Guide for parents and carers
Information for parents and carers of children and teens with migraine
Migraine affects children slightly differently than adults:
- The head pain often affects the whole head rather than just one side.
- Attacks are shorter, sometimes lasting less than an hour but often the pain will improve in between two and four hours.
- The headache may disappear but the child may feel sick or be sick and this may be worse than the head pain. Sometimes being sick marks the end of an attack and brings relief from all the symptoms.
- There may be abdominal pain and no head pain.
- Often car sickness is an indicator of migraine.
- The headache can come on very suddenly, and the child may be in severe pain in less than 15 minutes.
- Some childhood syndromes like vomiting in cycles every few months for some hours, turning the head to one side for a few seconds and turning it back again, episodes of dizziness like the room is spinning, and colic as a baby can be predictors of migraine in later life.
Like adults children may also experience:
- sensitivity to light and noise
- a lack of energy
- disturbed vision, or other aura symptoms may happen.
Migraine symptoms vary from child to child and can even be different from one attack to the next. Some children who are prone to migraine only suffer an occasional episode, others may have an attack every week, others may suffer from headaches nearly every day. Similarly, some children suffer attacks every day for a few weeks, but then have no further attacks for several months. Other children get migraine headaches in an almost regular monthly or weekly pattern.
The headache may get worse with even the slightest physical activity. Sleep, even for as little as 15 minutes helps migraine attacks to go away.
About 10% of children with migraine experience aura. These are temporary symptoms, which include eyesight or speech disturbances, feelings of tingling, dizziness, numbness or limb weakness. Eyesight aura can include blurring, blind spots, or a pattern of flashing lights, dark or coloured spots, sparkles, stars or zigzag lines. Symptoms usually last up to 1 hour. Aura usually leads to a headache starting, but may happen on its own. In adults aura usually happens before the headache itself, but in children it may happen at the same time as the headache.
How many children suffer from migraine?
Around 70% of school children have a headache at least once a year. One in four of these children suffer from recurrent headaches, and about 10% of school children suffer from migraine. Migraine can affect both boys and girls. About half of all migraine sufferers will have had their first attack before their 12th birthday.
Parents usually ask if their child will grow out of the condition. There is no simple answer to this question. They may do. One study found that headaches had improved for four out of ten childhood sufferers by the time they were 22 years of age. Up to one quarter of childhood sufferers had outgrown the condition completely.
Research suggests that managing childhood migraine effectively may stop young people from becoming frequent or long term sufferers when they become adults.
Migraine can be an unpredictable condition. Parents and children learn from experience that certain things can trigger an attack, but the influence of these triggers is complicated. On one occasion a known trigger will appear to bring on a migraine, yet on another it has no such effect. This suggests that a certain combination of factors together may be necessary to trigger an attack.
Children carry out a wide range of activities in a number of different environments and are under different pressures every day. It is possible that by making certain arrangements and setting up a regular routine, attacks can happen less frequently.
Common triggers include:
Some children can get migraines if their sleep pattern is disturbed. This can include having too much sleep, as well as not having enough. Setting regular times for getting up and going to bed may help avoid an attack developing.
Not drinking enough is a common trigger for migraine, especially in children who are very active. Following a routine of drinking regularly may mean asking permission from school to let your child drink water during class.
Many people with migraines try to avoid particular foods, however, they may find that they can control their migraine by identifying other trigger factors with only limited changes to their diet. An oncoming migraine attack may create a craving for a certain kind of food. If the child eats that food it will be difficult to decide if the food eaten before the attack brought on the migraine, or if the attack was already starting.
If your child thinks a certain food item does trigger your migraine, first try to establish whether this is the case by using a trigger diary.
Lack of food
Insufficient food is probably one of the most important dietary triggers. Missing meals, especially breakfast, or eating sugary snacks instead of a balanced meal can all contribute to a migraine attack. Your child may find that eating small nutritious snacks at regular intervals can help to control their attacks.
You may want to speak to someone at your child’s school about allowing them to snack outside of normal break times for instance if long breaks between eating happen to be one of the triggers for your child.
Children can feel under pressure from a range of different things. Stress can come from other children, from worrying about exams or from family problems. Dealing with stress can be difficult, and you can help by knowing about these pressures. Your child may find it helps to talk about how they feel. A child can learn specific ways to relieve tension and stress.
