Helping Kids Manage Migraine

The World Health Organization says migraine is one of the top 10 most disabling medical illnesses in the world. Anyone can be affected by migraines, including children. However, children sometimes experience a migraine differently. The good news is that there are new medications now available for kids that can make a meaningful difference.

It’s common to hear about an aura happening before the full migraine symptoms are experienced. Auras are neurological and can be related to vision, physical sensation or speech.

Deetra Ford, MD, chief of general neurology at the health system, explains that visual auras are the most common. This can be experienced as lights, spots, blurry vision and more. Sensory auras can feel like tingling or numbness in certain spots. There is also motor weakness, which can affect speech and be confused for a stroke.

Victoria Draffan, advanced practice registered nurse in neurology at the health system, says that visual auras tend to be more common in adults, while children often complain of gastrointestinal symptoms like nausea or stomachaches.

“Up to 2 days before a migraine, you can have this prodrome of symptoms,” says Dr. Ford. “You can get increased urination, increased yawning, increase in neck pain and irritability. Things just start firing and misfiring. It becomes more and more chaotic in there, and those chaotic signals release chemicals and inflammatory mediators that then lead to activation of our pain centers or sensitization, and leads to the debilitating pain, as well as other side effects that come along with a migraine.”

The other side effects or symptoms of a migraine include nausea, vomiting, light and sound sensitivity and pain. Those symptoms must last for at least 4 hours to be called a migraine.

Jennifer Dilts, DO, is a pediatrician who’s board-certified in headache medicine. She says children as young as 3 can have migraines. But it can be hard to understand what is happening based on the symptoms they describe. Instead, parents should keep a close watch on their behaviors.

“They may not tell you that their belly hurts or that they're light or sound sensitive, but they just want to go lay down in a dark, quiet room. I have kids that lie in their closets when they're having a migraine,” says Dr. Dilts.

According to Dr. Ford, stress is a significant trigger for migraines. Additionally, changes in sleep are also significant – getting too much, too little, going to bed later than normal or waking earlier than normal can all cause issues. Changes in the weather, like the barometric pressure increasing, may also kick off a migraine. And while caffeine can help some people manage migraine symptoms, Draffan says that being consistent with caffeine intake is important because too much or too little could trigger a migraine.

Additionally, migraine can be a genetic condition, which is often the case for very young children who experience them.

While there are many treatment options for migraine, the FDA recently approved using calcitonin gene-related peptide (CGRP) inhibitor medications for children ages 6 to 17.

“That really has been life changing for a lot of my teen patients. Before that, it was ages 18 and up,” says Dr. Dilts. “I am using CGRP inhibitors with a lot of my teen patients. They do a monthly shot at home, so they don't have to remember to take a daily medication. And there are a lot fewer side effects than a lot of the other medicines that we use.”

Dr. Ford explains that CGRP proteins are small molecules that get released at the beginning of a migraine.

“These new medications help block those molecules, or the receptors where they bind, and so that then reduces the pain that comes along with them,” says Dr. Ford. “For the folks who take them as prevention, over long periods of time, it kind of down regulates those processes, so that you have fewer migraines, less pain, less break through.”

While Botox injections are used in adults to help manage migraine, Dr. Dilts said that is an off-label use for those under 18. Botox provides direct muscle relaxation but also hits the nociceptive pain receptors.

“It actually has downstream activity on calcium channels and CGRP as well,” says Dr. Ford. “So, there are pain receptors in the head that you can kind of calm down and deactivate.”

Pay attention to your child’s behaviors and complaints. Track them if the same ones seem to happen multiple times. Use the information about auras and related symptoms to help identify if they could be experiencing migraine.

“A lot of times it's an invisible illness,” says Dr. Dilts. “It's not just a headache. There is brain fog and the stress of when the next attack is going to hit and the nausea and all of those things that go with it, too.”

If patterns start to emerge, seek treatment from their primary care provider as soon as possible and ask about rescue and preventive treatments. Dr. Dilts also recommends using free headache resources from the Meg Foundation.

“Right now, we have so many good treatments, and so the sooner we can see kids and teens with migraine, the better the treatments work, and the faster that we can get them back to doing everything that they want to do,” says Dr. Dilts.

Prevention and quick treatment are important when treating migraine. So having a treatment plan that you can start as soon as symptoms appear can help kids suffer less.

“A lot of kids can feel misunderstood with migraine, and so it is a big deal,” says Dr. Dilts. “But, again, we have such good treatments, so I think patients should feel really hopeful.”