Migraine in children

Key Points:

Research suggests 1 out of 15 children experience migraine
What are some notable differences in children's migraines?
My child has a "tummy ache" - could this be Abdominal Migraine?
Communication is not always possible. See suggestions
What is a Migraine Variant?
What supplements are "proven" to treat migraines?
Triggers are everywhere. Which ones does research recommend avoiding/managing?
How to help your child struggling with migraine in school
Is there a connection between Migraine and Colic?

Introduction

Migraine doesn’t just impact grown-ups. Unfortunately, about 70 percent of children with migraine have an immediate family member who currently has migraine attacks or who had them as a child, suggesting migraine may be a familial health issue. If you’re a parent who suffers from migraine, it’s especially important to be mindful of signs that your child or children may be exhibiting migraine symptoms. Migraine attacks can be just as debilitating and painful for children and adolescents as they are for adults, and their effects can extend beyond the physical. Children who suffer from headaches may end up socializing less or struggling with their schoolwork, among other activities. ¹

According to The Migraine Research Foundation about 10% of children experience migraine. ²

Migraine Canada suggests 4 to 11% of children from 6 to 11 years old have migraines (approximately 1 child out of 15). ³

Migraine Headache Differences in Children

Headaches experienced by children may be migraine with or without aura. There are some notable differences in migraine when comparing symptoms between children and adults:

The headaches may be shorter, lasting only two hours. Often, children may want to go to sleep because of their headache and the time they are sleeping should be included as part of the duration of the headache.
The episodes don’t occur as often. They may happen only once a month or every few months.
The pain tends to be more across the forehead (bi-frontal) than on one side of the head (unilateral). As children and adolescents get older, the pain tends to be more unilateral.
Children may not report many of the common symptoms normally associated with a migraine, such as sensitivity to light or sound. These symptoms may be inferred from their behavior (i.e. preferring to go lay down in a dark, quiet room).
In young children even before they complain of headache, they may get other childhood migraine syndromes. These include benign paroxysmal torticollis, benign paroxysmal vertigo, cyclic vomiting syndrome and abdominal migraine. Some headache experts have even suggested that infant colic may be an early form of migraine.
Cyclic vomiting syndrome consists of regular, predictable episodes of vomiting several weeks apart. These vomiting episodes can be very severe and can lead to dehydration.
Abdominal migraine seems like migraine except instead of headache, children complain of stomachaches. The pain is vague or cramping around the belly button.
Appropriate investigations should be completed prior to making the diagnosis of cyclic vomiting syndrome or abdominal migraine as episodic abdominal pain or vomiting may be due to other problems involving the gastrointestinal or urogenital system.⁴

Symptoms of Migraine in Children

According to Dr. Christina Szperka, Director of the Pediatric Headache Program at the Children’s Hospital of Philadelphia, migraine symptoms vary between younger children and adults. “There are children who would have a more classic migraine presentation, very similar to what you think of as an adult presentation, where pain is a predominant symptom,” explains Szperka. “But in younger children we see more common GI symptoms including vomiting and stomach pain.”⁵

Experts suggest early migraine warning symptoms in infants can be as subtle as excessive drowsiness, unusually inactive or more irritable, or your child can have dramatic mood swings. ⁶

Migraine can be overlooked or misdiagnosed in Children

Sadly, for years Abdominal Migraine symptoms were labeled a "tummy ache", yet a recent article from the Migraine Research Foundation, published in the Huffington Post suggests other possibilities.

The Editor of MigraineAgain quotes "When I first visited an inpatient headache clinic fifteen years ago, they determined that the traumatic episode that initiated migraine attacks started when I was 23. That’s because neither they nor I recognized the abdominal migraine symptoms that came on with a fury at puberty. We now know that childhood migraine is often mistaken for other illnesses and conditions. In my case, we now believe “anorexia” at 12 and “GI distress” at 19 were undiagnosed childhood migraine. If only my mom had read this Migraine Research Foundation article in Huffington Post decades ago." ⁶

Read the entire article here - https://www.huffingtonpost.com/migraine-research-foundation/8-things-you...

Authors Note - when you are doing research for your child that you suspect is experiencing migraines, please keep an open mind. Not all Children with Migraine have Abdominal Migraine. A Headache Neurologist or a family physician is the best person to advise you.

Communication is sometimes not possible in Young Children.