For some children, sudden physical exercise, such as running, can trigger a migraine attack. Setting up a routine of taking regular exercise, rather than avoiding it, may help to stop attacks. Making sure your child has enough to drink before starting exercise can also help to reduce this trigger.
It is difficult to avoid certain environments, such as bright lights and changes in the weather that may trigger a migraine. However it is also important that children do not worry about these situations. Worrying about a situation can cause an attack, and it is possible that certain environments can become ‘learned triggers’.
You need to be aware that the glare and flicker from computer or TV screens can trigger a migraine so encourage your child to take frequent breaks from working at the computer or playing games.
Many children find that they are more likely to get a migraine when they are not feeling well for another reason. For example, you might find that your child often gets a migraine when they are suffering from a cold or a stomach bug. Some girls regularly suffer migraine attacks at the start of their monthly period. If these things trigger a migraine in your child, remember that avoiding other trigger factors at these times can help to avoid an attack.
How does migraine affect a child’s daily life?
Migraine can have an enormous impact on a child’s life. As well as the physical pain and discomfort of an attack, some migraine symptoms can be quite frightening, especially when they happen for the first time. A child may feel anxious about having a migraine and having to miss certain activities. Some children may opt out of certain activities because they are frightened of bringing on an attack.
Many children miss school or are sent home from school because of an episode of migraine. This can leave a child feeling frustrated and ‘different’. Their education may also suffer especially if they find it difficult to catch up on missed lessons. This obviously can become a particular problem when attacks happen regularly.
Some children experience ‘weekend migraine’, where the headache is brought on by relaxing at the end of the week. It can affect activities with family and friends, so a child may feel left out. Migraine may begin to affect their social life which might lead to feelings of low self-esteem.
How to support a young migraine sufferer
You can help a child to cope with their migraine attacks in many ways. For example:
Reassure – Get a correct diagnosis from your child’s doctor, and advice on managing and treating your child’s migraines.
Record – Help your child keep a headache diary. Help to identify triggers and learn to predict when an attack is more likely to happen. It is also useful to keep a record of how your child treats their migraine so they know what to do when the feel an attack coming on. This is useful to give to the school. (A diary for young people and a treatment record sheet are included with the Migraine Advice for 7 to 12 year olds pack).
Watch your child – You may be able to sense when they are about to have an attack. You may suspect your child is going to have an attack by recognising certain warning signs, which can occur 2-48 hours before the headache comes on. These may include:
- tiredness and yawning;
- muscle pain;
- a pale complexion;
- a child being quieter or more irritable than usual;
- food cravings.
Encourage – Your child may feel more confident about their condition if they try to manage it.
Support – Your child may need extra attention to catch up on missed schoolwork. Give a copy of this information to your child’s teacher or school.
A child with headache must be seen by a doctor. Diagnosis of a headache can:
- give reassurance that the headaches are not a sign of a very serious illness;
- make sure your child feels the situation is understood;
- get you advice on stopping, managing and treating the headaches.
Diagnosing migraine can be more difficult when a child has the linked symptoms that go with it, but has only a mild or very short headache. For example, a child may keep having bouts of being sick or feeling really sick (severe nausea). Complicating diagnosis even more, there are a number of different types of migraine, each with unique symptoms that can happen in children. The main thing to remember is that each child’s condition is unique.
As a parent, you may notice vital clues about your child’s behaviour during an attack. For example, do they shy away from bright lights, or do they put themselves to bed in a quiet room with the curtains drawn? Your child may focus on the sensation of feeling sick. Do they often rub their forehead, or complain of head pain at the same time?
Migraine may be confused with other conditions and in some cases a child may get a wrong diagnosis. In other cases, a child or parent may suspect that a different condition is causing the headaches.
In children, migraine is often mistaken for sinus disease. Other common mistakes include blaming the headaches on an allergy or eyesight problems. It is also possible to misunderstand a change in your child’s behaviour caused by their headache. For example, you or a teacher may think a child is using headaches as an excuse to avoid school. It is important that a child who says they are having headaches sees a doctor. If migraine is diagnosed, other causes can be ruled out. Your child can be reassured, and their headaches can be managed and treated.
