Migraine in children is a neurological disease characterized by recurrent headaches. Severe pain may be accompanied by nausea, sensitivity to light, or sensitivity to sound. Since migraine can reduce school performance and quality of life, early diagnosis and treatment are very important.

Migraine attacks are generally triggered by stress, sleeplessness, certain foods, and hormonal changes. Appropriate lifestyle adjustments should be made by monitoring these factors in the child’s daily life.

In the diagnostic process, the pediatric neurologist benefits from a detailed history and physical examination, and imaging methods if necessary. In this way, migraine is distinguished from other causes of headache.

In treatment, medications, lifestyle adjustments, and attack-preventive methods are applied. With regular follow-up and a personalized treatment plan, the frequency and severity of migraine attacks can be significantly reduced.

What Is Migraine in Children?

In children, migraine is, in its simplest definition, recurrent headaches. However, these headaches are different from those short-lasting, mild pains that your child sometimes experiences. Migraine headaches are usually more severe, throbbing, or felt like a pulsation. You can think of it as if a tiny drum is constantly being played inside the head. These pains are often accompanied by nausea, vomiting, and extreme sensitivity to light or sound. For example, even the light of the television that they normally love very much may bother them, and even the sound of their favorite toy may become unbearable. Migraine is not actually just a headache but a neurological condition affecting the brain and nervous system. This condition may negatively affect your child’s daily activities, school performance, and social relationships. It should be remembered that the diagnosis of migraine in children may be made a little differently from adults. For example, even if a headache lasts as short as one hour in a child, if other migraine symptoms are also present, this condition may be considered migraine. Whereas in adults, this duration is usually longer. For this reason, it is important to carefully follow the headaches your child experiences and evaluate them as a whole together with the other symptoms.

What Causes Migraine in Children?

Scientists are still continuing their research on the causes of migraine in children. However, according to our current knowledge, it is thought that more than one factor plays a role in the emergence of this condition. One of the most important factors is genetic predisposition. If there is a history of migraine in your family, especially in the mother or father, your child is more likely to develop migraine as well. It can be thought of as if migraine is a trait passed down from generation to generation within the family. However, genetic predisposition alone is not enough. Environmental factors also play an important role in triggering migraine. For example, stress, problems experienced at school, tensions in friendships, and sometimes even very exciting events may trigger migraine. Eating habits can also be an important factor. Certain foods and drinks, for example processed meats, some types of cheese, chocolate, caffeinated drinks, or food additives may trigger migraine attacks. Changes in sleep pattern, for example going to bed late and waking up late on weekends or not getting enough sleep, may also trigger migraine. Environmental stimuli such as weather changes, bright lights, loud sounds, or strong smells may also cause migraine attacks in some children. When all these factors come together, they are thought to trigger a migraine attack by causing temporary changes in the normal functioning of the brain.

What Are the Symptoms of Migraine in Children?

Of course, the most prominent symptom of migraine in children is headache. However, this pain may manifest itself differently in every child. While some children describe the pain as throbbing, like a pulse beating, some may speak more of a squeezing or pressing pain. The location of the pain may also vary. While small children and young adolescents usually feel pain on both sides of the head, especially in the forehead or temple region, in older adolescents and adults the pain usually concentrates on one side of the head. But remember, bilateral headache is a typical feature of migraine in children. In addition to headache, nausea and vomiting often accompany migraine in children. In some cases, especially in small children, only abdominal pain and vomiting may be seen without a prominent headache. This is called “abdominal migraine.” Sensitivity to light and sound is also an important symptom. If your child has suddenly started being bothered by light or sounds that normally do not disturb them, and is seeking a dark and quiet environment, this may be a sign of migraine. Some children may also experience visual disturbances. Situations such as seeing bright spots in front of the eyes, flashes of light, or temporary vision loss may occur. Dizziness and lightheadedness are also among the frequently reported symptoms. During a migraine attack, children may generally look pale and unwell, and may feel tired and weak. In some cases, even hours or days before the headache starts, mood changes such as irritability, excessive joy, or sadness, and differences in appetite or sleep pattern may also be seen. For this reason, it is important to follow such symptoms in your child carefully and evaluate them as a whole.

