How do you distinguish the symptoms of migraines in children from those in adults?

Approximately 5% of children suffer from migraines up to the age of 10. Migraine attacks in children are often not recognized in a timely manner. They differ from adult migraine attacks in many ways. The very concept that migraine is a girl's disease leads to missing or delayed diagnosis in boys. This is particularly important because until puberty, migraines are more likely to occur in boys than in girls. While hypersensitivity to noise and light are very typical migraine symptoms in adults, such accompanying symptoms may be absent or less pronounced in children. In addition, it is very difficult for them to form concepts for such hypersensitivities and to communicate this. Migraine attacks in children are more often accompanied by increased sensitivity to smell, dizziness and abdominal pain. Around 70% of children experience so-called autonomic symptoms during a migraine attack. Such symptoms are more commonly described in cluster headaches in adulthood. In childhood they can also be observed with migraines. These symptoms include facial sweating or flushing. The eye may be red or watery. The nose may run or be blocked. The eyelids may be swollen and one eyelid may also show weakness. The headache phase in children is often shorter than in adults and can last less than 4 hours. Lateral localization is also less pronounced in children than in adults. While in adults the headache can often occur on one side, in children the pain is usually localized on both sides. Finally, there are so-called migraine variants in childhood. These are symptoms that occur periodically in childhood. These include episodic motion sickness, periodic sleep disorders such as sleepwalking, talking in your sleep, waking up in your sleep and grinding your teeth. Periodic vomiting or periodic abdominal pain are also striking. Sudden dizziness or a sudden onset of torticollis can also be episodic symptoms in childhood that can be associated with a migraine.

How do you recognize migraines in children?

The headaches during a migraine attack occur in 4 phases. In the phase before the headache attack, both children and adults show mood changes such as irritability. Children also show a higher degree of paleness or develop dark circles around their eyes. The children also report stomach pain, diarrhea or digestive difficulties more often. Muscular stiffness, fatigue and yawning may also occur. In the so-called aura phase, visual disturbances and other neurological symptoms can often occur. Children find it difficult to describe these changes. This makes it very difficult for them to communicate, for example, zigzag lines in the visual field, tingling sensations, dizziness or speech disorders. During the headache phase, children also find it very difficult to describe the characteristics of the pain. They also lack the vocabulary to communicate, for example, a pulsating pain. They also have difficulty putting into words the severity of the pain. For this reason, it is important to record pain in children by observing behavior and also by noticing changes in the effect. For example, children have difficulty communicating the onset of pain. However, they stop playing or eating, they may cry, become irritable, or even have tantrums. These changes do not constitute a diagnosis of migraine. However, they are indications of the onset and progression of a migraine. After the headache has subsided, the so-called post-migraine phase follows. In adulthood, fatigue, weakness, mood changes, neck pain, difficulty concentrating or dizziness are common. During this phase, children often complain of thirst, sleepiness, vision problems, hunger, tingling, numbness and eye pain.

Should children with migraines and headaches receive medical attention?

If headaches occur again in your life and there is still no clarity about the cause and type of headache, a medical diagnosis and a medical treatment plan should be drawn up. Therefore, children should be examined thoroughly by a doctor. The most common headaches are migraines and tension-type headaches. These two forms alone are responsible for over 92% of all headaches. However, today there are more than 367 main types of headaches. For this reason, it is important that rare headache disorders are detected early, even in individual cases. The earlier the diagnosis is clear, the greater the likelihood of effective treatment.

Are there general preventative measures for children?

Children and parents should receive advice about lifestyle factors that can worsen migraines and how to deal with migraine triggers. Anything too fast, anything too irregular, anything too sudden and anything too frequent should be avoided in everyday life. The principle is synchronicity and regularity in everyday life. A regular day-night rhythm should be maintained. Eating meals at regular times is also important. In particular, you should ensure that you eat a sufficient, carbohydrate-rich breakfast at rest. Drinking enough water throughout the day is also important. In particular, children should have time for relaxation and rest during the day. Media consumption should be limited and sufficient time should be planned for spending time in the fresh air and exercising.

Are there effective preventive relaxation procedures for children?

As a preventative measure, children can perform progressive muscle relaxation according to Jacobson. The procedure can be practiced, for example, with the help of the migraine app (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 treatments.

What general measures can help children in the event of a seizure?

Local cooling with a cool pack on the forehead and temples, as well as the opportunity to withdraw and sleep, are sufficient for some children to treat an acute migraine attack. This represents the basic therapy. Isolation from stimuli and avoidance of bright light and noise should also be possible.

If necessary, which medications can be given to children for migraine symptoms and when is the best time to do this?

Ibuprofen 10 mg/kg body weight is primarily recommended for the treatment of migraine attacks in children. From the age of 12, acetylsalicylic acid can also be used in a dosage of 500 mg. If there is nausea or vomiting, domperidone can be used from the age of 12. Sumatriptan 10 mg and Zolmitriptan 5 mg as a nasal spray are approved for the treatment of migraines in adolescents aged 12 and over. There is also now extensive data available to support 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, and rizatriptan 5 or 10 mg in tablet form if the response to acute therapy with painkillers is insufficient and Almotriptan 12.5 mg in tablet form can also be justified before the age of 12 with appropriate information. If acute migraine attacks in children and adolescents cannot be treated sufficiently effectively, treatment with subcutaneously injected sumatriptan can also be considered after appropriate information according to the current guidelines. Both children and their parents should be comprehensively informed about the treatment options for migraine attacks. You should also be made aware of the need to take the acute medication early in the event of an attack. This can improve the effect and tolerability.