Helping the doctor make a correct diagnosis
There is no test to diagnose migraine. To make a firm diagnosis the doctor will take a detailed history of the headaches that includes:
- the features of the headaches (for example, how often they happen, how severe the pain is, what symptoms go with them);
- the effect the headaches have on a child’s everyday activities;
- any family history of headaches.
The doctor is also likely to give your child a thorough physical examination and complete a neurological assessment.
CAT or MRI scans, where a picture is taken of the brain cannot be used to diagnose migraine, although in a few cases they are used to diagnose other causes of headache.
Keeping a migraine diary
A correct diagnosis is more likely if you and your child keep a record of the details of the headache attacks. The more information you can give a doctor the better. See below to download a migraine diary. You and your child can use this diary to record important information about their attacks. Include any triggers or warning signs felt or noticed by you or your child before an attack happens. Recording when the attack starts and finishes gives vital information about the recurrent nature of your child’s condition.
Your child should also describe how severe their head pain is, and the features of the headache. You might even come up with your own scale to judge the level of your child’s pain. A record of medication taken during each attack will also be useful.
It is important to continue to record the headaches after a diagnosis has been made. You can use this information to judge the effectiveness of different ways of managing and treating the headaches. The effect of different aspects of the child’s lifestyle on their migraine may also become clear, and you may identify new triggers.
Gauging the effect of migraine
In children you can measure the effects of migraine by noting the number of days they miss school, the number of social or sporting activities they miss and any extra hours spent resting or sleeping during episodes.
Doctors can use the MIgraine Disability Assessment Scale, or MIDAS which involves asking your child a series of questions that have been specially designed and tested. The answers are used to work out the number of days of disability caused by migraine in a three-month period. A migraine sufferer is then given one of four different MIDAS grades. A doctor can easily use and interpret these grades.
Principles of managing migraine
Once a child’s headaches have been diagnosed and the level of disability assessed, managing the condition can potentially lessen its impact. Taking steps to manage the attacks in childhood may help the condition to improve in later life. Setting up ‘migraine-friendly’ routines when a child is young may help to prevent the condition from manifesting as they grow older.
It is important you and your child are clear about what you expect to achieve from a routine for managing migraine. For example, aiming to reduce how often the headaches happen may be realistic, but wishing for a life without headaches may not be. A realistic goal gives your child something to aim for. They may have a sense of real achievement when their condition has been brought under better control.
Some migraine sufferers use ways of relieving physical tension to avoid attacks. For example, massage and physical therapy are used to help muscle pain in the neck and shoulder. A common cause of such pain in children is a heavy school bag.
Medication taken to relieve the pain and disability of an attack and to stop the attack developing is known as “acute treatment”. In many children, treating migraine early can lead to recovery in less than an hour.
Your child may be able to tell you that they feel they are going to get a headache. In these situations, if you start the treatment, you may stop the attack from developing further.
It is important to treat the attack early before the pain becomes more severe. The earlier medication is taken, the more likely it is to stop all the features of a migraine. Non-prescription medicines such as paracetamol or ibuprofen are suitable first medications to try. It is important to give these in the right doses and in an appropriate form, perhaps a syrup. You can get information about doses from the information sheet that comes with the medicine, or from a doctor or pharmacist. If non-prescription medicines do not help, it is important to talk to a doctor about what else is available (rather than increase the dose, and risk over-using the medication and making the headaches worse).
In many cases, these simple treatments can stop a migraine attack from developing. If the attack continues, despite the treatment, put your child to bed and encourage them to sleep. Another dose of the pain-killing drug may be given when it is due. When they wake up from a sleep, however short, many children have fully recovered.
Specific anti-migraine drugs
Sometimes a child may still have a severe headache, even after they have followed the acute treatment steps. Or it may be that their headaches usually do not respond to these simple steps. In these cases, a doctor may prescribe specific anti-migraine drugs. Your child’s doctor will talk to you about the best time to take them.
Many adults with severe migraines are treated with one of a class of migraine specific drugs called triptans. Trials have shown that children are able to take triptans too. Triptans can be taken as pills, as quick dissolving tablets, as a nasal spray, or as an injection. On average, patients who take triptans by mouth get relief from the symptoms of migraine in around half an hour. A doctor will be able to talk to you about your child’s specific needs, and the best way for them to take the medication.
There is one triptan which is specifically licensed in the UK on prescription for children aged between 12 and 17. This is the sumatriptan (Imigran) nasal spray at 10 mg which is sprayed into one nostril.