How Is Migraine Diagnosed in Children?

Unfortunately, we do not have a magic wand or a special laboratory test to diagnose migraine in children. Diagnosis is generally made through what your child and you describe, that is, a detailed medical history and a comprehensive physical examination performed by the doctor. Your doctor will ask you and your child detailed questions about when the headache started, how long it lasts, where it is felt, what kind of pain it is (throbbing or squeezing?), its severity, how often it recurs, and other accompanying symptoms (such as nausea, vomiting, sensitivity to light or sound). Whether there is a family history of migraine is also an important clue for diagnosis. If there are other people in your family with migraine, this increases the likelihood that your child may also have migraine. In addition, possible factors triggering the headache, whether the pain passes after sleep, and how the headache affects your child’s daily life are also points your doctor will pay attention to. When diagnosing migraine in children, the criteria used in adults are considered somewhat more broadly. Because children may not be able to express their symptoms as clearly as adults and their headaches may last a shorter time. Therefore, your doctor will try to diagnose migraine by carefully evaluating the headaches and other symptoms your child experiences. Sometimes, especially in small children, the correct diagnosis can only be made after recurrent attacks are observed. During this process, keeping a “headache diary” in which you note your child’s headaches, their frequency, possible triggers, and the response to treatments will be very helpful for your doctor.

How Is Migraine Treated in Children?

Migraine treatment in children can be examined under two main headings: attack treatment and preventive treatment. Attack treatment aims to relieve the pain and other symptoms as quickly as possible when a migraine attack starts. For this purpose, over-the-counter painkillers such as paracetamol or ibuprofen may be used with your doctor’s recommendation. Especially when taken early, right when the pain begins, these medications can often be effective in mild and moderate migraine attacks. However, remember that you should definitely consult your doctor before giving any medication to your child. In more severe migraine attacks or in situations where over-the-counter medications do not help, your doctor may prescribe special migraine medications called triptans. These medications are generally suitable for children older than 6 years of age and may be in tablet or nasal spray form. If your child’s migraine attacks are also accompanied by nausea and vomiting, your doctor may also prescribe anti-nausea medications. In addition to medication treatment during an attack, resting in a quiet and dark room, applying a cold compress to the forehead, and consuming plenty of fluids may also provide relief. Preventive treatment aims to reduce the frequency, severity, and duration of migraine attacks. If your child experiences migraine attacks frequently (more than once a week or more than four times a month) and this negatively affects daily life, your doctor may recommend preventive medications. These medications are generally taken regularly every day, and it may take several weeks or months for them to show their effect. Preventive treatment options may include different types of medications such as beta blockers, some antidepressants, antiepileptics, and antihistamines. Your doctor will choose the most appropriate medication for your child’s condition. In addition to medication treatment, lifestyle changes and behavioral therapies also play an important role in preventing migraine.

What Are the Factors That Trigger Migraine in Children?

There are many different factors that may trigger migraine attacks in children, and these factors may vary from child to child. One of the most common triggers is stress. Both positive and negative stress factors such as exam stress at school, problems in friendships, family issues, or an intense lesson schedule may trigger migraine. Eating habits also play an important role. For some children, aged cheeses, pizza, processed meats (such as sausage and salami), foods containing nitrates, foods and drinks containing caffeine (such as chocolate, cola, coffee, and tea), and foods containing monosodium glutamate (MSG) may trigger a migraine attack. Skipping meals or eating irregularly may also lead to low blood sugar and therefore migraine. Dehydration, that is, not taking enough fluids, is also an important trigger. Changes in sleep pattern may also trigger migraine. Sleeping too much or too little, or changing the sleep pattern on weekends may cause migraine attacks. Environmental factors may also be triggers for some children. Factors such as bright or flickering lights, loud sounds, sharp smells, weather changes, pressure changes, travel, and motion sickness may trigger migraine. Hormonal changes may also cause migraine attacks in adolescent girls. In some cases, exercise (although regular exercise may help prevent migraine), head trauma, infections, and some medications may also trigger migraine. Most of the time, migraine occurs due to the combination of these factors rather than a single cause. For this reason, carefully monitoring which factors trigger your child’s migraine attacks and keeping a “trigger diary” may be useful.

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