Migraine in children

Migraine, which is divided into migraine without aura and migraine with aura, is one of the two most common types of headache in children, along with tension headaches. While tension headaches typically cause mild to moderate, steady pressing pain, migraines are characterized by more severe, often pulsating attacks that make the child uncomfortable and often draw them to quiet, dark places.

What is migraine in children?

Migraine in children is a severe, recurring headache that is often accompanied by nausea, vomiting, and sensitivity to light and sound. In children, the pain is typically on both sides of the head and lasts for a shorter time than in adults — often between 1 and several hours. The condition is common: about 7 percent of schoolchildren aged 6-17 have migraines, and the incidence increases with age through the teenage years.

How common are migraines in children?

Migraines are already seen in young children, but their incidence increases steadily with age. In preschool age, migraines are seen in about 3 percent of children, while the proportion increases to about 11 percent by the age of 15-18. In the early years, boys are most often affected most frequently and earliest, with an average age of onset of about 7 years for boys and 11 years for girls. During puberty, this picture changes, and girls increasingly get migraines more often than boys — a pattern that continues into adulthood.

Symptoms of migraine in children

Migraines in children typically present as an intense, often pulsating or throbbing headache. In younger children, the pain is most often on both sides of the head, often towards the front of the forehead, while older children and teenagers may have headaches on one side of the head, like adults.

The attack is often accompanied by nausea and vomiting, and the child may become hypersensitive to light and sound and therefore likes to seek a dark and quiet room. Many children just want to sleep, and when they wake up again, the attack is often over or significantly reduced. Physical activity, such as climbing stairs or running, can worsen the pain during an attack.

A migraine attack in a child typically lasts from about 1 hour to several hours, and in some cases up to a few days. This is shorter than in adults, where attacks can last 4-72 hours.

Migraine with aura in children

Some children with migraines also experience aura — transient neurological symptoms that may occur before or at the same time as the headache. Approximately 15-30 percent of children with migraines experience aura.

The most common form of aura is visual disturbances, such as flickering or luminous areas, zigzag patterns or blind spots in the field of vision, which typically develop gradually over a few minutes. Some children also experience sensory disturbances such as tingling or numbness, which can start in the hands and spread to the face. Aura is not usually dangerous in itself, but the symptoms can be confusing and worrying for both child and parent, and should always be evaluated by a doctor — especially if they occur for the first time.

Warning symptoms (prodromal phase)

Before a migraine attack begins, some children experience a form of warning, hours to days in advance. This may manifest as changes in behavior — increased or decreased appetite, fatigue or irritability, increased talkativeness, or social withdrawal. These signs can be a useful indication for parents that an attack is coming.

Abdominal pain and vomiting as migraine symptoms in children

In younger children, especially those under 10 years of age, migraines can present differently than classic headaches. Recurrent abdominal pain or periods of severe nausea and vomiting can sometimes be a sign of migraine, even without a clear headache. This is also referred to as abdominal migraine. This is one of the reasons why migraines in younger children can be difficult to diagnose, as the symptoms do not always fit the picture typically associated with migraines.

What causes migraines in children?

Migraine is a neurological condition in which the blood vessels, nervous system and pain centers of the brain interact in a way that makes the brain more sensitive to certain stimuli. Heredity plays a major role — if a child has a parent with migraine, the risk of developing migraines themselves is increased. The exact mechanism behind migraines is still not fully understood, but it is known that a combination of genetic and environmental factors play a role.

What can trigger a migraine attack in a child?

The migraine condition itself is often hereditary, but the individual attacks are usually triggered by specific factors in the child's everyday life — so-called trigger factors. The most common are:

• Physical or mental stress, e.g. in connection with school or social situations
• Hunger or irregular meals
• Too little or too much sleep, and irregular bedtimes
• Bright or flashing light
• Too little to drink
• Too much screen time

It is important to emphasize that the factors that trigger attacks vary greatly from child to child, and that the same factor does not always trigger an attack every time. Many families find it helpful to keep a headache diary, noting when attacks occur, how long they last, and what preceded them — this can, over time, provide a clearer picture of the patterns that apply to each child.

Examination and diagnosis of migraine in children

The diagnosis of migraine is primarily based on a thorough interview about the child's symptoms, the nature, duration and accompanying symptoms of the headache, as well as a clinical examination. The doctor will typically ask about where the pain is located, how it feels, how long the attacks last, and whether there are accompanying symptoms such as nausea, sensitivity to light or visual disturbances.

The clinical examination includes a general examination of the child, including measurement of pulse and blood pressure, and a neurological examination. In most children with migraine, there are no abnormal findings between attacks, and the diagnosis itself is therefore made primarily from the medical history.