Ideally, the individual features of your child’s headaches should be matched to a suitable plan for managing them at an early stage. You should record details of the attacks throughout the treatment programme to help the doctor assess the effect of the medication.
There may be times when acute medication does not give enough relief from an attack. Your child’s doctor may prescribe different medication to use at these times. ‘Rescue medication’ can be used if your child’s acute treatment does not work. An anti-nausea (anti-emetic) medication (to stop sickness), plus an anti-inflammatory or pain-relieving medication may be prescribed. Write down when you use rescue medication on your child’s diary.
Preventative medication and children
Some children may continue to have disabling headaches even after changing their lifestyle and taking acute treatments. If this is the case, you need to talk to a doctor about the possibility of using preventative medication (medication to try and stop the headaches happening).
How often your child has a headache is not the only thing a doctor will look at to decide whether to prescribe preventative medication. The decision will be based on the effect the headaches are having on your child’s life. When headaches are affecting your child badly, a doctor can prescribe a number of different preventative medications. Very little scientific evidence has been gathered from children with migraine. Research involving adult migraine sufferers is used when deciding which drug to prescribe. Doctors will also base their treatment decisions on experience from their own practice.
Migraine preventatives have usually been developed to treat other conditions. Experience has shown that these drugs also stop migraine attacks from happening. Therefore, your child may be prescribed:
- an anti-convulsant, such as divaloproex sodium or topiramate;
- an anti-depressant such as amitriptyline;
- an anti-histamine, such as cyproheptadine;
- a beta-blocker, such as propranolol;
- an anti-inflammatory drug, such as pizotifen.
Other drugs not listed here may also be used, based on the experience of your child’s doctor. A doctor will also talk to you about how long your child should take preventative medication. Migraine-preventative medication is usually used for between 3 and 18 months. This treatment generally leads to a considerable reduction in the number of headaches a child has. This improvement often carries on when a child stops taking the preventative drug.
It may be wise to choose carefully the time for your child to stop taking the preventative medication, for example at the start of a long school holiday. This will help to reduce any disruption. It is important to record fully any attacks that happen when your child is taking preventative medication. You need to watch and record what is happening, to help the doctor decide if the medication is helping to cut down the headaches.
Concerns about medication and children
The action of any drug in the body is complicated. Drugs can act on many places in the body, not just the parts we want them to. This can lead to side effects, as well as the planned benefits. When prescribing medication for a child, a doctor will talk to you about the possible side effects. These will also be listed on the information sheet that comes with the medication. Write down any changes you or your child see or notice that you think might be a side effect of the medication. It is important to tell a doctor about these changes. Some side effects go away with time, but a doctor may want to reduce the dose or change the medication.
The dangers of over-using medication
There is a condition called ‘medication overuse headache’ that has been linked with over-using painkillers, such as paracetamol. Some medicines containing combinations of drugs with codeine or caffeine have been strongly suspected of causing medication overuse headache. Therefore, rather than managing migraine, regular use of these drugs on more than three days a week can actually make the headaches worse. It is important to avoid over-using medication. You should get medical advice if your child is starting to use painkillers on more than three days a week.
When to worry about a headache
In most cases, the headaches children have are ‘primary’; in other words, the headache itself is the condition. However, in some cases the headache may be secondary, where the pain is caused by a more serious condition.
There are a number of important warnings that may suggest a headache is secondary:
- Constant head pain which may get worse may show the condition has a more serious cause.
- A sudden, severe headache that happens without the other recognised migraine symptoms may be cause for concern.
- Symptoms that happen early in the morning should be discussed with a doctor.
- Excessive vomiting, changes in a child’s vision, balance problems, weakness or lack of co-ordination should also be discussed with a doctor.
- A change in behaviour with a headache may be a warning sign. Examples include a drop in school performance, or a sudden personality change.
If the symptoms of the headaches change, it is important to talk about these changes with a doctor.
The role of your child and of supervising adults
It is important for a child suffering from migraine to take an active role in managing their condition. The more your child understands about their migraine, the less worry the condition is likely to cause. A child recording attacks and triggers should learn about the positive steps they can take to manage the condition. The aim is to make your child feel more in control, rather than feeling the headache is controlling them.
