Migraine Headaches in Children: What We Discuss at the First Appointment

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Children can get migraine headaches. Many adults assume that migraines are something only other adults have, but even young children can suffer. If your child or teen suffers from headaches of any kind, please seek medical care. Today, I’ll share what I usually discussed with kids and their families at their first appointment for migraine headaches. 

If we diagnose migraines, there’s a lot to say. We need to review what migraine headaches are, why someone may get them, and what they can do about the pain.

This is not, by any means, a comprehensive post on the topic, but I’m hoping it will help prepare someone for an appointment for their headaches. If you’ve already met with your doctor, maybe it can help review or connect the dots.

What is a migraine headache in children?

The way I usually describe a migraine to a child is a “really bad headache with something extra.” The really bad headache often means a “throbbing” pain. Kids may describe throbbing in a variety of ways, like “pushing pain,” or they may gesture with their hands. Depending on the age, having a child draw their pain can be very helpful. The “something extra” can mean sensitivity to light or sound. Some children will describe a place where their headache is worse. We adults can then ask follow up questions about why that place makes things worse. (I’ve had many patients say the school cafeteria made their headaches worse. With further clarification, it’s often specifically the bright lights or loud sounds that made the pain worse).

Another “something extra” includes nausea. This is also hard for kids to describe. Many times, we see it as them not wanting to eat normally. 

For other kids, their additional symptoms may include feeling light-headed or belly pain.

Important note: Not all bad headaches are migraines. Migraines need to be diagnosed by a child’s physician. Again, this post is the discussion we have after the diagnosis has been made. 

Why do we need to recognize migraines in kids?

For both children and adults, migraines can be debilitating. Missed school or work just scratches the surface. And, there is treatment! It’s important to recognize because we can help these kids and teens. 

Who gets migraines and why?

Migraine headaches tend to run in families. If a child’s parent has migraines, they’re more likely to have them themselves. 

Migraines may have a “trigger.”

It’s not always easy to find, but it’s possible that something specific causes a migraine episode. Below, we’ll review some of the more common triggers.

Lack of sleep may cause migraines in teens.

Lack of sleep is a very common cause, especially in teens who may have irregular schedules and bedtimes. It’s not always obvious. And, it may not be until someone keeps track of their headaches (more on that later) that we see if this is the case. If lack of sleep triggers migraines, then prioritizing sleep can improve symptoms.

Foods are a less common migraine trigger.

It’s not common, but some people are very sensitive to specific ingredients. For these individuals, eating a food with one of these ingredients may cause a migraine. MSG (monosodium glutamate) is a well-known trigger for some. Chocolate, artificial sweeteners, and caffeine are other triggers. I don’t usually suggest any kind of elimination diet for someone trying to see if a food causes their headaches. It’s too uncommon to recommend for everyone. However, if you notice a pattern of your child getting a migraine after a certain meal or in specific situations, it’s worth thinking about ingredients. 

On the other hand, skipping meals is a migraine trigger.

Menses

Many people notice a pattern between their menstrual period and migraine headaches. What may feel inevitable is also treatable if we can see the pattern. As I’ve mentioned before, all menstruating people should keep track of their periods. For someone with migraines, this can be even more important. 

Stress

Emotional or physical stress can cause migraine headaches in some people. Some kids have a hard time explaining that they’re stressed. Or, they may use different words to describe it. This is where asking “what’s happening when your headache starts?” can be a helpful question. A specific class, a sports competition, tension at home, and a demanding schedule can all cause stress that leads to migraines. 

Dehydration can cause headaches.

Even mild dehydration causes headaches. For someone with migraines, it can trigger even more severe pain. Most kids, in my experience, need to drink a bit more water. There is no magic formula for the correct amount for everyone. (If someone eats a lot of high-water foods like fruit and does not exercise, they’ll need to drink less water than someone active outside and not eating much at all).

For a very rough guide to hydration, look at a child’s urine. This usually gets a few giggles in conversation, but I ask older kids and teens to look at their pee after they use the restroom. Ideally, it should be pale and clear, like dilute lemonade. If it’s bright yellow (“like a highlighter,” as some patients have said), they probably need to drink more. 

How do we figure out the trigger for headaches in kids?

I’ve listed some of the more common triggers. To figure out if one applies to your child, it’s helpful to keep a “headache diary,” or just notes about each migraine. If they haven’t already, I usually ask kids to start keeping track of their migraines. They can use a notebook, a paper calendar, or their smart phone. Here is a free downloadable paper form that I use.

In an ideal headache diary, they’ll note:

• the time and place of the headache
• what they’re doing when the pain starts
• the number of hours they slept the night before
• the last thing they ate or drank
• last menstrual period
• anything else they notice about the headache

Then, I ask them to note what they do to make the pain go away. Maybe they rest in a dark room, drink a glass of water, or take ibuprofen. This is useful when we discuss treatment. 

If they do this for a few migraine episodes, many start to see a pattern for themselves. Sometimes, it’s an easy fix (avoiding a particular food ingredient for example). Other times, it’s a much longer process to address (stress at home). Either way, knowledge is powerful. This information is an important step in addressing their pain. 

Note on Medication Overuse

If someone is taking pain medication (including acetaminophen or ibuprofen) more than about 10 times in a month, it can lead to another type of headache called “medication overuse headaches.”

So, along with keeping track of all symptoms, I strongly suggest children avoid using pain medication more than about twice a week. Depending on the child, we discuss a variety of non-medication approaches. I’m endeared to the fact that many kids, anecdotally, reported their pain improved when a parent rubbed their back, forehead, or shoulders. A gentle massage can go a long way. 

What if you’ve identified a trigger, avoided medication overuse, and your child still has migraine headaches?

This is when a follow up appointment with their physician is critical. There is more to be done! Sometimes, we have additional ideas for addressing the trigger.

Other times, we discuss preventative medications or vitamin supplements (magnesium and riboflavin are two promising options for many kids). And, of course, there are (non-opiate) prescription medications that can be used specifically to treat migraine headaches once they’ve started.

In addition to medical therapy, there are many alternative and natural migraine treatments worth discussing. (Here is information about one non-medicine option).

That’s beyond today’s topic, but I want the message to be clear: there is treatment. A pediatrician can often get the process started. In some cases,  a neurologist can be even more helpful.

Summary

Migraines in children need to be taken seriously. For some kids, a lack of sleep, skipped meals, menstrual periods, or stress triggers their pain. I hope this empowers young people to start to address their own health challenges. However, many children and teens need additional treatment. A visit with their doctor will be worth the getting process started.

Maya M. Mahmood, D.O., F.A.A.P. is a board-certified pediatrician and mom. She is passionate about parents having evidence-based information to help their families be healthier. Subscribe to the newsletter or follow on social media @mayapeds.