What are migraines?

Migraines are the most common type of acute and recurring headache seen in children and adults. The attacks are separated by pain-free intervals. Migraine symptoms may be identified in children as young as one year old. As many as 3% of 7 year old patients suffer from migraine. By the age of 15 as many as 11% of children suffer from migraines.

What causes migraines?

The cause of migraines is not fully understood. It is felt that there is an interplay between a proposed migraine generator in the brainstem which then has effects on brain vascular, neurochemical, and pain systems. Individuals with a warning phase or aura also have temporary depression of brain function that can slowly spread over time.

How are migraines diagnosed?

Migraines are a clinical diagnosis. As such specific criteria have been established to make the diagnosis. The criteria for Pediatric migraine without aura is as follows:

Signs which may precede the attack by hours or days include: mood changes, irritability, euphoria, increased thirst, increased urination, fluid retention, food cravings, yawning, and sighing.

How are migraines treated?

There are three approaches to treatment. The first is to try and attempt to identify any trigger factors. Triggers include certain foods, sleep issues, hormonal changes, environmental factors (light glare, odors, altitude, weather change), physical exertion, stress and anxiety. Avoidance of an identified trigger is advised. The next approach is to do something at the time of the migraine to have it go away. In children a simple nap may be adequate. Non pharmacological treatments might include relaxation and biofeedback. Simple analgesics may be effective in children. In children who do not respond to these simple measures prescription medications may be required. The third approach is used in children who are experiencing frequent migraines, one or more times per week. This requires the administration of a daily medication or substance to block and prevent the migraines from occurring.

How do I know my child doesn't have a brain tumor?

The majority of headaches in children are benign. A careful history, physical and neurological exam performed by your physician or neurologist will detect findings in patients with a brain tumor 99% of the time. In a study of over 500 patients who had neuro-imaging studies for pediatric headache, all patients with significant lesions had abnormalities on examination. Historical features which might suggest a brain tumor include: 1) Chronic, progressively worsening pattern. 2) Headaches which awaken children from sleep or are present upon awakening. 3) Pernicious vomiting. 4) Declining school performance. 5) A change in personality. 6) Double vision. 7) Head tilt. 8) Difficulties with balance or walking

  CSSD Division of Neurology