Brief overview
- Frequency: About four to five percent of all children
- Symptoms: severe headache, also: abdominal pain, nausea, vomiting, dizziness, pallor, loss of appetite, fatigue
- Causes: The cause is still unknown, the tendency is probably congenital. Factors such as irregular sleeping times or meals, stress and pressure to perform favor migraine attacks
- Diagnosis: Detailed medical history, physical examination, e.g. for neurological abnormalities (visual problems/balance disorders), examination using imaging techniques such as MRI
- Treatment: Mainly supportive measures (e.g. heat applications, relaxation techniques, autogenic training, biofeedback). Medication if necessary (e.g. painkillers)
- Prognosis: Migraines in children cannot be cured, but can usually be treated well. In half of children, migraines disappear during puberty, in the rest they persist.
- Prevention: Keep a migraine diary, eat a balanced diet, drink enough, exercise regularly, avoid stress, adapt everyday life to the weather, limit media consumption.
How common are migraines in children?
How do migraines manifest themselves in children?
Sudden headache attacks that occur repeatedly or last for a long time are the most common symptom in children with migraines. Sometimes the headache also manifests itself as severe pressure on the head. The younger the child is, the more likely the headache is bilateral.
Rarely does the migraine headache only affect one side of the head. The most common areas of pain are the forehead, temples and eye area. Pain at the back of the head, on the other hand, is rather atypical for migraines in children.
Some children with migraines also or exclusively show other symptoms:
- Sensitivity to light, noise and odors
- increased temperature (from 37.5 degrees Celsius) or fever (from 38 degrees Celsius).
- Some children have abdominal pain (so-called “abdominal migraine” or abdominal migraine)
- Loss of appetite, nausea, vomiting.
- increased urge to urinate, they are
- thirst
- palpitations
Migraine attacks with aura perception
Other typical aura symptoms are sensory disturbances such as numbness, paralysis or tingling in the arms and legs. Some children also have problems speaking.
How long does a migraine attack last in children?
In most cases, a migraine attack in children is over after two to six hours. The attacks are therefore shorter than in adults. Occasionally, however, a migraine in children can last for 48 hours.
The symptoms of an aura are also only temporary in children. They usually occur before the actual migraine headache begins. The aura perceptions usually subside quickly and generally last for around half an hour to an hour. Permanent neurological damage is not to be feared.
How do you recognize migraines in children?
Young children in particular are not yet able to interpret and express their sensations and body signals correctly. Therefore, pay attention to whether your child behaves differently than usual. For example, many children stop playing, are pale or red in the face or would like to lie down and sleep.
Migraines in children often manifest themselves differently than in adults. You should therefore pay close attention to your child’s behavior and, if necessary, have any symptoms clarified by a doctor.
What are the causes of migraines in children?
It has not yet been fully clarified what triggers migraines in children. However, doctors suspect that migraines are hereditary, as they occur more frequently in many families. Certain trigger factors also appear to favor migraine attacks in children.
Children’s brains react to many stimuli and events more frequently with a migraine attack than those of adults. They are therefore more frequently exposed to triggering factors in everyday life. The most important trigger factors for migraines in children include, for example
Low blood sugar and dehydration
If children exert themselves too much physically, they often suffer from headaches. One of the reasons for this is that they are not drinking enough or their blood sugar is too low. Children in particular are especially sensitive to low blood sugar levels. Migraine attacks often occur if, for example, the child has not had breakfast in the morning.
Irregular sleep
Stress
Mental strain and stress also contribute to migraines in children. These include, for example, sensory overload from electronic devices such as computers, smartphones or televisions. Too much media consumption before bedtime has a particularly negative effect.
A lack of physical exercise, family conflicts and excessive performance demands at school as well as bullying are also frequent triggers for migraine attacks. The anticipation of a birthday party or a cold can also cause stress and promote migraines in children.
Weather
Children are particularly sensitive to certain weather conditions. A sudden change in temperature (usually a rise in temperature) and high humidity often trigger migraines in children. However, a direct link between the weather and migraines has not yet been scientifically proven.
