Migraines in Children
by Joshua Rotenberg, MD
Talk to the Doc — June 2011
Grinning cats, smoking caterpillars, and butterflies made out of bread. Talking doorknobs, marching cards, and a chronically-late rabbit.
Famous author Lewis Carroll must have had one heck of a headache when he dreamed up these characters.
It’s said that Carroll was inspired to write Alice in Wonderland after experiencing migraine auras—the distorted sense of perception that sometimes precedes a migraine.
Migraine auras have also been referred to as “Alice in Wonderland Syndrome,” rather fitting considering the book became one of the most popular children’s stories of all time, and children themselves have been getting migraines since the beginning of time.
Headaches are quite a common pediatric problem, with approximately eight percent of kids experiencing one by the age of 3, and two to three percent of those fitting the criteria for migraine. By elementary or middle school, 60 percent of children have had a headache; in approximately 10 percent, that headache was a migraine.
How do you know if your child has a headache or a migraine? It can be a grey area, but migraines are what I call “sick headaches.” Run-of-the-mill headaches do not fit the following criteria.
Brain Dysfunction/Phenomena
Adults are more likely to experience migraine with aura, seeing moving lights and distorted images, but I’ve had kids tell me their entire visual field is upside down. It’s called Benign Paroxysmal Torticollis, and the younger kids are, the weirder their experience with it seems to be. Even infants will exhibit symptoms, most often by tilting their heads to one side. In children who display BPT, there is frequently a family history of migraines.
Pain
Light hurts, sound hurts, even smell sometimes hurts. People who get migraines often retreat to a dark, quiet room. But children and adults alike can have migraines with zero head pain, experiencing only aura or vertigo. Benign Paroxysmal Positional Vertigo—the sensation that the room is spinning—is the most common form of vertigo in children and is most often associated with migraines.
Sick and Tired
There are basically three phases of migraines—the third and final one being what I call the “after party.” Children are more susceptible than adults to vomiting at this stage, followed by the need to sleep it off.
Causes and Triggers
Poor sleep habits are definitely a trigger in children. Going from 11 or 12 hours of sleep on weekends back to eight or nine hours on weeknights… all that back and forth is disruptive to sleep patterns. In fact, in the summer, I see very few kids with migraines.
Stress as a trigger versus lack of sleep is sometimes hard to discern with children.
Poor eating habits, most often in the form of highly-processed foods, can trigger migraines.
There also seems to be some kind of genetic component, as up to 90 percent of kids who have migraines have a family member who does as well.
Boys are more likely than girls to develop migraines, but only before puberty. After puberty, girls are three to four times more likely than boys to get migraines.
Treatment
Mounting evidence shows that getting recurrent migraines under control now decreases the chance of recurrent migraines later.
The simplest treatment is sleep. Most adults wake up and the migraine is gone—the same thing goes for children.
There are several over-the-counter medications that can ease migraine pain. The most effective is a mixture of acetaminophen, aspirin, and caffeine. Excedrin Migraine has all of that, but is not FDA-approved for use in children. Talk to your child’s doctor about safe dosing amounts.
Prescription triptan-based medications work by increasing the amount of serotonin flowing to the brain stem, in effect halting the migraine process. Sumatriptan nasal sprays are available for adolescents.
The American Academy of Neurology has been studying the efficacy of riboflavin, also known as Vitamin B2, in the reduction of migraines. Approximately 60 percent of people who have tried it have reported less frequent and less severe migraines.
And now there’s Botox. Many people who have received Botox injections for cosmetic purposes reported fewer migraines and headaches. It’s since been approved by the FDA for chronic migraine prevention in adults—“chronic” being defined as 15 or more days a month of headaches. Although not FDA-approved, Botox is being used to ease tight muscles in children with cerebral palsy. The efficacy of Botox as a treatment for children with migraines remains to be seen, however.
Overall, treatment is aimed at preventing attacks in the first place, and if that fails, by relieving symptoms. I call it the “shield and sword” method. Shields are the protector—for children, first and foremost, the strongest shield is proper sleep habits. Swords, such as pain medications, are pulled out when the shield drops. It’s important to stress, however, that whatever method you end up having to use—shield or sword—the battle against childhood migraines is a battle that can be won. Most kids eventually outgrow migraines with no lasting ill effects
Joshua Rotenberg specializes in the diagnosis and treatment of neurological and neurodevelopmental disorders in infancy to young adulthood, and the diagnosis and treatment of sleep disorders in all ages. Dr. Rotenberg primarily serves the Houston and the greater central and South Texas regions, but also accepts international referrals for expedited evaluations.
Headaches by the numbers
- 60 – percent of children who will experience a headache by middle school
- 10 – percent of which will be a migraine
- 8 – percent of children who will experience a headache by age 3
- 3 – percent of which will be a migraine
Fast facts
- Migraines are divided into four phases – premonitory, aura, headache, and postdrome.
- The two major types of migraines are “migraine with aura” and “migraine without aura.”
- Migraine with aura includes visual disturbances, with or without headache pain.
- Migraine without aura is the more frequent form of migraine, and is usually felt as pain on one side of the head.
Source: National Institute of Neurological Disorders and Stroke
