What causes migraine?

It's not clear why migraines occur. If a family member has migraines, your child may be more likely to have them. Many people do not know why they develop a migraine, while others find that their migraines may be set off by a “trigger.” Common migraine triggers include:

• Chemicals in certain foods and drinks, such as aged cheeses, processed meats, chocolate, coffee, and sodas

• Chemicals in the air, such as tobacco smoke, perfume, glue, paint, or cleaning products

• Dehydration. This means there's not enough fluid in the body.

• Not enough sleep or too much sleep

• Hormone changes during puberty

• Environmental factors, such as changes in weather, bright or flashing lights, hot sun, or air pressure changes

• Stress both good and bad

• Skipping meals

The stages of migraines

Migraines often progress through four stages. Your child may or may not have all four stages. And the stages may not be the same every time a migraine occurs. The four basic stages of migraine headaches are:

• Prodrome. In this early stage, your child may feel tired, uneasy, or moody. It may be hours or days before the headache pain starts.

• Aura. Up to an hour before a migraine, your child may have an aura (odd smells, sights, or sounds). This may include flashing lights, blind spots, other vision problems, confusion, or trouble speaking.

• Headache. Your child has severe throbbing pain in one or both sides of the head. They may feel nauseated and have a strong sensitivity to light, sound, and odors. Nausea, vomiting, or diarrhea may also occur. This stage can last anywhere from a few hours to a few days.

• Postdrome or recovery. For up to a day after the headache ends, your child may feel tired, achy, and “wiped out.”

What are the symptoms of migraines?

Your child may have some or all of these symptoms:

• Throbbing or pulsating severe headache pain, occurring in a specific area of the head such as behind one eye

• Aura (odd smells, sights, or sounds)

• Nausea, vomiting, or diarrhea

• Sensitivity to light or sound

• Feeling drowsy

How are migraines diagnosed?

To diagnose migraine headaches, the healthcare provider will:

• Examine your child and ask about your child’s symptoms and any other health issues your child may have. You may also be asked if a family member has a history of migraine headaches.

• Ask you and your child to keep a “headache diary” for a short period. This means writing down what time of day your child gets headaches, where the pain is felt, how often the headaches happen, and how bad the headaches are. You may also be asked to write down things that make the headache better or worse. The diary can help the healthcare provider learn more about the headaches and determine the best treatment.

• Before diagnosing migraines, your child's healthcare provider may order a CT scan or MRI to be sure no other issues are causing the migraines.

How are migraines in children and teens treated?

How your child's migraines are treated will depend on how often they have a migraine and how severe they are. If diagnosis is difficult, your child's primary care provider may recommend you see a headache specialist called a neurologist. Some over-the-counter products may relieve some migraines. For mild to moderate migraine, use acetaminophen, ibuprofen, and naproxen early in the course of the headache. If your child also has poor appetite, abdominal pain, and vomiting with migraine, your healthcare provider may prescribe medicines that treat nausea and vomiting. 

Some migraines need prescription medicines to treat and prevent them. Your child's healthcare provider will determine if medicine is needed now or if referral to a headache specialist is needed.

Overuse of headache medicines can cause rebound headaches. Use all medicines with care, including over-the-counter medicines and prescriptions. Consult your child's healthcare provider if your child is taking any medicine for headache more than twice a week.

Lifestyle changes may also help control migraines. These include:

• Relaxation techniques such as biofeedback, imagery, or hypnosis

• Cognitive-behavioral therapy

• Acupuncture

• Exercise

• Rest

• Healthy diet

For some children, avoiding known "triggers," eating a balanced diet without skipping meals, getting regular exercise, and a consistent sleep schedule may help reduce migraines.

What are the long-term concerns?

As your child gets older, the frequency of migraine may change. The likelihood of lifelong migraine may also increase if one parent has lifelong migraines.

When should I call my healthcare provider?

Call your child’s healthcare provider right away if your child has any of the following 

• Headache pain that does not respond to your routine treatment

• Headache pain that seems different or much worse than previous episodes

• Headache upon awakening or in the middle of the night

• Severe confusion or altered behavior linked to a headache

• Dizziness, clumsiness, slurred speech, or other changes with a headache

• Migraines that happen more than once a week or suddenly increase in frequency

Unless advised otherwise by your child’s healthcare provider, call the provider or seek medical care right away if:

• Your child has a fever of 100.4°F (38°C) or higher, or as advised by your healthcare provider

• Your child has a stiff neck

• Your child has a seizure