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Migraine in Children
by Michael B. Robbins, M.D., F.A.A.P., Division of Pediatric Neurology
In the course of our practice, we are often presented with children who suffer from headaches, some of which are migraine. While the layperson generally equates migraine headaches with adults, they are surprisingly common in childhood.
Frequency in Children
Some 2.5% of preschoolers and 5% of elementary school age children have migraines. In the preschool and elementary school age group, males and females have migraines of equal frequency. In the teenage years, migraines are more common in females. Approximately 5% of teenage males and 10% of teenage females have migraines.
The Cause of Migraines
Migraine headache is also called a vascular headache. This is because the pain of migraine is believed to be due to the dilatation of blood vessels over the surface of the brain. In recent years, it has become clear that the primary event in migraine involves changes in nerve cell activity, mediated by neurochemicals in the brain.
Migraines also run in families. The key to making a diagnosis is the history. Sometimes the child gets classical symptoms, including visual disturbances, sensitivity to light, a pounding headache, nausea, vomiting and then a desire to sleep. Sometimes, other symptoms occur that are not as classical, including weakness and numbness, difficulty walking, difficulty talking or confusion. Occasionally the headaches come on for no reason at all. At other times, they can be triggered by activities, diet, a change in sleeping pattern, stress, and other factors. The neurological examination is important to exclude other causes of the migraine symptoms.
Managing Migraine in Children
Management of children's migraine headaches involves making a diagnosis through history and exam and any necessary diagnostic studies. There are medications which are effective when a child already has a headache, and medications which can be taken every day to prevent headaches if they are frequent or severe. Each year, new and more effective medications with fewer side effects are developed and introduced.
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