Should my child be scanned for migraines?

In most children with a typical migraine history, a scan such as an MRI of the brain is not needed. However, a scan may be considered if the headache has an atypical course, if there are new neurological symptoms, or if the doctor, based on the overall assessment, finds it relevant to exclude other causes of the headache. It is always an individual medical assessment whether further examinations are needed.

Treatment of migraine in children

Treatment of migraine in children is planned individually and is based on how often and how severe the child's attacks are, as well as how they affect the child's everyday life. Treatment typically has two tracks: treatment of the individual attack when it occurs, and — in some children — preventive measures that can reduce the frequency and severity of the attacks.

Treatment of the individual migraine attack

In the case of a migraine attack, the first step is often to take over-the-counter painkillers such as paracetamol or ibuprofen, possibly combined with anti-nausea medication. It can also help the child to calm down in a dark and quiet room, where they can relax or sleep through the attack. For many children, sleep is the best way to relieve a migraine attack.

If over-the-counter medications are not effective enough, prescription migraine medication may be needed in some cases. However, this is always assessed individually by the doctor, and the use is adapted to the child's age and the individual episod pattern.

Preventive treatment of migraine in children

If a child has frequent and bothersome migraine attacks, preventive measures may be considered. This often starts with a focus on lifestyle factors — regular sleep, regular meals, adequate water intake, and limiting known triggers. For some children, this alone can significantly reduce the number of attacks.

In rare cases, where migraines are very frequent and significantly affect the child's everyday life, preventive medical treatment may be considered. This is always an individual medical assessment, and the treatment is planned in close consultation with the family.

How do you keep a headache diary for your child?

A headache diary is a simple but valuable tool in the assessment and treatment of migraine in children. The diary records when an attack starts and ends, where the pain is located, what symptoms accompany it, whether medication has been given and with what effect, as well as any possible trigger factors prior to the attack — e.g. poor night's sleep, a stressful school day or a missed meal.

Over time, a headache diary can provide a good overview of the child's headache pattern and make it easier for the doctor to assess whether there are connections that can be adjusted and whether the treatment is working as expected.

Do migraines in children go away?

Migraines in children often change as the child gets older. In a large proportion of children who have migraines in childhood, the attacks decrease or disappear completely during the teenage years — studies indicate, according to the Danish Paediatric Society, that around 60 percent of children with migraine experience a calmer state during adolescence. However, in some of these, the migraines return later in life. It is therefore not uncommon for migraines in children to follow an undulating course throughout childhood, and that both the frequency and strength of attacks can change significantly over the years.

When should you see a doctor about your child's migraine?

Most children with migraines have a condition that is not dangerous, but can have a significant impact on schoolwork, sleep and mood. It is therefore always a good idea to have your child's headaches evaluated by a doctor, especially if the attacks are recurrent, severe or affect the child's daily life.

However, there are certain signs where you should react more quickly and seek medical attention more urgently:

• Headache that occurs suddenly and is very severe and is different from the child's usual headaches
• Headaches that wake the child at night or that are worst upon awakening
• Aura symptoms such as visual disturbances, sensory disturbances, or speech difficulties that occur for the first time
• Headache accompanied by fever, stiff neck, or an affected general condition
• Headache associated with behavioral changes, increased head size, or motor symptoms

These symptoms are not in themselves signs that something serious is at stake, but they should always lead to the child being examined so that other causes of the headache can be ruled out.

Migraine in children at Charlottenlund Private Hospital

At Charlottenlund Private Hospital, your child can be examined by a specialist who has experience with headaches and migraines in children and adolescents. The examination starts with a thorough conversation about the child's symptoms, the nature of the headache and how it affects the child's everyday life, and builds on the information you as parents already have about the child's headache pattern — for example, from a headache diary.

Based on the overall assessment, we create a plan for the further course of action, which may include guidance on trigger factors, attack treatment and — if relevant — further examinations. Since migraine in children sometimes occurs together with other conditions, such as abdominal pain or sleep problems, we can, if necessary, draw on our other specialists in pediatrics and psychology in the same course.

Experience and skills at Charlottenlund Private Hospital

At Charlottenlund Private Hospital, children with migraine are assessed by specialists with experience in headaches in children and adolescents. The assessment is based on a thorough medical history and a clinical and neurological examination, and an individual plan for attack treatment and prevention is drawn up. You will find an overview of all departments on our department page.

Sources:

- National Knowledge Center for Headache: Headache in children and adolescents – incidence of migraine in children.

- Danish Paediatric Society: Guideline for the treatment of headache in children and adolescents (2021)