How do you differentiate the symptoms of migraine in children from those in adults?

Approximately 5% of children suffer from migraines by the age of 10. Migraine attacks in children are often not recognized in a timely manner. They differ in many aspects from migraine attacks in adults. The very notion that migraine is a "girls' disease" leads to a lack of diagnosis or a delayed diagnosis in boys. This is particularly significant because migraines are more likely to occur in boys than in girls until puberty. While sensitivity to noise and light are very typical migraine symptoms in adults, such accompanying symptoms may be absent or less pronounced in children. Furthermore, children often struggle to articulate and communicate these sensitivities. Migraine attacks in children are more frequently accompanied by a greater sensitivity to smells, dizziness, and abdominal pain. Around 70% of children experience so-called autonomic symptoms during a migraine attack. Such symptoms are more commonly described in adults with cluster headaches. In childhood, they can also be observed in migraines. These symptoms include facial sweating or flushing. The eye may be red or watery. The nose may be runny or blocked. The eyelids may be swollen, and one eyelid may be weak. The headache phase in children is often shorter than in adults and can last less than four hours. The localization of headaches is also less pronounced in children than in adults. While headaches in adults are often one-sided, in children the pain is usually localized on both sides. Finally, there are so-called migraine variants in childhood. These are recurring symptoms. They include episodic motion sickness, periodic sleep disturbances such as sleepwalking, sleep talking, waking up startled, and teeth grinding. Periodic vomiting or abdominal pain are also characteristic. Sudden dizziness or torticollis can also be episodic symptoms in childhood that may be associated with migraine.

How can you recognize migraines in children?

Headaches during a migraine attack progress through four phases. In the pre-headache phase, both children and adults exhibit mood changes such as irritability. Children are also more likely to be pale or develop dark circles under their eyes. They also frequently report abdominal pain, diarrhea, or digestive problems. Muscle stiffness, fatigue, and yawning can also occur. In the so-called aura phase, visual disturbances and other neurological symptoms are common. Children often find it difficult to describe these changes. Therefore, they may struggle to communicate symptoms such as zigzag lines in their field of vision, tingling sensations, dizziness, or speech difficulties. During the headache phase, children also have great difficulty describing the characteristics of the pain. They lack the vocabulary to, for example, describe a throbbing pain. They also struggle to put the severity of the pain into words. For this reason, it is important to assess the pain in children by observing their behavior and noticing changes in its effects. Children, for example, often find it difficult to communicate the onset of pain. However, they may stop playing or eating, cry, become irritable, or even have tantrums. These changes alone cannot confirm a migraine diagnosis. However, they are indicators of the onset and progression of a migraine. After the headache subsides, the so-called post-migraine phase begins. In adults, this phase is often characterized by fatigue, weakness, mood swings, neck pain, difficulty concentrating, or dizziness. Children during this phase more frequently complain of thirst, drowsiness, visual disturbances, hunger, tingling, numbness, and eye pain.

Should children with migraines and headaches be examined by a doctor?

If headaches occur for the first time and their cause and type are unclear, a medical diagnosis and treatment plan should be developed. Therefore, children should undergo a thorough medical examination. The most common headaches are migraines and tension-type headaches. These two types alone account for over 92% of all headache disorders. However, more than 367 main types of headaches are now recognized. For this reason, it is important that even rare headache disorders are identified early. The earlier a diagnosis is established, the greater the likelihood of effective treatment.

Are there any general preventative measures for children?

Children and parents alike should receive counseling on lifestyle factors that can exacerbate migraines, as well as how to manage migraine triggers. Anything too fast, too irregular, too sudden, and too frequent should be avoided in daily life. Consistency and regularity are key. A regular day-night rhythm should be maintained. Eating meals at fixed times is also important. Particular attention should be paid to a sufficiently carbohydrate-rich breakfast eaten in a relaxed atmosphere. Adequate hydration throughout the day is also crucial. Children, in particular, should have time for relaxation and quiet during the day. Media consumption should be limited, and sufficient time should be allocated for fresh air and physical activity.

Are there effective preventative relaxation techniques for children?

To prevent migraines, children can practice progressive muscle relaxation according to Jacobson. This technique can be practiced, for example, using the migraine app (available free in the app stores for iOS and Android). Biofeedback is also an effective form of therapy that can be learned as part of behavioral therapy.

What general measures can help children during a seizure?

Local cooling with a cold pack on the forehead and temples, along with the opportunity for rest and sleep, is sufficient to treat an acute migraine attack in some children. This constitutes the basic therapy. Shrinking the child from stimuli, avoiding bright light and noise, should also be provided.

What medications can be given to children for migraine symptoms if needed, and when is the best time to do so?

For the treatment of migraine attacks in children, ibuprofen 10 mg/kg body weight is the primary recommended medication. From the age of 12, acetylsalicylic acid (aspirin) at a dose of 500 mg can also be used. If nausea or vomiting is present, domperidone can be used from the age of 12. For the treatment of migraine in adolescents from the age of 12, sumatriptan 10 mg and zolmitriptan 5 mg are approved as nasal sprays. Extensive data are now also available to justify the use of triptans in the form of sumatriptan 10 mg or 20 mg as a nasal spray, zolmitriptan 2.5 or 5 mg in tablet form, rizatriptan 5 or 10 mg in tablet form, and almotriptan 12.5 mg in tablet form, even before the age of 12, if the acute treatment with analgesics is insufficiently effective, provided the child is properly informed. If acute migraine attacks in children and adolescents cannot be treated effectively with conventional methods, subcutaneously injected sumatriptan can be considered after appropriate counseling in accordance with current guidelines. Both children and their parents should be thoroughly informed about the treatment options for migraine attacks. They should also be advised of the importance of taking the acute medication early during an attack. This can improve both efficacy and tolerability.