Noise and light
Noise and changes in light in particular can cause migraines in children. Noise in particular triggers severe stress. This applies not only to loud noises at building sites or from road traffic, but also to music that is played too loudly (especially with headphones).
Chemical irritants
Children are often very sensitive to chemical irritants. Typical headache-inducing substances are, for example
- Exhaust fumes from cars
- Paint and adhesives (e.g. when doing handicrafts)
- Perfumes and deodorants
- Household toxins (e.g. wood preservatives or solvents in furniture or floors)
- Cigarette smoke
Food
Certain foods are also suspected of triggering migraines. An intolerance to certain ingredients such as the proteins tyramine and histamine is a possible cause. However, scientific evidence is still lacking. The following foods are being discussed as possible triggers of migraines in children:
- Cow’s milk, eggs, cheese
- Chocolate, products containing cocoa
- caffeine
- Cereals containing gluten (e.g. wheat, rye, spelt, barley, oats)
- tomatoes
- Citrus fruits (e.g. lemons, oranges)
- fatty foods such as sausage, ham, salami, pork
According to current knowledge, it is not necessary to avoid certain foods in general if you suffer from migraines. According to nutritionists, a special migraine diet is not advisable.
Migraine in children: Diagnosis
The pediatrician or family doctor is the first point of contact. If necessary or for further examinations, they may refer you to a neurologist or pediatric neurologist.
If sudden headaches occur more frequently in your child, last longer or get worse, consult a doctor as soon as possible!
Consultation with the doctor
First of all, the doctor will conduct a detailed consultation (medical history) with the parents. This involves recording the child’s medical history. With young children in particular, it is important that the parents describe the symptoms they have noticed in their child. Doctors also recommend asking friends, relatives or caregivers at school or kindergarten about this.
Young children are often not yet able to express their pain and complaints. It is therefore often difficult for doctors to diagnose migraines in children.
Older children are usually questioned directly by the doctor. He will ask questions such as:
- Can you show where it hurts?
- How long has it been hurting?
- Do you have this often or is this the first time?
- Where else does it hurt apart from your stomach? (Children tend to describe pain like a stomach ache that they already know)
Physical examination
After the interview, the doctor examines the child. To do this, he will palpate the child’s head, arms and legs and check for neurological abnormalities: Does it see flashes of light? Does it have a wobbly gait? Do the arms or legs feel numb? He also determines whether the child’s mental and physical development is in line with his age.
Misaligned teeth or jaws, vision problems, tense muscles or blockages can also lead to severe headaches. Further examinations are therefore often necessary to rule out other causes for the headaches. These include, for example, imaging examinations of the skull such as magnetic resonance imaging (MRI).
Keeping a headache diary
It is useful for the diagnosis if you keep a headache diary together with your child and bring it with you to every visit to the doctor. For example, enter in this diary exactly when the headache occurs, how severe it is, how long it lasts and whether it is accompanied by other symptoms (e.g. nausea, vomiting, abdominal pain, etc.).
Migraine in children: What helps?
The treatment of migraines in children differs from that in adults. Doctors recommend treating migraines in children initially with supportive measures without medication.
Experience has shown that these are much more effective in children than in adults. If the symptoms cannot be sufficiently alleviated in this way or if the child is in severe pain, doctors will also prescribe medication if necessary. However, children are given different preparations than adults.
Treatment without medication
Relaxation techniques: Children with migraines are usually helped by simple relaxation techniques such as Jacobson’s muscle relaxation. This teaches affected children to tense and relax certain muscle areas.
Autogenic training is also suitable, in which the children repeatedly say thought formulas to themselves (e.g. “My arm is getting very heavy”) and thus relax. With both methods, however, it is important that the children do the exercises regularly – preferably daily.
Physical therapy: Physical therapy with heat applications or massages of the throat, neck, head and face as well as acupuncture can also help children against severe headaches.
They can weaken an acute migraine attack and prevent migraine attacks (prophylaxis).
According to the German Migraine and Headache Society (DMKG), methods without medication are usually just as effective as medication in children.
