Common Types of Migraine in Paediatrics

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Guest post: Common Types of Migraine in Paediatrics by Dr Merle Diamond. The content in this post is for informational use only and should in no way be used as medical advice. Please read my disclaimer for more information.

Common Types of Migraine Headaches and Symptoms

The only thing worse than seeing your child in pain is not knowing why.

If your son or daughter experiences severe headaches or pain in his or her midsection, it may be an indication of suffering from migraines. In particular, abdominal migraines may not be accompanied by head pain until later in life, as migraine symptoms can change as a person gets older.

In some cases, children may experience bouts of extreme nausea and vomiting without complaining of a headache. It won’t be until years later, however, that aspects of the affliction make themselves known. For parents, identifying warning signs that may not be so obvious is key to getting kids suffering from this chronic illness the help they need.

Recognising the basic elements of a migraine headache is crucial for identifying the problem. These often include sensitivity to light and/or sound, pounding pain on one or both sides of the head, and paleness. Similarly, the abdominal migraine can be accompanied by a pale appearance as well as dark shadows under the eyes. Ability to articulate these symptoms to your paediatrician may be critical for receiving proper care.

The inability to determine what is ailing your child is a position in which no parent wants to be. Dr Merle Diamond of Diamond Headache Clinic provides some basic information about common migraines and their symptoms in adolescents.

Abdominal Migraine

Abdominal migraine occurs mainly in children between 5 and 9 years of age. Many of these children who experience abdominal migraines go on to develop migraine headaches (with or without aura) later in life.

What Are the Symptoms of Abdominal Migraine?

Symptoms may include:

  • Midline abdominal pain of moderate to severe intensity that lasts 1 – 72 hours
  • Chronic (lasting more than three months) or recurring pain severe enough to interfere with normal activities
  • Mild or no headache
  • Nausea, vomiting, loss of appetite
  • Pallor with dark shadows under the eyes or flushing
  • The absence of another illness, including a gastrointestinal disorder

How Is Abdominal Migraine Diagnosed?

There are no specific diagnostic tests to confirm abdominal migraine. A diagnosis is made through a thorough evaluation of the patient’s medical history, the incidence of migraine headache in the family (family history), the symptoms the child has, and a physical exam and tests to rule out other conditions.

What Are the Treatment Options for Abdominal Migraine?

For children and teens, abdominal migraine treatment includes:

  • Rest
  • Plenty of fluids
  • Over-the-counter pain relievers
  • Relaxation/behavioural therapy techniques

For older children and adults with infrequent abdominal migraine attacks, physicians may prescribe medications used for other forms of migraine, such as non-steroidal anti-inflammatory drugs (NSAIDs), anti-nausea medication and triptans. Children who experience frequent abdominal migraines are treated with the same preventive therapies used for other types of migraine.

Migraine Headache

The average age of onset for migraine is 7 years old for boys and 10 years old for girls, although symptoms may appear in much younger children. Up to age 12, equal numbers of boys and girls suffer from migraine; by the ages 21 – 24, up to 80% of migraineurs are women. Children with migraine often have a family history of migraine. Migraine affects up to 5% of school-aged children. From 50% to 75% of children with migraine will cease having attacks between adolescence and early adulthood, but some will redevelop migraine later.

What Are the Symptoms of Migraine Headache?

Common symptoms of migraine in youngsters include:

  • Pain on one or both sides of the head or a child may report pain “all over”
  • Pounding or throbbing pain, although children may not be able to articulate this
  • Abdominal upset, nausea and/or vomiting
  • Sensitivity to light and/or sound
  • Sweating
  • Becoming pale or quiet
  • Experiencing an aura, or a sense of flashing lights, funny smells and changes in vision

Tension-Type Headache

This common headache type is triggered by stress or emotional/mental conflict.

What Are the Symptoms of Tension-Type Headache?

Generally, symptoms of tension-type headache include:

  • Headache that develops slowly
  • Pain usually present on both sides and may involve the back of the head
  • Dull pain or pain that feels like a band around the head
  • Mild to moderate, not severe, pain
  • Change in sleep habits

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Cluster Headache

Cluster headache usually begins in children over 10 years of age and is more common in adolescent males. This type of headache occurs in a series, or “cluster”, that can last for weeks or months. Cluster headaches may recur annually or every other year.

What Are the Symptoms of Cluster Headache?

Common symptoms of cluster headache in children and adolescents include:

  • Unilateral (one-sided) pain, often behind an eye
  • The affected eye may look droopy
  • The affected eye may have a small pupil
  • The eyelid of the affected eye may be red and swollen
  • Congestion or runny nose
  • Swollen forehead

Headache Associated With a Serious Issue

If your child shows these symptoms, consult a headache specialist to determine if there is possibly a serious underlying cause:

  • Headache in a very young child
  • Headache pain that awakens a child
  • Headaches that begin very early in the day
  • Pain worsened by strain like a cough or sneeze
  • Recurrent episodes of vomiting or other signs of a stomach virus
  • Child complaining about “the worst headache ever”
  • Increasing severity of headache, or one that continues
  • Changes in the child’s personality
  • Weakness in limbs or problems with balance
  • Seizures or epilepsy

How are Paediatric/Adolescent Headaches Diagnosed?

The first step to effective treatment in children and adolescents with headache is an accurate diagnosis. A paediatric headache specialist should evaluate your child thoroughly, including doing a physical exam, making enquiries into medical and family history, and doing diagnostic tests. In an appointment with a paediatric headache specialist, the child may be asked to describe the pain, its location, the duration of the headache and more. The specialist may ask parents about changes in behaviour, personality, sleeping patterns, emotional stress and if physical trauma that preceded the headache. If symptoms indicate migraine or tension headache, specialists may not recommend further testing. However, sometimes additional diagnostic tests may be necessary; these may include blood tests, an MRI or CT scan, or a polysomnogram (sleep study) to check for a sleep disorder.

What Is the Recommended Paediatric/Adolescent Headache Treatment?

Each child receives an individualized treatment regimen that may include these components:

  • Medication
    Specific therapeutic agents are prescribed, and patient response is closely monitored to evaluate the efficiency and minimise side effects.
  • Lifestyle Modification
    Patients are instructed in the areas of diet, recreation, sleep patterns and other habits linked to headaches.
  • Biofeedback Training
    Biofeedback training is a non-drug therapy that enables patients to actively participate in their treatment while alleviating headache symptoms. About 70% of all patients, and especially children, benefit from biofeedback training. Biofeedback augments other therapies and is particularly useful for patients for whom stress is a major contributing factor to headaches, or for those patients who are unable to use standard headache agents.

About Dr Merle Diamond

Dr Merle Diamond is President and Managing Director for Diamond Headache Clinic. She graduated with honours from the University of Michigan in Ann Arbor and received her medical education from Northwestern University Medical School in Chicago. Dr Diamond has been a part of Diamond Headache Clinic since 1989, has contributed numerous articles to medical literature, and has lectured extensively on various headache subjects.

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