Migraine is a complex disorder that may cause headaches or abdominal pain. There are certain features of child migraine headache that make the diagnosis likely. Children will have a severe headache, will often look pale, feel sick and may even vomit. The headache will be relieved by sleep and there is often a family history of migraine headache. The headache is often on only one side of the head. Between attacks of migraine, children are well.

Migraine headaches occur in between 3 and 10% of children and about 50% of children "grow out" of the migraines by adolescence. Even toddlers and pre-school children can suffer from migraine headaches.

Is there a cure for child migraine headache?

No, but the good news is that we can usually help you take more control of your child's migraine headaches by learning what things trigger the attacks in her, and by having a clear plan of what to do when she gets an attack.

What is the treatment for child migraine headache?

The best treatment for child migraine headache is sleep. The sooner your child can get to sleep after an attack starts, the sooner the attack will be over. It is a good idea to give your child a snack or a sweet drink before she sleeps and she can have pain relief (such as Paracetamol or Ibuprofen) as well.

We often also prescribe an anti-sickness agent (Metoclopramide,) because in child migraine headache there is often a feeling of sickness (nausea) and sometimes without an anti-sickness agent, the pain reliever would not work so well. I tend to reserve this for older children unless there are big problems with vomiting in toddlers. After a short sleep, the migraine will often be gone completely.

Studies have shown that Ibuprofen is effective in reducing symptoms of child migraine headache, as is Sumatriptan. The studies in sumatriptan have mostly been in children over 12 years of age. I would advise a simple regime of Ibuprofen first in children with migraine and only try Sumatriptan in older children with migraine.

What can trigger child migraine headaches?

Many things, including lack of sleep, missing meals, certain foods (such as cheese and citrus fruits), stress and worry can trigger child migraine headaches. Sometimes, it's a combination of factors. Everybody is slightly different so it is important for you to find out what your child's trigger factors are. Once you know the trigger factors, you can try and avoid them and so reduce your child's migraine headaches.

If stress or worry is a trigger, (and sometimes it's just getting worked up about even little things that can trigger migraine), you need to teach your child to do something different in those times - like take 10 deep breaths or go for a long walk. This is easier with an older child.

How do I find what my child's trigger factors are?

The best way is to do a 24-48 hour diary of what happened before the child migraine headache attack. You can do this once your child has had a sleep and is feeling better. You need to think about what she ate and drank (and when), what the weather was like, what was going on in school (if she's in school), what was happening with friends and family etc. Then keep this somewhere safe. When you have 2 or 3 of these, look and see if you can see a pattern. If you see a pattern, change that thing and hopefully your child's migraine headaches will improve.

An example of a diary is:

You can export this child migraine headache diary to an Excel table by right clicking on it.

What if your child gets a migraine headache in class?

Children can't learn properly with a migraine headache, and as she needs to get to sleep as soon as possible, it's best if your child leaves class immediately and goes and lies down somewhere quietly. This doesn't necessarily mean going home - she could just go to the medical room. After 2 or 3 hours, she may be able to come back to class. If your child doesn't leave class, she probably won't learn much and worse still, the headache will probably linger, sometimes for days. In the end, she'll miss more school. You need to explain this to her teachers.

Is there any way to prevent child migraine headaches?

The best way is to know your child's trigger factors and to avoid them.

Sometimes, your child will be prescribed a medication to try and reduce the frequency of attacks. These medications are only usually given for 2 -3 months, and they are given every day, regardless of whether your child has an attack or not. It is important that you do not stop these medicines suddenly at the end of the 2 or 3 month period. You need to gently wean the dose over 3 or 4 weeks, (so from every day, go to every day but Sunday, then every day but Sun and Wed, then every 2nd day, then stop).

Medications used as preventative agents include:

• pizotifen
• propanolol
• cyproheptadine

but none of them have been shown conclusively to work. They work in some children some of the time.

Studies have shown that children (average age 11 years) who have tension or migraine headaches respond well to self-hypnosis technniques for reducing the frequency of headaches and the pain associated with the headache. Learning these techniques is a good option for your child and preferable to using medication.

Are there any side effects to the medicines for child migraine headaches?

• Occasionally, Metoclopramide can cause an unusual reaction where the face muscles twitch and move by themselves - this doesn't happen that often and you can't predict if it will happen. If it did, there is an antidote which your doctor or emergency service could give you to stop the reaction- take the medicine with you.
• Pizotifen and Cyproheptadine, which are sometimes given as preventative agents, cause an increased appetite and so can cause weight increases.

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