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Migraines in Children and Teens


Treatment and prevention plans are unique for younger people who experience migraine headaches.

If you’ve ever experienced a migraine, you know it’s not your average, run-of-the-mill headache. And a migraine is more than just a “bad headache.” Migraines are in a headache class all their own. They have specific clinical criteria. Migraine headache pain is often described as throbbing or pulsating in nature. The headaches typically last at least a few hours, but in extreme cases can last for a few days. What’s worse, these headaches can be accompanied by light and sound sensitivity, or nausea and vomiting in some people. Unfortunately, it isn’t only adults who are prone to migraines. Kids and teens can suffer from them too. The symptoms of migraine headaches in kids are very similar to those experienced by adults. However, new research indicates that the appropriate plan for treatment and prevention of migraine in children may differ from the approach taken with adults.

Based on recent research performed by a multidisciplinary panel, and for the first time since the early 2000s, the American Academy of Neurology (AAN) has updated both its acute treatment guidelines for migraine in children and adolescents, as well as its prevention protocol. It recommends that treatment should center on early intervention and identification of the best route to administer medication. For migraine prevention, the academy recommends counseling on lifestyle factors that might increase the risk of a migraine episode, as well as avoidance of migraine triggers and the dangers of medication overuse.

For child and adolescent treatment, the AAN says evidence continues to support the use of ibuprofen and acetaminophen for migraine pain relief in young people. What the AAN also reports is high confidence in the use of medications known as triptans. Triptans are used to treat acute moderate or severe migraines – meaning they are designed to stop an episode after it begins. Different than other typical pain-relievers, triptans are designed to work through effects on the serotonin neurotransmitter in the brain. When activated, serotonin helps to reduce inflammation and constricts blood vessels – which helps to stop a migraine headache. The AAN’s research also revealed that adolescents who received both an oral and nasal spray type of triptan were more likely to be migraine-free after two hours than those who had only received a placebo. The rationale is that the nasal spray is absorbed more quickly and can get to work on the migraine faster than if it were to be taken orally. Though there wasn’t any evidence that acute treatments helped with migraine-associated nausea and vomiting, some triptans did help with phonophobia (sensitivity to sounds) and photophobia (sensitivity to bright lights) related to the migraine episode.

Of course, one of the most critical questions on the minds of parents with children who suffer from migraines is: How can we help stop a migraine before it starts? In its research, the AAN determined that the majority of medications studied failed to be superior to placebo. So, while there may not currently be a recommended medication for migraine prevention in children, the AAN does provide prevention recommendations in its new guidelines. These recommendations comprise two general categories: lifestyle modifications and trigger reductions.

Lifestyle Modifications – Chronic or frequent migraine headaches are as different as the people who experience them, but they are associated with certain lifestyle factors, especially in adolescents. These include obesity/overweight, caffeine and alcohol use, lack of physical activity, poor sleep hygiene, and tobacco use/exposure. If your child is affected by any of these factors, improving or modifying them may help tremendously in reducing the frequency of migraine episodes.

Trigger Reduction – Similar to lifestyle factors involved in chronic migraines, migraine triggers can also vary from one child to the next. Stress, altered eating patterns (skipping meals), weather changes, travel (motion sickness), diet (foods with nitrates or MSG), and changes in a routine can all be enough to trigger a migraine episode. For parents trying to get to the bottom of what’s triggering their child’s migraines, keeping a “migraine journal” can help. In the journal, you can enter each migraine episode, its duration, and any triggers that may have brought it on.

Though there is currently no cure for migraine headaches, much research is being done to get to the bottom of what causes them and effective ways to treat or eliminate them. When it comes to treatment for children and adolescents, consult with your child’s pediatrician or a pediatric neurologist to determine the best next steps. And of course, if there are lifestyle modifications or trigger reductions you can help your child make, give it a shot. You might be surprised how even the slightest alterations can make a significant difference.