Up to 4 percent of children do have their first headaches before they reach elementary school and they may not yet know how to describe the pain. If a young child has been crying or not eating, or has been inexplicably restless or irritable, consult with your doctor about finding the source of discomfort or pain.⁷

Using a face scale (or drawing a face picture as to where the pain “hurts”) and/or using a numerical pain scale (with 1 being the least and 10 being the worst) can really help parents or caregivers better understand their child’s headaches.

Migraine Variants in Children

According to two Pediatric Headache Neurologists, there are 3 Migraine Variants that have close ties to migraine. These disorders can mimic migraine disorders, due to their “close relations” to Migraine. They are:

Abdominal Migraine
Benign Paroxysmal Vertigo
Cyclic Vomiting Syndrome

See the linked article at the end of this document on Abdominal Migraine to help you and your physician.

According to Migraine Canada a fourth condition known as benign paroxysmal torticollis can also produce symptoms similar to migraine. ⁸

Supplements & Nutraceuticals in Pediatric Migraine

Riboflavin (vitamin B2)
Magnesium
Coenzyme Q10 (CoQ10)
Feverfew (Tanacetum parthenium)
Butterbur (Petasites hybridus)

Vitamins

Riboflavin (vitamin B2)

Riboflavin, also known as B2 is found in small amounts in the body. It is a vitamin in the body needed for converting food to energy and acts as an antioxidant. Lean meats, eggs, legumes, nuts, green leafy vegetables, dairy products, and milk provide riboflavin in the diet. Many breads and cereals also contain Riboflavin.

In its vitamin form (off-the-shelf) it has been proven to help alleviate migraine headaches. Scientific evidence suggests that Riboflavin is effective for treating children and adolescents with migraine. There isn't consensus among experts as to it's therapeutic use - with some professionals reaching opposite conclusions as to its benefit.

Magnesium

Magnesium is a mineral that is found naturally in human bodies. It is required to help with calcium absorption. Rich sources of Magnesium include some spices, nuts, cereals, coffee, cocoa, tea, and vegetables. Caffeine, alcohol and stress can increase excretion, from the human body and Magnesium has been shown to aid in bodily absorption.

There are many kinds of Magnesium, however, Magnesium Citrate has been found to be the most beneficial in treating migraines.

Coenzyme Q10 (CoQ10)

This vitamin supplement has recently shown confirmed scientific results from the medical community in the treatment of migraine headaches.

CoQ10 occurs naturally in the body and can be found in some meats and fish. It can also be found in dietary sources that include oily fish (such as salmon and tuna), organ meats (such as liver), and whole grains. Most of us have sufficient amounts of CoQ10 in our diets, however, supplementation may be required for certain health conditions.

Professional physician-based headache associations like the International Headache Society, the Canadian and American Headache Societies, and the American Academy of Neurology have all endorsed the use of CoQ10 as a valid treatment for migraine prevention in children.

Herbs

Feverfew (Tanacetum parthenium)

Feverfew is a perennial shrub found in Europe, Asia and North America. It has long since been used for medicinal purposes. Centuries ago it was used to treat fever and Bubonic plague, asthma and lung disease. This is also how its name originated as a "fever reducer”.

Despite it use in adults, Feverfew has not been studied in children or adolescents as a treatment for migraine and is therefore not recommended for adolescents or children.

WebMD further suggests that Feverfew may cause a problem with blood clotting, and it may cause issues for people with heart disease or blood disorders. ⁹

Butterbur (Petasites hybridus)

Butterbur Root (Petasites hybridus), originates as a perennial shrub grown in the riverbanks in Germany and is found in Europe, Asia and North America.

Scientists suggest that it contains a substance that inhibits inflammation and also serves as a calcium channel blocker resulting in improvement in migraine symptoms.

In its raw form, it is a toxic plant, but when purified (patented by a German company and marketed as Petadolex®) it is an effective preventive for the treatment of migraine headaches.

These toxins need to be removed in commercial preparation, but not all marketed butterbur formulations have adequate quality control. Butterbur is therefore best

avoided, although the Petadolex® brand appears to have good quality control and appears to contain the required amount of ingredients and has had the toxins removed adequately.

