Chronic illness

Migraines in Children and Adolescents

When I was diagnosed with abdominal migraines as a 12-year-old by an adolescent medicine specialist at Boston Children’s Hospital, there wasn’t as much information out there as there is now. My parents and I would have really loved a resource for patient education information like this one from the Diamond Headache Clinic to help clarify things. My abdominal migraines developed into classic migraine without aura and eventually chronic migraine over time. That is what I deal with now. If your child is dealing with headaches and you would like to learn more, definitely keep reading to increase your knowledge and awareness.

Abdominal Migraine

Abdominal migraine affects mainly children between 5 and 9 years of age. Many of these children go on to develop migraine headaches (with or without aura) later in life.

What Are the Symptoms of Abdominal Migraine?

Symptoms may include:
  • Midline abdominal pain of moderate to severe intensity that lasts 1 – 72 hours
  • Chronic or recurring pain severe enough to interfere with normal activities
  • Mild or no headache
  • Nausea, vomiting, loss of appetite
  • Pallor with dark shadows under the eyes or flushing
  • The absence of another illness, including a gastrointestinal disorder

How Is Abdominal Migraine Diagnosed?

No specific diagnostic test is available to confirm abdominal migraine. A diagnosis is made through a thorough evaluation of the patient’s medical history, incidence of migraine headache in the family, symptoms, and a physical exam and tests to rule out other conditions.

What Are the Treatment Options for Abdominal Migraine?

For children and teens, abdominal migraine treatment includes rest, plenty of fluids, over-the-counter pain relievers and relaxation/behavioral therapy techniques. For older children and adults with infrequent abdominal migraine attacks, physicians may prescribe medications used for other forms of migraine, such as NSAIDs, anti-nausea medication and triptans. Frequent abdominal migraines are treated with the same preventive therapies used for other migraines.

Migraine Headache

The average age of onset for migraine is 7 years old for boys and 10 years old for girls, although symptoms may appear in much younger children. Up to age 12, equal numbers of boys and girls suffer from migraine; by the ages 21 – 24, up to 80% of migraineurs are woman. Children with migraine often have a family history of migraine. Migraine affects up to 5% of school-aged children. From 50% to 75% of children with migraine will cease having attacks between adolescence and early adulthood, but some will redevelop migraine later.

What Are the Symptoms of Migraine Headache?

Common symptoms of migraine in youngsters include:
  • Pain on one or both sides of the head, or a child may report pain “all over”
  • Pounding or throbbing pain, although children may not be able to articulate this
  • Abdominal upset, nausea and/or vomiting
  • Sensitivity to light and/or sound
  • Sweating
  • Becoming pale or quiet
  • Experiencing an aura, or a sense of flashing lights, funny smells and changes in vision

Tension-Type Headache

This common headache type is triggered by stress or emotional/mental conflict.

What Are the Symptoms of Tension-Type Headache?

  • Generally, symptoms include:
    • Headache that develops slowly
    • Pain usually present on both sides, and may involve the back of the head
    • Dull pain or pain that feels like a band around the head
    • Mild to moderate, not severe, pain
    • Change in sleep habits

Cluster Headache

More common in adolescent males, cluster headache usually begins in children over 10 years of age. This headache type occurs in a series, or “cluster,” that can last for weeks or months. This series of headaches may recur annually or every other year.

What Are the Symptoms of Cluster Headache?

  • Common symptoms in children and adolescents include:
    • Unilateral (one-sided) pain, often behind an eye
    • The affected eye may look droopy and have a small pupil, or the eyelid may be red and swollen.
    • Congestion or runny nose
    • Swollen forehead

Headache Associated With a Serious Issue

If your child shows these symptoms, consult a headache specialist to determine if there is a possible serious underlying cause:

  • Headache in a very young child
  • Headache pain that awakens a child
  • Headaches that begin very early in the day
  • Pain worsened by strain like a cough or sneeze
  • Recurrent vomiting episodes or other signs of a stomach virus
  • Child complaining about “the worst headache ever”
  • Increasing severity of headache, or one that continues
  • Personality changes
  • Weakness in limbs or problems with balance
  • Seizures or epilepsy

How Is Pediatric/Adolescent Headache Diagnosed?

An accurate diagnosis is the first step to effective treatment in children and adolescents with headache. A pediatric headache specialist should evaluate your child thoroughly, including a physical exam, inquiries into medical and family history, and diagnostic tests. The child may be asked to describe the pain, its location, the duration of the headache and more. The specialist may ask parents about changes in behavior, personality, sleeping patterns, emotional stress and if physical trauma preceded the headache. If symptoms indicate migraine or tension headache, specialists may not recommend further testing. But sometimes, additional diagnostic tests may be necessary; these may include blood tests, an MRI or CT scan, or a polysomnogram to check for a sleep disorder.

What Is the Recommended Pediatric/Adolescent Headache Treatment?

Each child receives an individualized treatment regimen that may include these components:

  • Medication
    Specific therapeutic agents are prescribed, and patient response is closely monitored to evaluate efficacy and minimize side effects.
  • Lifestyle Modification
    Patients are instructed in the areas of diet, recreation, sleep patterns and other habits linked to headaches.
  • Biofeedback Training
    This is a non-drug therapy that enables patients to actively participate in their treatment while alleviating headache symptoms. About 70% of all patients, and especially children, benefit from this training. Biofeedback augments other therapies and is particularly useful for patients for whom stress is a major contributing factor to headaches, or for those patients who are unable to use standard headache agents.

Information courtesy of Diamond Headache Clinic.

Take care,
Lindsay B.

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