaches also tend to strike with other symptoms, such as nausea, vomiting, sensitivity to light and sound. Vision problems (seeing spots or flashing lights, for example) can happen with migraines, too.
At what age can children get a migraine?
Any child can get a migraine. About 10% of children age 5-15 and up to 28% of teens get them. Half of people who get migraines have their first attack before age 12. Migraines have even been reported in children as young as 18 months!
Childhood migraines: a colic connection?
Research suggests that children who had
colic as babies may be more prone to develop migraines. One study found children with migraines were 7 times more likely to have been colicky infants.
What are some migraine causes, risk factors & triggers?
Family history. Migraines tend to run in families. If one parent has migraines, there is roughly 50% chance that their child will too. If both parents have them, the chance is close to 90%.
Gender. Before
puberty, boys and girls have roughly the same incidence of migraines. After age 12, girls have more migraines, and by age 17, as many as 8% of boys and 23% of girls have had a migraine. For adults, migraines are more common in women.
Stress and sleep. Irregular sleep schedules – getting too much or too little sleep – and poor sleep quality (such as frequent awakenings) can be migraine triggers. So are changes in
stress levels.
Exercise. While exercise can sometimes trigger migraines,
regular exercise may help prevent or reduce the number of attacks and attack intensity.
Food and fluids. Skipping meals and eating certain foods and
additives can set off migraines. Common triggers include aged cheeses and meats, chocolate, citrus fruits, red and yellow food dyes,
monosodium glutamate (MSG) and the
artificial sweetener aspartame. Too much caffeine and spicy foods can also trigger migraines, but sometimes help headaches because they act as vasodilators and expand blood vessels. Not drinking enough water and other
beverages can cause dehydration, another migraine trigger.
Weather. Stormy weather with changes in barometric pressure, extreme heat or cold, bright sunlight and glare, high humidity or very dry air all can be triggers.
Are there different stages of migraines?
Migraines headaches often develop in stages that include:
Premonitory or warning phase: tiredness, stiff neck, mood changes (can last up to 24 hours).
Aura: seeing spots or squiggly lines, dizziness, weakness, tingling, numbness and/or confusion. These symptoms, which don't happen with all types of migraines, may last up to an hour.
Headache or attack: severe, throbbing/pulsating pain with nausea, vomiting and light sensitivity.
Resolution: sleep ends the headache pain for some children.
Recovery: feeling tired (lasts hours to days).
How is a migraine diagnosed?
The
diagnosis of a migraine is usually based on a thorough medical history along with physical and neurological exams. Occasionally, tests like bloodwork, MRI or lumbar punctures may be recommended.
Measuring migraines: mild, moderate or severe?
To measure how strongly migraines impact a child's school, home, and social activities, pediatricians and pediatric neurologists use a tool called the Pediatric Migraine Disability Assessment (PedMIDAS), which consists of 6 questions:
In the last three months, how many...
Full days of school were missed due to headaches?
Partial days of school were missed due to headaches?
Days did you function at less than half your ability in school because of a headache?
Days were you not able to do things at home (e.g., chores, homework, etc.)?
Days you did not participate in other activities due to headache (e.g., play, go out, sports, etc.)?
Days did you participate in these activities, but functioned at less than half your abilities?
The total number of days are then added up. A score of less than 10 is considered little or no impact; 11-30 is mild; 31-50 is moderate, and more than 50 is severe.
How are migraines treated?
Lifestyle changes
Keeping healthy, regular routines can help prevent or reduce the frequency and severity of migraines:
Sleep hygiene. Children, especially those with migraines, should get 8-10 hours of sleep daily. If your child has trouble sleeping, your pediatrician may recommend tests to monitor for snoring or sleep disorders, which have been linked to migraines. Make sure TVs, cell phones, tablets and other
media devices are turned off an hour before bedtime, since they can interfere with sleep.
Healthy diet. Eat three regular meals each day at consistent times. Avoid heavily processed foods, which tend to contain more migraine triggers like additives and artificial colors and sweeteners. Drink plenty of water and other healthy beverages to stay hydrated.
Helpful tip: keep a headache diary
If your child has migraines, keeping a
headache diary can help you start to recognize triggers and which therapies are most helpful. Simply write down when the headache started, where the pain was located, how severe the pain was, how long it lasted, any other symptoms and if medications were effective. You may also want to keep track of how much sleep your child had, what they ate and drank, amounts of exercise and stress, as well as weather changes.
