Migraine and children
By: Dr David Kernick, GP with a special interest in headache, Exeter Headache Clinic
Many children get migraine and I am often asked a lot of questions about it. Here are the most common questions that I am asked.
Is migraine inherited?
There is a strong genetic predisposition to migraine. If you have migraine, there is a 70% chance your child will develop it at some stage. Although migraine can occur at any age the most common age is early to mid-teens.
Is it a common problem in children?
Studies we have undertaken in Exeter suggest that 20% of children between the ages of 11 and 15 have headache that impacts upon the quality of their life. For 10% of children this impact is significant. Approximately 12% of this will be migraine and the rest tension type headache although there is quite a degree of overlap and both occur commonly in young people. The migraine headache phase can be shorter – as little as one hour and aura is less common. Figure 1 shows the difference between migraine in adults, migraine in children and tension type headache.
| Migraine in adults | Migraine in children | Tension type headache |
|---|---|---|
| Usually unilateral | Usually bilateral | Usually bilateral |
| Moderate-to-severe headache | Mild-to-severe headache. May be inferred from behaviour in younger children | Mild-to-moderate headache |
| Throbbing/stabbing nature of pain | Can take any form | Pressure or band-like pain |
| 4-72 hours | Usually less than four hours | Variable |
| Associated symptoms include nausea, vomiting, photophobia or phonophobia | Not always present | No associated symptoms |
| Associated with an aura in 30% | Aura less common | No aura |
| Frequently prevents normal activity | Frequently prevents normal activity | Sufferer usually able to continue with normal activities |
What causes headache in children?
The causes of headache in children are complex and the current view sees pain as emanating from a complex interaction between genetic, biological, psychological and social factors. Children with headache have higher levels of anxiety and depression and migraine can be associated with other recurrent painful conditions, particularly abdominal pain in younger children.
Should I be worried that there may be a serious cause for my child’s headache?
Headache understandably causes concern that there is something serious going on in the brain. Fortunately, the risk is very small. Studies we have undertaken in Exeter suggest that when a young person visits a GP with new headache the risk of an underlying brain tumour is less than 1 in 3000 and even lower with a migraine headache. Problems that may prompt further examination would include headache with seizure or other abnormal neurological problems, headache that is awaking at night or progressing quickly or headache associated with unexplained changes in personality or deterioration in school work.
Will my child’s headache continue into adulthood?
Approximately one third will get better but two thirds will continue past the age of 18. There is no evidence to suggest that early treatment reduces the risk of continuation into adulthood, but early control is important to gain an understanding of the problem and ensure optimum management.
How can my child’s migraine be managed?
Trigger factors can be subtle but if identified excluded. People with migraine can find difficulty with changes in their environment and this is more so in young people. Missing meals, inadequate hydration and irregular sleep patterns can be problematic. Not skipping breakfast and high fibre cereal snack taken at regular intervals can be helpful, as is a regular intake of fluid and avoidance of caffeinated drinks. Sleep hygiene is important and electronic devices within two hours of retiring to bed should be avoided. Psychologically, the teenage years can be challenging for young people and it is important to exclude problems at school, particularly bullying.
Paracetamol and Ibuprofen can be useful, particularly if taken early in an attack. If this simple approach is not helpful then an appointment with your GP is the next step.
Conclusion
Migraine in children is common with a considerable impact upon quality-of-life of the individual yet it remains undiagnosed and poorly treated. Less than 10% of children with problematic headache will seek medical help for their problem.
Unless simple painkillers and lifestyle management are helping you should seek medical help from your GP. If you’re not satisfied with your child’s treatment you should ask for a specialist referral to a paediatrician, ideally with an interest in headache.
