Posted here December 5, 2023

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According to the National Headache Foundation, 20% of school-aged children from 5 to 17 are prone to headaches. Of that population, 15% will suffer from tension-type headaches, while the other 5% will be prone to migraine (this number is often reported as up to 10%).

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Headaches and migraine can happen to anyone, at any age, including young children. Not only that, but the intricacies and symptoms of the disorder are different in children than in adults; common migraine symptoms such as nausea, vomiting, and sensitivity to light and sound are not always prevalent in child sufferers. Children, in addition, cannot always vocalize or describe in detail what they are feeling, which makes diagnosis even more difficult. These patients may go undiagnosed for years, leading into adulthood, which can take a toll on their emotional and mental well being.

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The American Migraine Foundation outlines a few key differences between children’s migraine and those of adults:

• migraines in children are typically shorter in duration and occur less frequently

• the pain children experience tends to be more bilateral, such as across the forehead, rather than unilateral (on one side of the head)

• while common symptoms may not be reported, a lot can be deferred from a child’s behavior, such as wanting to sleep or lay down in a dark, quiet room.

 

Here are a few of the types of migraine that commonly affect children:

 

1.  Common Migraine Without Aura

According to John Hopkins Medicine, migraines may start early in childhood, with an average onset around age 7 for boys and 10 for girls. Early triggers may include a family history of migraine, or correlation with menstrual periods for females.  According to the Migraine Trust, children can often feel or be sick (nausea) after a migraine attack, which brings relief from symptoms and often represents the end of a migraine attack. Typical adult migraine symptoms such as muscle tenderness and light/sound sensitivities may be seen. Certain early indicators of migraine are specific to children, including car or motion sickness, cyclic vomiting periods, and infant colic.

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2.  Classic Migraine With Aura

According to the Cleveland Clinic, young children under the age of 10 often experience classic migraine in the late afternoon, and as they get older (12 and above), the onset may change to early morning.  Aura is a warning sign that a migraine is about to begin (it also can occur as the migraine is attacking), usually occurring about 10 to 30 minutes before onset. In some cases, aura appears as early as the night before the onset. The most common auras are visual and include blurred or distorted vision, blind spots, or the appearance of flashing or moving lights. Other auras may include speech disturbances, motor weakness, or sensory changes.  About 10% of children with migraine experience aura, according to the Migraine Trust; the symptoms can last up to an hour.

 

3.  Tension-type Headache

Tension-type headaches are the most common type of headache in both children and adults, and are usually caused by secondary factors such as stress, certain foods, or environmental triggers. According to the Mayo Clinic, tension headaches can cause: a pressing tightness in the muscles of the head or neck; mild to moderate, non-pulsating pain on both sides of the head; pain that’s not worsened by physical activity; and a headache that is not accompanied by nausea or vomiting, as is often the case with migraine. Tension-type headaches typically last from 30 minutes up to several days in severe cases.  Younger children may withdraw from normal activities and want to sleep more, according to the Mayo Clinic; a good indicator that a tension headache or migraine has occurred. Sleep, according to the Migraine Trust, can help headache and migraine attacks go away for children, even for as little as a 15-minute nap.

 

4.  Abdominal Migraine

Some children have distinct abdominal pain that accompanies a migraine, and while they typically grow out of this condition, they may go on to develop constant migraine in adulthood. Abdominal migraine is prevalent in children from ages 5- to 9-years-old and occurs in 4% of children, with a mean onset of age 7, according to the American Migraine Foundation. It is recognized as an episodic syndrome that may be associated with migraine.  Abdominal migraine pain can be crampy, dull, or sharp in nature and can last from a few hours to up to three days. The pain may be described as moderate to severe in intensity, and typically surrounds the bellybutton. Pain can be severe enough to interfere with normal daily activities, and come with a loss of appetite, nausea, vomiting, paleness, or sensitivity to light or sound, according to the American Migraine Foundation.  Abdominal pain can also be a sign of gastrointestinal or renal disease, so a thorough evaluation should be conducted to rule out these conditions.

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5.  Basilar Migraine

According to the International Classification of Headache Disorders (3rd edition), basilar migraine is defined as migraine with aura symptoms clearly originating from the brainstem, with no other motor or retinal weaknesses. According to the Migraine Trust, typical symptoms can include visual disturbances in both eyes, speaking difficulties, hearing problems, tingling in the hands and feet, dizziness, vertigo, or ringing in the ears. Each of these symptoms usually only lasts up to one hour. Many of these symptoms may occur with anxiety and hyperventilation, which makes proper diagnosis challenging.  The American Migraine Foundation suggests that migraine with brainstem aura is more common in adolescent females, but notes that it can affect all age groups. However, basilar migraine does exhibit the same female predominance seen overall in migraine.

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6.  Ophthalmoplegic Migraine

Ophthalmoplegic migraines are headaches with pain surrounding the eye, sometimes with symptoms such as droopy eyelids, double vision, and other sight problems, according to Stanford Health Care. Also known as ocular migraine or retinal migraine, these types of migraine can occur without any noticeable accompanying head pain, according to the American Migraine Foundation.  Much like other migraine aura conditions (such as basilar migraine), this migraine is considered to be a result of abnormal electrical activity involving certain regions of the cortex (outer surface) of the brain, according to the American Migraine Foundation. Ocular/retinal migraine features pain at the back of the eye in the retina, and may be the result of a reduction in blood flow to the retina. Harsh lights and screens, eyestrain, and other weakening visual activities can trigger attacks.

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What to Do if You Suspect Your Child is Experiencing Migraine

While headaches can seem to be inescapable, there are many things that both the parent and child can do together to prevent the onset of migraine, such as getting a proper diet, drinking plenty of water, and regularly exercising.  Due to these small differences in the characteristics of migraine in young people, seeing a pediatrician or a pediatric headache specialist may be a good first step to helping your child or young teen find relief. Comprehensive evaluations by these doctors and/or specialists may both be a way to determine the specific type of migraine, while also making sure that the head pain isn’t associated with a serious underlying cause, such as viruses, seizures, or mood changes.

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