Introduction
A migraine is a neurological condition. Migraines commonly present with a moderate to severe headache. Migraines can start in childhood or adolescence, and some individuals will grow out of it by adulthood. Some children get migraines every now and then while others get them more than once a week. Although they are painful and disruptive at times, migraines are not life-threatening.
Signs and symptoms
The pain with a migraine can be pulsating (throbbing) and affect one or both sides of the head.
Children with migraines may experience:
- disturbed vision
- disturbed sensation like tingling
- change in speech
- unsteadiness when walking
- sensitivity to light, sound or smell
- nausea and vomiting
- dizziness
- sore tummy (called abdominal migraines)
- weakness or even paralysis in one side of the body (called hemiplegic migraines).
It is not clear what causes migraines. Migraines often have a genetic basis. That means that there is a tendency for other family members to also get migraines.
Migraines can be triggered by:
- dehydration
- missing meals
- stress
- being tired
- illness
- not enough sleep
- bright lights
- menstruation
- rarely certain foods (these vary from person to person, but can include caffeine, chocolate and cheese)
- weather changes.
Diagnosis
Your child’s doctor will be able to make a diagnosis, based on their signs and symptoms and/or after any appropriate tests.
Take your child to a local doctor if:
- your child is less than 5 years of age
- you notice that your child is: walking differently or falling over often, weaker, or complaining of dizziness or numbness
- you see changes in their behaviour, or
- they are losing daily skills (e.g. starting to drop things)
- your child should also see a doctor if their migraine:
- their migraines are increasing in severity and/ or frequency
- their migraines wake them from sleep or stops them from getting to sleep
- their migraines cause them to miss school or other activities
- their migraines occur early in the morning with or without vomiting
- their migraines are constant and daily
- their migraines are not relieved by over-the-counter medicine.
Your doctor will take a detailed history and physical examination to make a specific diagnosis of migraine. They will decide if your child needs any scans or if you need to be referred to a specialist doctor. You may be asked to keep a headache diary to track patterns of migraines, as well as to assess the safety and helpfulness of treatments.
Treatment
While there is no cure for children who have regular migraines, there are strategies to help manage the symptoms of migraines. If your child is having frequent migraines, your child’s doctor might suggest preventative medication (prophylaxis) to reduce their frequency.
Once your child has a migraine, you can help control your child’s symptoms by having:
- pain relief early
- a rest in a quiet dark room
- a sleep
- something to eat or drink
- a wet cloth on the forehead
- a gentle massage or stretching the head and neck muscles, if they are tight or tender
- non-prescription pain medicine (e.g. paracetamol or ibuprofen).
Give your child the dose that is recommended on the packaging for your child’s age and weight. Do not use more than two days in a week without seeing your doctor.
Note: Aspirin should NOT be used for children for pain management.
Life can be disrupted for children with migraines. Migraines can impact on school attendance and performance, social activities, sleep, mood, appetite and family interactions.
Management
Managing migraines involves a combination of medicines, movement and mind-based strategies. Good sleep habits, regular healthy meals and adequate hydration are also important.
Below are some general ideas to manage regular migraines. Your doctor will give you more specific, individualised recommendations.
Generally, successful migraine management is measured by participating more in everyday activities. Once treatment has started, it is recommend that you focus on recovery and prevention strategies and your child’s daily activities, while focusing less on the pain.
Medicine
Your doctor may suggest one or more medicines that your child can take. They could include:
- simple over-the-counter medicines which are most commonly used to manage migraines. Instructions on the pack must be followed.
- prescribed medicines that reduce nausea and vomiting.
- medicines to prevent migraines or make them less severe.
- some children may benefit from acupuncture with needles or laser. It is recommended that this be done by a registered health care provider.
Movement
You may think it is best to rest and reduce activities like school and sport when your child has ongoing migraines. However, lack of movement can make pain worse. The key to managing ongoing migraines is to find ways to continue with typical activities as often as possible.
- When we exercise, the body’s own pain relievers called ‘endorphins’ are released. These can help reduce subsequent migraine episodes.
- Gradually increasing activities (in time and effort) may be recommended if your child has been inactive for some time. Regular breaks may be needed when initially participating in activities.
- Rest periods should be brief.
- Seeing a physiotherapist may be recommended if migraines are impacted by tight neck muscles, a painful jaw, or poor posture.
- Movement is very important for general well-being. Regular physical activity helps improve strength, fitness, energy, mood, sleep and stress management and reduces sensitivity to pain. Children and adolescents should aim for an hour of physical activity per day.
- Attending school is an important part of managing migraines. School is a good distraction and helps your child keep in touch with friends and teachers. You may talk with the school so that they can help plan rest breaks and reduce stress with friends or grades.
Mind
- Living with migraine can be stressful for your child and for the whole family. However, pain can also feel worse if your child or others around them are stressed or anxious.
- Using relaxation strategies everyday can be helpful to calm the mind and body, and turn down pain. This may include guided imagery, meditation, chilled music, distraction or deep breathing. There are many websites and apps that are available to help with these strategies such as Smiling Mind.
- Getting enough sleep at night is also important. A good sleep routine may include: going to bed at the same time each night and waking at the same time each day, not having daytime naps, using the bed only for sleeping and not using screens an hour before bed.
- A psychologist is often recommended when people have ongoing pain, stress or anxiety, or troubles sleeping. They can help with pain management strategies that will best suit your child, help them develop skills to manage feelings such as worry or sadness, as well as effective sleep routines. Psychologists can also provide advice on how you can support your child.