Migraine in children

Migraine, which is divided into migraine without aura and migraine with aura, is one of the two most common types of headaches in children, alongside tension headaches. While tension headaches typically cause mild to moderate, steady, pressing pain, migraines are characterised by more severe, often throbbing attacks that make the child feel unwell and frequently lead them to seek rest in a quiet, dark environment.

What Is Migraine in Children?

Migraine in children is a condition characterised by episodes of severe headache, often accompanied by nausea, vomiting and sensitivity to light and sound. In children, the pain typically affects both sides of the head and lasts for a shorter period than in adults — often between one and several hours.

The condition is common: approximately 7% of school-aged children between the ages of 6 and 17 experience migraines, and prevalence increases with age throughout adolescence.

How Common Is Migraine in Children?

Migraine can occur even in young children, but its prevalence increases steadily with age.

Among preschool-aged children, approximately 3% experience migraines, while the proportion rises to around 11% by the ages of 15–18.

In early childhood, boys are generally affected more frequently and at a younger age, with an average age of onset of around seven years for boys and eleven years for girls.

During puberty, this pattern changes, and migraines become increasingly common in girls compared with boys — a trend that continues into adulthood.

Symptoms of Migraine in Children

Migraine in children typically presents as an intense headache, often with throbbing or pulsating pain.

In younger children, the pain usually affects both sides of the head, particularly around the forehead, while older children and teenagers are more likely to experience headaches on one side of the head, as is common in adults.

Migraine attacks are often accompanied by nausea and vomiting, and the child may become sensitive to light and sound, preferring to rest in a dark, quiet room.

Many children simply want to sleep, and when they wake up, the migraine attack has often ended or significantly improved.

Physical activity, such as climbing stairs or running, can make the pain worse during an attack.

A migraine attack in a child typically lasts from around one hour to several hours and, in some cases, up to a couple of days. This is generally shorter than in adults, whose migraine attacks may last 4–72 hours.

Migraine With Aura in Children

Some children with migraines also experience what is known as an aura — temporary neurological symptoms that may occur before or during the headache.

Approximately 15–30% of children with migraines experience aura.

The most common type of aura involves visual disturbances, such as flashing or shimmering lights, zigzag patterns or blind spots in the field of vision, which typically develop gradually over several minutes.

Some children also experience sensory disturbances, such as tingling or numbness, which may begin in the hands and spread towards the face.

Aura is generally not dangerous in itself, but the symptoms can be confusing and worrying for both children and parents. They should always be assessed by a doctor, particularly if they occur for the first time.

Warning Symptoms Before a Migraine Attack (Prodromal Phase)

Some children experience early warning signs hours or even days before a migraine attack begins.

These may include changes in behaviour, such as increased or reduced appetite, tiredness or irritability, becoming more talkative than usual or withdrawing from social interaction.

For parents, recognising these signs can provide a useful indication that a migraine attack may be approaching.

Abdominal Pain and Vomiting as Migraine Symptoms in Children

In younger children, particularly those under the age of ten, migraines may present differently from the classic headache pattern.

Recurring abdominal pain or episodes of severe nausea and vomiting can sometimes be manifestations of migraine, even without an obvious headache.

This is also known as abdominal migraine.

It is one reason why diagnosing migraines in younger children can be challenging, as the symptoms do not always match what is typically associated with migraine.

What Causes Migraine in Children?

Migraine is a neurological condition involving interactions between blood vessels, the nervous system and the brain's pain-processing centres, making the brain more sensitive to certain stimuli.

Genetics plays an important role. If a child has a parent with migraines, their own risk of developing the condition is increased.

The exact mechanisms behind migraine are still not fully understood, but it is known that both genetic and environmental factors contribute.

What Can Trigger a Migraine Attack in a Child?

Although the tendency to develop migraines is often hereditary, individual attacks are usually triggered by specific factors in the child's everyday life, known as triggers.

The most common triggers include:

• Physical or psychological stress, for example related to school or social situations.
• Hunger or irregular meals.
• Too little or too much sleep, as well as irregular bedtimes.
• Bright or flashing lights.
• Not drinking enough fluids.
• Excessive screen time.

It is important to emphasise that migraine triggers vary considerably from child to child, and the same factor does not necessarily cause an attack every time.

Many families find it helpful to keep a headache diary, recording when attacks occur, how long they last and what happened beforehand.

Over time, this can help identify patterns and provide a clearer understanding of the individual child's triggers.

Examination and Diagnosis of Migraine in Children

Migraine is primarily diagnosed through a thorough discussion of the child's symptoms, the characteristics and duration of the headaches, any accompanying symptoms and a clinical examination.

The doctor will typically ask where the pain is located, what it feels like, how long the attacks last and whether there are additional symptoms, such as nausea, sensitivity to light or visual disturbances.

