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Migraine Headache in Children

Migraine Headache in Children Overview

Migraine headaches are the most common acute and recurrent headache pattern experienced by children. These often incapacitating experiences are noteworthy for their sudden onset and accompanying symptoms of nausea, abdominal pain, vomiting, and relief by sleep. Doctors focus on ruling out other serious diseases or conditions when they first examine migraineurs (people who have migraines). Treatment consists of finding and avoiding trigger factors in the environment, giving immediate pain relief, and taking preventive drugs.

Migraineurs may present with an array of various signs and symptoms. During a migraine episode, patients often endure the sudden onset of a severe headache located around the eyes, in the forehead region, or in the temples. Some children experience vision changes or other sensory changes ("auras") during or proceeding a headache. A sick feeling in the stomach or vomiting is common. Many children avoid bright lights, loud noises, or strong odors since these may amplify the pain of their headache. While various medications may be employed to treat a migraine headache, the severe head pain is often completely relieved by deep sleep.

An inherited tendency is believed to make some people more likely to have a migraine after some minor trigger, although no single theory explains how the human body produces all the symptoms of a typical migraine headache. Emotional or physical stress, the onset of an illness, and/or certain foods or liquids may trigger a migraine headache. One rare migraine presentation (familial hemiplegic migraine) has been shown to have specific gene mutations that predispose to the patient's symptoms.

Although migraine headaches have long been considered a benign (relatively harmless) condition, their symptoms may wreak havoc on a person's quality of life and ability to take part in normal life activities. Migraine pain is so intense that migraineurs often cannot think or function very well during or immediately following episodes.

The symptoms of migraines interrupt normal activities in approximately 65% to 80% of children who suffer from them. In one study of 970,000 self-reported migraineurs aged 6 to 18 years, 329,000 school days were lost per month. The sense of vulnerability of the sudden and unanticipated onset of migraine symptoms may cause emotional changes such as anxiety or sadness. Appropriate diagnosis and treatment of migraines can greatly improve quality of life for a person who suffers from migraine headaches.

Frequency

Studies suggest that migraine headaches occur in 5% to 10% of school-aged children in the United States This frequency gradually increases through adolescence and peaks at about 44 years of age. Many people experience spontaneous remission, meaning that the headaches go away on their own for no clear reason.

Gender

The age of onset of migraine headaches is earlier in boys than in girls. From infancy to 7 years of age, boys are affected equally or slightly more than girls. The prevalence of migraines increases during the adolescent and young adult years, during which 20% to 30% of young women and 10% to 20% of young men experience migraines. After menarche (the time when the first menstrual period occurs), a female predominance occurs. This continues to increase until middle age. The frequency of migraines declines in both sexes by 50 years of age.

Age

Most migraineurs begin to experience attacks before 20 years of age. Approximately 20% have their first attack before their fifth birthday. Preschool children experiencing a migraine attack usually look ill and have abdominal pain, vomiting, and a strong need to sleep. They may show pain by irritability, crying, rocking, or seeking a dark room in which to sleep.

Migraineurs aged 5 to 10 years of age experience:

  • headache,
  • nausea,
  • abdominal cramping,
  • vomiting,
  • photophobia (sensitivity to light),
  • phonophobia (sensitivity to sound),
  • osmophobia (sensitivity to smells), and
  • a need to sleep.

They usually fall asleep within an hour of the time the attack begins. The most common accompanying signs and symptoms include:

  • paleness with dark circles under the eyes,
  • tearing,
  • swollen nasal passages,
  • thirst,
  • excessive sweating,
  • increased urination,
  • and diarrhea.

Older children tend to present with headache on one side of their skull. The headache location and intensity often change during or between attacks.

Research has shown that many "sinus headaches" are really of migrainous origin. As children grow older, headache intensity and duration increases, and migraines begin to happen at more regular intervals. Older children also describe a pulsating or throbbing characteristic to their headaches. Headaches often shift to the one-sided temple location that most adult migraineurs report. Childhood migraines often stop for a few years after puberty.

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