Understanding paediatric migraines

Paediatric migraines are a common and often debilitating condition that can significantly impact a child's quality of life. However, with proper diagnosis and treatment, most children can manage their migraines effectively and lead a happy, healthy life.

This article provides a comprehensive understanding of paediatric migraines, including their causes, symptoms, and treatment options.

What is a paediatric migraine?

A migraine is a complex neurological condition characterised by recurrent, often severe headaches that can be accompanied by other symptoms, such as nausea, vomiting, and sensitivity to light or sound.

When migraines occur in children and adolescents, they are known as paediatric migraines. Paediatric migraines can occur at any age, even in infancy, but they are most commonly diagnosed in children between the ages of 7 and 15. It’s estimated that about 10% of school-aged children and up to 28% of adolescents experience migraines.

What are the symptoms of migraines in children?

The symptoms of paediatric migraines can vary widely, but they generally include the following:

• headache pain
• nausea and vomiting
• sensitivity to light and sound
• visual disturbances, known as auras
• weakness, fatigue, and dizziness
• mood changes

Unlike adult migraines, which can last for hours or even days, paediatric migraines typically have a shorter duration. They may last for as little as one to two hours, but the impact on the child can still be significant, affecting their ability to attend school, participate in activities, and enjoy a normal childhood.

What can trigger migraines in children?

Triggers can vary from child to child, but some common ones include: stress, lack of sleep, dehydration, hormonal changes, certain foods like artificial sweeteners, physical exertion, and environmental factors like bright lights and loud noises. Notably, migraines often run in families, suggesting a genetic predisposition.

How are paediatric migraines diagnosed?

A detailed medical history is essential in diagnosing paediatric migraines. A specialist such as a paediatric neurologist will ask about the child's headache patterns, including the frequency, duration, location, and intensity of the pain. They will ask about related symptoms, and because migraines often run in families, the paediatric neurologist will also ask about any family history of migraines or other types of headaches.

A physical examination, including a neurological assessment, will then be conducted to rule out other possible causes of the headaches. The paediatric neurologist will evaluate the child's reflexes, coordination, and other neurological functions.

In some cases, imaging tests such as an MRI or CT scan may be ordered to rule out other serious conditions that could be causing the headaches, such as a brain tumour or structural abnormalities.

How are migraines in children treated?

Over-the-counter pain relievers such as Ibuprofen can be used to treat mild to moderate migraines.

In cases where migraines are frequent or more severe, preventive medications may be prescribed to help decrease the frequency and severity of migraines. Examples include beta-blockers and certain antidepressants, which are taken daily. If nausea and vomiting are significant, antiemetic medications may be prescribed to help control these symptoms during a migraine attack.

Additionally, CBT (cognitive behavioural therapy) is a type of therapy that can help children manage the stress and anxiety that may trigger migraines. It can also teach them coping strategies to deal with the pain and discomfort associated with migraines. Equally, stress-management techniques, such as deep breathing, relaxation exercises, or mindfulness, can help reduce the impact of stress-related triggers.

For children who experience frequent migraines, it may be necessary to make accommodations at school. This can include allowing the child to rest in a quiet, dark room during an attack, providing extra time for assignments, or reducing the amount of screen time.