Introduction

Migraine headaches are common in children. It is the most common cause of acute and recurrent headache pattern experienced by children.

Migraine itself is not dangerous, but can be serious enough to disrupt a child’s activity and schooling.

Many children with migraine outgrow their problem, but some will continue to have it throughout their lives, though with lesser degree in the later years.

There is strong genetic influence in the background of a child who suffers from migraine. This means that a number of family members especially the parents may also have headaches.

Migraine Facts

• 75% of headache in children referred for neurological assessment are due to migraine.
• Prevalence
  • 2.5% below 7 years (boys slightly more than girls)
  • 5% in primary schools (slightly more in girls)
  • 5% in post-pubertal boys
  • 10% in post-pubertal girls
• 90% of children with migraines have at least one parent with headaches.
• 25% of children with migraine become symptom-free by 25 years of age.
• 50% still have headache by 50 years of age.
• 50% of adults with migraines will have at least one child who has migraine.

Symptoms of migraine in children

1. The pain. The typical migraine headache is described as:
   • Throbbing in nature
   • Severe headache that occurs with sudden onset that can locate anywhere around the scalp; usually around the eyes, in the forehead or in the temples.
   • Some children may experience pain that is one-sided, but others experience pain all over the head.
   • Some may also experience abdominal pain.
   • These headaches may last from one hour to three days.
   • Most children will report varying degree of relief by sleep.
2. The aura. Some children with migraine may notice premonitory symptoms that herald or precede the headache. This is known as aura. This may take the form of:
   • Visual disturbance such as seeing flashes of lights, zig-zag patterns, blurred vision or defects in field of vision – this is the most common type of aura.
   • Numbness and tingling sensation.
   • Other less common auras include:
     • Hearing strange sounds, like a ringing sound in the ears
     • Unsteadiness (ataxia)
     • Spinning sensation (vertigo)
     • Confusion
     • Transient weakness of the limbs
   • Only 15-30% of children with migraine experience aura. However, the percentage could be higher as many children are unable to describe their abnormal sensations.
3. Associated symptoms
   • Children who are experiencing a migraine headache usually withdraw from activity at home and even in school.
   • Some prefer just to go to sleep.
   • Others may avoid bright areas or loud places, preferring to rest in a quiet, darkened room.
   • Parents may notice that the child appears pale and sometimes has dark circles around the eyes.

Precipitating Factors

Some children with migraine describe events or situations that may bring on the headaches. These precipitating factors include:

• Certain foods
• Excessive tiredness
• Lack of sleep
• Travel

Is there any Test for Migraine?

Generally no test is necessary to confirm a migraine. When a child sees a doctor for headaches, the doctor or paediatrician will look for any symptoms that may indicate other more sinister causes of headache. Should there be any doubt; the child may be subjected to brain scans, usually CT scan, or sometimes MRI scan.

Treatment for Migraine

This constitutes measures to relieve acute attacks of headache as well as treatment to prevent further episodes if necessary.

Measures for acute headache

• Sleep. This is still the most powerful and the best treatment for migraine headache. The child should be allowed rest and fall asleep, preferably in a quiet, dark room.
• For the pain that located on a side of the scalp, ice compression over the areas sometime may help to partially releive the pain.
• Medication. This is often necessary in many children. The usual medications are paracetamol, ibuprofen, naproxen and mefenamic acid. Aspirin is not advised in young children as it may cause serious side effects to liver and brain especially during fever (Reye’s syndrome).
• For children who have strong nausea and vomiting, anti-emetic (vomiting) medications can also be helpful. The common ones are metoclopramide and promethazine.
• These medications are most effective if taken during the aura or early period of the headaches.

Preventive Measures (Prophylaxis)

The primary goal of preventive therapy is to prevent further attacks of migraine or reduce the frequency and severity of the attacks.

• Identifying and avoiding triggers. This can be helpful to reduce the frequency of attacks but not always easy to do.
• Keeping a headache diary. This will help to track any possible triggering factors. It will also be handy when time comes to see a doctor, because the doctor will always be interested to know the frequency of headache attacks.
• Medication.
  • There are a few choices of medications available for this purpose. However none of them is truly effective and without side effects.
  • Medications will only be advised when a child has at least 1 or 2 attacks per week, especially when they are disruptive to his/her schooling and activities.
  • Parents should not expect a cure or complete control of symptoms with the medication. However an improvement of at least 50% in frequency and severity of attacks would be possible.
  • Examples of available medication are: propranolol, pizotifen, flunarizine, topiramate, valproate and amitriptyline. All of them are available on prescription basis by doctors.
  • The prescribed medication should be taken on daily basis for a period of time (at least a few weeks) to assess its effectiveness. Discuss with your doctor if your child experienced any side effects.
  • The common side effects include excessive sleepiness, change in appetite and weight gain.