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Although most people think of Migraines as not starting before the teen years and ending in late middle-age years, Migraines can and do occur outside of that age range. Even children who are too young to talk can have Migraines. At that age, Migraine is diagnosed by parents carefully observing and reporting symptoms to their child’s doctor. It’s also important that doctors be informed of any family history of Migraines, “sick headaches,” and sinus headaches. We need to remember that Migraine is under-diagnosed, and people who have them only occasionally may never report them to their doctors or discuss them with their doctors. True sinus headaches usually occur only in the presence of a sinus infection, and 90% of what people think are sinus headaches are really Migraines. 1
The Migraines children and adolescents have can have differences from those of adults…
See Also
Migraines in children & teens
Your Child’s Doctor Visit
Migraines & School
Forms For School
Children are more likely to have abdominal Migraine than adults. Abdominal Migraine is a form of Migraine seen mainly in children. It’s most common in children ages five- to nine-years-old, but can occur in adults as well. Abdominal Migraine consists primarily of abdominal pain, nausea, and vomiting. It was recognized as a form of Migraine disease as links were made to other family members having Migraines and children who had this disorder grew into adults with Migraine with and without aura. Most children who experience abdominal Migraine eventually develop Migraine with aura and/or Migraine without aura.
There can be some differences between adults and children in Migraine with aura and Migraine without aura:
- In children, attacks may last 1–72 hours.
- The headache of a Migraine attack is commonly bilateral (on both sides) in young children; an adult pattern of unilateral pain usually emerges in late adolescence or early adulthood.
- In young children, photophobia and phonophobia may be inferred from observing their behavior.
- The headache of a Migraine attack is usually frontotemporal (front and sides, toward the front, of head). Occipital (lower back of the head) headache in children, whether unilateral or bilateral, is rare and calls for caution in diagnosing as many cases are attributable to structural lesions.
Trigger identification and management:
Trigger identification is a vital part of Migraine management for all Migraineurs, regardless of age. Some triggers can be avoided, thus escaping any Migraines precipitated by them, but we have to identify them. A Migraine diary is an excellent tool for helping adolescents, parents, and doctors identify those triggers.
Treating Migraine in children:
For acute treatment (treatment used when a Migraine occurs), there are fewer options for children. This is primarily because researchers don’t want to “experiment” with children, so far fewer clinical trials are conducted with them. Of the Migraine abortive medications – triptans such as Imitrex, Maxalt, Zomig, etc., and ergotamines such as DHE 45 and Migranal Nasal Spray – only one is approved for adolescents. Axert (almotriptan), a triptan, was approved by the FDA for adolescents 12- to 17-years-old in 2009. Some doctors prescribe triptans for younger children after discussing options with parents.
As with adults, preventive treatment may be appropriate if a child or adolescent experiences three or more Migraines a month or if their Migraines are very severe. Several types of medications may be used – beta blockers such as propranolol; Periactin, technically an antihistamine; anticonvulsant medications such as Depakote and Topamax; and others. Doctors should be willing to discuss the various options with parents and include parents in deciding which medications to try. Parents should not hesitate to tell doctors if they are uncomfortable with certain medications.
Migraine is a genetic neurological disease that has no respect for age. Migraines do not, however, need to dominate or disrupt the lives of children and adolescents. By working with their doctors, and by consulting a Migraine specialist if necessary, proper management can help control the disease rather than the disease controlling children and adolescents – or adults.
Live well,
© Teri Robert, 2010
Resources:1 Platform Presentation. 46th Annual Scientific Meeting of the American Headache Society (AHS). June, 2004. 2 International Headache Society. “International Classification of Headache Disorders, 2nd Edition” (ICHD-II), First Revision. May, 2005. 3 Press Release. “Almotriptan (Axert®/Almogran®) approved by the FDA for the treatment of migraine in adolescents.” Barcelona. Almirall. June 3, 2009.
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"I had my first migraine when I was 12. I thought I was going blind, the spots in my vision all grouped together and everything went black. The pain was intense and felt like my head would crack open above my right eye." 
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Ellen,
Although Periactin and Benadryl are both antihistamines, there’s something in their pharmacokinetics that makes Pericactin a good preventive for some people, but not Benadry.
I’ve talked with several parents whose children were helped by using Periactin for prevention; a few adults too.
Take heart, Ellen. Already, I see things are so much better for our grandchildren who have Migraines than they were for me as a child.
Teri,
Geesh, Periactin was given to us not as a preventative, but to take when the Migraine hit. Maybe the doctor didn’t understand how it was supposed to be given. That’s sad for us though, if it could have helped as a preventative it might have saved us so much heartache.
Do you see a lot of parents having luck with it? Benadryl was already a big part of our lives due to the serious allergy situation. Periactin and Benadryl is prescribed to be taken together?
I pray that someday when my kids have their babies, maybe this will be behind us. At least we’ll have better resources and be better prepared than the old days…
Ellen,
Thanks!
Isn’t it horrid when our children have Migraines? Four of our grandchildren have them. Alexandra had her first at 2-1/2. UGH!
On the abortives and kids. There is only one abortive FDA approved for use under 18. Axert is approved for kids 12 – 18. Some doctors do prescribe triptans off-label for younger kids, but I don’t think I’ve seen that for kids under 8 or 9. Doctors will often suggest something that makes kids sleepy, sometimes children’s Benadryl, because deep sleep is a natural abortive. For preventives, Periactin is pretty commonly used in kids. Sometimes beta blockers too. Any preventive used for kids is used off-label. Nothing has been FDA approved for Migraine prevention in kids.
There’s a problem with researching meds and kids. People are reluctant to do clinical trials with pre-teen kids, partly because of the risks, and partly because it’s hard to get good data because younger kids don’t understand things well enough to participate well in reporting. When I look through Migraine clinical trials, there are usually some enrolling teens, but seldom any enrolling younger kids.
I totally agree with you on being glad that our children and grandchildren have more options than we did!
Oh Teri, I’m so glad you wrote about this. I know it will help many parents who struggle with this in their family.
I’ll never forget my son’s Migraines. He wasn’t even a year old when they began, and they were truly terrible. This was many years ago, and little was offered to us to help him. It was so awful to listen to him scream when there was nothing I could do for him but hold him and try to help him sleep.
I’m wondering – is there much difference in the effect of preventives or abortives on very young children? babies? What about the treatment of babies – is there research showing it is safe to use Triptans or some of these other medications, or are they usually being used off label in hopes of getting attacks under control?
We were given Periactin, which did *sometimes* help to get him to sleep which would often end the attack, but that was essentially it. Finding out later that many of his Migraines were triggered by his very serious allergies did help us in the way of prevention, but honestly, once an attack hit, there was little we could do but hang on and pray. Now that he is getting married and considering starting his own family soon, I am so thankful there do seem to be options that weren’t being used (enough?) 25 yrs ago…
Thanks again,
Ellen