Home remedies
Parents often feel helpless when their child has a migraine attack. However, simple measures and home remedies are often very effective:
Even the smallest activities such as walking around or watching TV usually exacerbate migraines in children. During an acute migraine attack, it is particularly important for children to get some rest. It is best to put your child in a well-tempered and darkened room. Also shield them from disturbing stimuli and sources of noise such as the radio or television. Also make sure that your child drinks enough water.
A few hours’ sleep, a cool cloth on the forehead or a neck massage with peppermint oil (do not use on babies and small children!) will in most cases ensure that headaches and migraines in children improve quickly.
Home remedies have their limits. If the symptoms persist over a longer period of time, do not improve or even get worse, you should always consult a doctor.
Medication for a migraine attack
For children and adolescents who have an acute migraine attack, doctors primarily recommend painkillers such as ibuprofen or paracetamol. For children aged twelve and over, acetylsalicylic acid (e.g. aspirin) is also approved for migraines. These medications are available as tablets, powder or suppositories.
Taken at an early stage, migraine attacks can sometimes be stopped. However, as migraine attacks in children are usually shorter than in adults, the medication often only takes effect once the attack is already over. However, there are also children who have very severe pain and often require urgent medication. Your doctor will therefore explain to you whether and in what dose your child should take painkillers.
The doctor can also prescribe the anti-emetic domperidone as tablets or suppositories for children aged twelve and over. This medication not only combats nausea, but above all enhances the effect of painkillers. However, children should not take this medication without medical advice!
Many migraine medications (e.g. metoclopramide or steroids) that help adults can cause serious damage in children! Therefore, do not give your child any medication that you take yourself!
Medication for prevention
According to the German Society of Neurology, it has not yet been proven beyond doubt whether medication to prevent migraines in children is actually effective.
Studies indicate that the beta-blocker propanolol and the calcium channel blocker flunarizine can help children and adolescents with migraines. Other studies also show that botulinum toxinA (better known as Botox) prevents migraine attacks in adolescents. However, these agents are not yet approved for use in children with migraine due to a lack of data.
Migraine in children: Prognosis
In around half of children, migraines disappear during puberty; in the rest, they persist. However, migraines in children can usually be treated well. The following applies: the decisive factor for a favorable prognosis is ultimately how well it is possible to avoid triggering factors such as stress.
How do you prevent migraines in children?
Migraine attacks in children cannot be completely avoided. However, there are some measures you can take to prevent them. First and foremost, it is important to avoid possible triggers.
Keeping a migraine diary: Keeping a migraine diary can help you to find out which triggers are responsible for your child’s migraines. In this way, triggering factors can be identified and avoided in advance.
Eat a balanced diet: Make sure your child eats a balanced diet and eats regularly. Children should not skip meals. A constant blood sugar level without major fluctuations has been proven to prevent migraine attacks. Regular meals with complex carbohydrates from wholegrain products, potatoes, fruit and vegetables are ideal for this.
Drink enough: It is important that your child drinks enough fluids (especially during sport) and drinks water regularly. This will help prevent dehydration and headaches.
However, drinks containing caffeine and tein (e.g. cola drinks) are not suitable for children! These may prolong the migraine attacks or cause the attacks to occur more frequently.
Get enough sleep: It is particularly important for children with migraines to maintain a regular sleep rhythm with consistent bedtimes and wake-up times. Children’s need for sleep varies from person to person. While younger children usually need more sleep, older children and adolescents usually need a few hours less.
Limit media consumption: Children who frequently use smartphones, computers or televisions are more frequently affected by migraine attacks. Therefore, make sure to limit your children’s daily media consumption to a reasonable level and in particular keep aggressive and stressful content away from your children.
Avoid stress: Psychological stress often triggers migraine attacks in children. Therefore, try to keep psychologically stressful situations such as arguments within the family away from your child. Also make sure that your child has a balance (e.g. outdoor exercise) to the stressful school day and that you do not put any pressure on your child to perform.
Avoid irritants: Some substances trigger headaches. Therefore, avoid exposing your child to irritants such as exhaust fumes, dyes and fragrances. You should also refrain from smoking in the presence of your child.
If unusual, very severe headaches suddenly occur, if the symptoms persist for a long time despite the usual measures or if they keep coming back, you should consult a doctor!
