Migraine is one of the causes for recurrent headaches in children. Migraine is commonly underdiagnosed and undertreated. It is crucial to recognize and manage Migraine at an earlier age, as proper treatment can help the growing child have a good quality of life. Most of the headaches in children are associated with improper life style and all headaches in children are not migraine.

 

Triggers of migraine

Migraine headaches in children can be triggered by multiple factors. These include- disturbed sleep pattern, hormonal changes, drugs, physical exertion, anxiety, exercise, hunger (skipping meals), change in weather, olfactory stimuli(smell), visual stimuli(light), auditory stimuli(noise) and such other sensory stimuli. Independent factors contributing to the risk of migraine headaches in children include- female gender, older age at presentation, family history of migraine, smoking in the household and low socioeconomic status.

Signs and symptoms of migraine

The clinical presentation of migraine as we understand currently can be varied based on the age of presentation. In toddlers' migraine, headache may present as excessive head movements as they are not able to communicate their feelings well. In older children, migraine presents as headache associated with nausea, vomiting or even thirst. Presentation in teenagers is similar to adults, in being more intense and sometimes associated with aura symptoms.

How can we diagnose it?

Diagnosis of migraine in children requires a comprehensive history taking, thorough neurological examination by a qualified physician. Migraine attacks in children can be preceded by sluggishness, hunger, difficulty with words(speaking), a feeling of doom and dizziness. Migraine in children can often involve both sides of the face/head. During an attack of migraine headache, the child would want to lie down/sleep in a dark and quiet place. Facial sweating, runny nose, red eyes, mood changes(irritability), vomiting, confused or dazed state of mind, generalized tiredness- can all be associated symptoms of migraine head ache in children.

What tests are needed?

Evaluation should also include ruling out other secondary causes of headache like fever. Neuroimaging like CT scan, MRI and a consultation by neurologist should be considered for symptoms like headache on straining, coughing or sneezing and above-mentioned factors A visit to the nearest emergency setting is warranted in headache associated with repeated vomiting, fever with chills, neck stiffness and headache not responding to medications over few hours.

How to manage migraine?

Identification and rectification of triggers is one of the cornerstones of migraine management in children. Life style changes related to exercise, hydration, sleep and diet optimization should be done under expert care. Expert psychological care is also required for relaxation, biofeedback and cognitive behavioral therapies for migraine. Pharmacological interventions include graded analgesics for pain management and modifying agents in select cases.

Tips for parents include-Limit the screen time. maintain be aware of the triggers and clinical presentation, avoid the triggers, good hydration(fluids), ensure adequate sleep, reduce sugar intake, maintain sleep dairy, maintain a migraine dairy, help them establish health habits, include the school teachers in caring for the child and just be there for the child when needed.

For personal advice and further consultation, you can consult our doctors, available online at ASK A DOCTOR.

Written by Dr Kampana