Migraine Trust - Potential Side Effects

“Studies have reported safety and good tolerability of commercially available butterbur products that are free of potentially carcinogenic pyrrolizidine alkaloid constituents, when used short-term, orally and in recommended doses. Raw, unprocessed butterbur plant should not be eaten due to the potential for liver damage of pyrrolizidine alkaloids with long-term use. This includes any teas, capsules of raw herb, or unprocessed tinctures or extracts. Use should be limited to commercially available products free of pyrrolizidine alkaloids and is not recommended in women who are pregnant or breastfeeding due to a lack of safety studies. ¹⁰

Migraine Triggers in Children

Migraine triggers in children are unfortunately, all-to-common. Dr. Marcy Yonker,MD.Professor of Clinical Practice, Pediatrics - Neurology, from the University of Colorado, suggests the following triggers, that children and parents can be aware of. (and manage - if possible)

Lack/irregularity of sleep - This is certainly one trigger, especially in teens who tend to get two to three hours less sleep than their younger brothers and sisters. Too much sleep can also bring on a migraine. Irregular sleep cycles have been linked to Migraine.
Diet - This means healthy eating but also not missing meals. Overall, the best diet is a healthy diet full of vegetables and fruits, and whole grains. Food sensitivities can be nuts, mint, caffeine, sugar.
Menstruation (for female teenagers) - There is evidence that teenage girls may get more severe migraines just before or during their periods. See website page on Women's Issues.
Dehydration - Encourage your child to drink water periodically during the day, even to get teacher permission during classes.
Avoid Stress - Stress it everywhere, even in grade school. Worries about tests, family problems, bullying and teasing all affect young people. Sometimes its hard to spot, so trying to ask your child about these triggers is important. Be sure to discuss this with your child and consult a professional. ¹¹
Sensory Overload - These include strong odors, loud noises, bright or flickering or fluorescent lights. There are other sensory triggers.
Physical exertion - This includes physical play or sports. Again, there are other physical exertions. Coming soon is an article Migraine Brought on By Exercise.

Migraine in School Aged Children: What every Parent needs to Know

According to the Migraine Trust in the UK, school children can experience occasional migraines or be tremendously impacted by their migraines that present themselves while they are at school. The Migraine Trust created a booklet called Migraine: Help at School, and in this booklet they suggest:

"Migraine and headache are common in children and young people and can have a substantial impact on their lives. Children with migraine take on average between 32 days and three months off from school due to their migraine compared to the general population who take between three and 13 days off per year."¹²

They recommend the following adjustments in school:

access to medication
food regularity
access to a quiet dark room
proper ventilation and lighting
assistance with coursework

To view the entire document Migraine: Help at School click here

Is there a Connection between Migraine and Colic?

Researchers and physicians have long since reported on the association between migraine and colic.

The lay definition of infantile colic is “excessive, frequent crying of an otherwise healthy and well-fed infant.” It follows the rule of threes: crying must last for at least 3 hours, occurring on at least 3 days per week, and persist for at least 3 weeks. Colic occurs in five to nine percent of infants, peaks at six to eight weeks, and usually resolves in three to four months. If you are concerned that your infant may have colic, your child should be assessed by their doctor to ensure that there are no other potential causes for their symptoms and not just assume they have colic. ¹³

MigraineAgain.com notes that:

Children with Migraine are more likely to have experienced infantile colic compared to children without Migraine
Mothers with migraine are 2.5 times more likely to have infants with colic
Fathers with migraine are 2 times more likely to have infants with colic ¹⁴

To view the clinical definition of Infantile Colic please access the guidelines from the International Headache Society at https://www.ichd-3.org/appendix/a1- migraine/a1-6-episodic-syndromes-that-may-be-associated-with-migraine/a1-6-4- infantile-colic/

References

1. American Migraine Foundation - How to treat Children with Migraine

2. Migraine Research Foundation, Statistics

3. Migraine Canada - Can Children be affected by Migraine?

4. Children get Migraines Too!

5.Understanding Pediatric Migraine - American Migraine Foundation.

6.Migraine Again - Surprising things you must know about Childhood Migraine

7.National Headache Foundation, Children's Headache Disorders.

8.Migraine Canada - Do children get migraines?

9.Web MD - Feverfew

10. Migraine Trust - Butterbur - Potential Side Effects

11. Yonker, M, Migraine in Children, U of Colorado\

12.Migraine Trust - Migraine: Help at School - Migraine in School Children

13. American Migraine Association, Connection between Migraine and Colic

14. MigraineAgain, Statistics, The likelihood of Colic, if Migraine is in your Family

by Brent Lucas BA (Psych)
Help for Headaches

London, Ontario, Canada

N6A 5M3

www.headache-help.org
www.helpforheadaches.org