The clinical assessment includes a general physical examination of the child, including measurements of pulse and blood pressure, as well as a neurological examination.

In most children with migraines, there are no abnormal findings between attacks, so the diagnosis is primarily based on the medical history.

Does My Child Need a Brain Scan for Migraine?

Most children with a typical migraine history do not need a brain scan, such as an MRI.

However, imaging may be considered if the headache follows an unusual pattern, if new neurological symptoms develop or if the doctor considers it necessary to rule out other possible causes.

The need for further investigations is always determined through an individual medical assessment.

Treatment of Migraine in Children

Migraine treatment in children is tailored individually, taking into account how frequently attacks occur, how severe they are and how much they affect the child's everyday life.

Treatment generally has two main approaches: managing individual migraine attacks when they occur and, for some children, introducing preventive measures to reduce the frequency and severity of attacks.

Treatment of Individual Migraine Attacks

During a migraine attack, the first step often involves standard over-the-counter painkillers such as paracetamol or ibuprofen, sometimes combined with medication to relieve nausea.

It may also help the child to rest in a dark, quiet room where they can relax or sleep until the attack passes.

For many children, sleep is one of the most effective ways to help a migraine attack subside.

If standard over-the-counter medication does not provide sufficient relief, prescription migraine medication may sometimes be necessary.

However, this is always assessed individually by the doctor, and treatment is adapted to the child's age and specific pattern of migraine attacks.

Preventive Treatment of Migraine in Children

If a child experiences frequent or troublesome migraine attacks, preventive measures may be considered.

These often begin with lifestyle adjustments, including regular sleep, consistent meal times, adequate hydration and limiting exposure to known triggers.

For some children, these changes alone can significantly reduce the number of attacks.

In less common cases, where migraines are very frequent and have a substantial impact on the child's everyday life, preventive medication may be considered.

This is always based on an individual medical assessment, and 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 diagnosis and treatment of migraines in children.

The diary should record when an attack begins and ends, where the pain is located, any accompanying symptoms, whether medication was given and how effective it was, as well as possible triggers before the attack — such as poor sleep, a stressful school day or a missed meal.

Over time, a headache diary can provide a useful overview of the child's headache patterns and make it easier for the doctor to identify factors that could be adjusted and assess whether treatment is working as expected.

Can Children Outgrow Migraine?

Migraine in children often changes as they grow older.

For many children who experience migraines during childhood, the attacks become less frequent or disappear entirely during adolescence.

According to the Danish Paediatric Society, studies suggest that approximately 60% of children with migraines experience remission during their teenage years.

However, in some of these individuals, migraines return later in life.

It is therefore not unusual for migraines in children to follow a fluctuating course throughout development, with both the frequency and severity of attacks changing considerably over the years.

When Should You Seek Medical Advice for Your Child's Migraines?

Most children with migraines have a condition that is not dangerous but can significantly affect school attendance, sleep and mood.

It is therefore always a good idea to have your child's headaches assessed by a doctor, particularly if the attacks are recurring, severe or interfere with everyday activities.

However, certain warning signs require more urgent medical attention:

• A sudden, extremely severe headache that is different from the child's usual headaches.
• Headaches that wake the child during the night or are worst upon waking.
• Aura symptoms, such as visual disturbances, sensory changes or difficulty speaking, that occur for the first time.
• Headaches accompanied by fever, neck stiffness or a noticeably deteriorated general condition.
• Headaches associated with behavioural changes, an increase in head circumference or motor symptoms.

These symptoms do not necessarily indicate a serious underlying condition, but they should always prompt a medical examination to rule out other possible causes of the headaches.

Migraine in Children at Charlottenlund Privathospital

At Charlottenlund Privathospital, your child can be examined by a medical specialist experienced in headaches and migraines in children and adolescents.

The examination begins with a thorough discussion of the child's symptoms, the nature of the headaches and how they affect everyday life.

The assessment also takes into account information that you, as parents, have already gathered about your child's headache patterns, for example through a headache diary.

Based on the overall assessment, we develop a plan for the next steps, which may include advice on triggers, treatment of individual attacks and, where appropriate, further investigations.

As migraines in children sometimes occur alongside other conditions, such as abdominal pain or sleep problems, we can involve our other specialists in paediatrics and psychology as part of the same care pathway when necessary.

Experience and Expertise at Charlottenlund Privathospital

At Charlottenlund Privathospital, children with migraines are assessed by specialists experienced in headaches in children and adolescents.

The diagnostic assessment is based on a thorough medical history and a clinical and neurological examination. An individual plan is then developed for managing migraine attacks and preventing future episodes.

You can find an overview of all departments on our departments page.

Sources:

• Danish National Headache Knowledge Centre: Headaches in Children and Adolescents – Prevalence of Migraine in Children.
• Danish Paediatric Society: Guideline for the Treatment of Headaches in Children and Adolescents (2021).