Acute migraine medications & treatments
Your child's doctor may recommend or prescribe medications that can help during a migraine attack. These work best when taken at the first sign of an attack. Keep in mind that
medication overuse headaches may start if these are used more than 10-15 days a month. Examples of medicines and treatments that can help during a migraine include:
- Analgesic pain medicines such as
acetaminophen, products that combine acetaminophen, aspirin and caffeine, and nons teroidal anti-inflammatory medicines such as
ibuprofen and naproxen.
- Triptans, a category of drugs called selective serotonin receptor agonists. Some are approved in children as young as 6, and others for children ages 12 and up.
- Neuromodulatory devices act on the pain perception and response pathways of the nervous system. Neuromodulation devices have been approved for children 8 years old and up to treat migraines. Types include remote electrical neuromodulators, nerve stimulators and transcranial magnetic stimulators.
Preventive medications & treatment for migraines
There are some daily medications and treatments that can help reduce the severity and/or frequency of migraines. Discuss their risks and benefits with your child's doctor. There are currently no large clinical trials that have shown clear benefits in children with migraines. In addition, with the exception of topiramate, they are not FDA-approved. Options include:
Cardiovascular drugs: propranolol
Antidepressants drugs: amitriptyline
Anti-seizure drugs: topiramate
Antihistamines: cyproheptadine
Neuromuscular blockade and analgesic drugs: botulinum toxin (Botox) as a series of injections in muscles
Calcitonin g-receptor peptide (CGRP) inhibitor drugs: erenumab, fremanezumab as monthly injections, rimegepant as a pill every other day
Clinical trials of CGRP inhibitors for migraines
Calcitonin g-receptor peptide, a type of chemical messenger released by nerve cells, is known to promote migraines. The first CGRP inhibitor approved by the FDA for adult migraine prevention was erenumab (Aimovig) in 2018. There is a 2024 pediatric migraine trial of fremanezumab (Ajovy) that shows it to be effective for children ages 6-17 to prevent episodic migraines. This CGRP inhibitor is currently under FDA review for approval in children. It is given as a monthly injection and has few interactions with other medications.Are there any alternative therapies shown to help migraines?
There are some alternative or
natural and non-pharmaceutical approaches to migraine treatment that may help. These include:
Cognitive behavioral therapy (CBT)
CBT focuses on coping skills, positive thinking, sticking to healthy habits, and relaxation techniques to help ease migraine pain. Research also has found that CBT combined with migraine medications is more helpful in treating migraines that medication alone.
Herbs, vitamins & minerals
Certain extracts and supplements may help with migraines, although some should be avoided for safety reasons. Talk with your child's doctor before using any herbal or vitamin supplements. Common supplements include:
Riboflavin (vitamin B-2), magnesium and coenzyme Q10 supplements may decrease the frequency of migraines.
Feverfew: this plant contains parthenolide, which some small studies suggest may help prevent migraines in some people. However, the evidence remains mixed.
Butterbur extract: plant containing petasins is
NOT recommended because of long-term liver disease risk.
Vitamin D, melatonin, and PEA (palmitoylethanolamide) are all currently being studied.
How can I help my child avoid missing school from migraines?
Children who suffer from migraines are
absent from school twice as often as other students. Talk with your child's teachers and school nurse about ways to help avoid missed class time. A letter from the doctor explaining your child's diagnosis and the medications they can take at school when they feel a migraine coming on can help the conversation. Helpful
accommodations may include making sure your child has ready access to water, snacks and the restroom.
More information
About Dr. Jeng
 Susy Jeng, MD, FAAP, is a general child neurologist and Clinical Associate Professor of Neurology at Stanford Children’s Hospital at Stanford University. Dr. Jeng is a member of the American Academy of Pediatrics (AAP) Section on Neurology with an interest in medical education. She serves as an associate program director for the Stanford medical student neurology program.
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About Dr. Gordon-Lipkin
 Eliza Gordon-Lipkin, MD, FAAP, a member of the AAP Section on Neurology, is a child neurologist at the National Human Genome Research Institute within the National Institute of Health in Bethesda, Maryland. Dr. Gordon-Lipkin has special expertise in neurodevelopmental disabilities and sees patients with a broad spectrum of genetic and developmental disorders.
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