Managing migraine at school and away from home
Children suffering with headaches are bound to get them when they are away from home. The supervising adult needs to have enough information to deal with the attack. If a child gets a severe headache, parents are often contacted and asked to take their child home. In many cases, if the appropriate help is given early enough, the child can recover and continue their activities.
If your child is at school, you may find it useful to talk to the head teacher about your child’s condition. Each school will have a policy on supporting children with medical needs. You may want to make a special appointment, for you, the supervisor, and your child to talk about the headaches. School staff do not have a legal duty to give medication, or to supervise a child taking medication. This is a voluntary role, but many staff are happy to take it on. Teachers and school nurses, or others who regularly supervise children, can change the effect migraines have on a child.
Staff who do support pupils with medical needs, or who volunteer to give them medication, need:
- support from the head teacher and parents;
- information and training;
- reassurance about their legal responsibility.
More information on this issue is available in the booklet ‘Managing medicines in schools and early-years settings’, produced by DfES and Department of Health updated November 2007. It explains the roles and responsibilities of employers, parents and carers, governing bodies, head teachers, teachers and other staff and of local health services. It considers staffing-issues including employment of staff, insurance and training. Other issues covered include drawing up a health-care plan for a pupil, confidentiality, record keeping, the storage, access and disposal of medicines, home to school transport, and on-site and off-site activities. Information can also be found at: www.medicalconditionsatschool.org.uk.
In addition, the Royal College of General Practitioners (RCGP) and Headache UK (of which The Migraine Trust is a member) launched School Policy Guidelines for Students with Migraine and Troublesome Headache in 2011 – this can be downloaded below.
Migraine treatment sheet
As migraine is very individual children may need a different plan to manage their condition. You should try to give the school as much information as possible about avoiding an attack and recognising when your child is about to have an attack. You can also give the staff advice about what to do if your child does have an attack. For example, you may want to give them a dose of painkillers they can give your child if an attack develops while they are away from home.
Managing migraine at school
In many cases, two simple treatment steps can help to stop a migraine attack from developing.
- Encourage the child to eat. If they are not hungry, or food makes them feel sick, they may be able to have a drink with added sugar (such as a sports drink, juice, or soft drink), or a glucose tablet.
- The child should take the medication their doctor has given them. You may therefore be asked to keep a dose of this medication and give it to the child when necessary. Or you may be asked to supervise the child while they take a dose of the medication they carry with them. A child may need to take an anti-sickness drug, as well as medication for the headache.
In many cases the child will recover quickly and be able to rejoin the class. If the attack continues, you should let the child rest and encourage them to sleep. Many children recover fully after waking up from a sleep, however short it has been. Some children will not respond to simple painkillers. When headaches are having a major effect on a child’s life, their doctor may prescribe a specific anti-migraine treatment.
Anti-migraine medications can take effect in as little as 30 minutes. The child and parent(s) will be able to tell you what usually happens with the attack after treatment has been given. They will also be able to tell you about any side effects, and what action to take if the child has these effects.
Making sure the classroom is well ventilated can also help some children to avoid attacks at school. Suggesting ways of studying which reduce stress may also help a child. When a child is having, or recovering from, an attack, they will find it very difficult to do their homework. Giving a child support to catch up on missed work may help to break a pattern of attacks. You may also want to talk to them about when they feel most sensitive to attacks, for example, during exams. The ability of a young migraine sufferer to revise for, and perform in, exams, may be affected by their condition, and their results may vary.
Although a child with migraine may need special attention, it is also important they feel as normal as possible. A child should be graded according to their ability, and not downgraded as a result of their condition.
Supporting a young migraine sufferer can put a strain on your family and may mean canceling events at short notice. This can leave the whole family, including the child with migraine, feeling frustrated. It is important that your whole family talks together about these feelings so that the child is not labeled as being different because of their condition.
Answering your questions
We hope you find this information useful. It is not a substitute for the expert advice of a doctor or pharmacist.
Migraine may create problems for you and your child that will be common to other conditions. For example, your child may not want to go to school because they are scared of having an attack in front of friends. This may also be true for children who for example, suffer from epilepsy. A child suffering from asthma may have problems catching up with work in the same way as a child who has missed school because of migraine. The following organisations may be able to give you advice on these general issues:
- Family Lives – a national family support charity Website: www.familylives.org.uk
- Advisory Centre for Education (ACE) Website: www.ace-ed.org.uk