Migraine headaches (migraines) are a type of severe headache, which is often felt on one side of the head. Some children get migraines every now and then, while others get them more than once a week.

Migraines tend to run in the family and about half of children who get migraines will continue to have them when they are adults. In teenagers and adults, migraines are more frequent in females, but in children they happen equally between boys and girls.

While they can be painful and disruptive at the time, migraines are not usually a serious problem, and they are not life-threatening. Treatment involves controlling your child's symptoms and preventing further migraines.

Signs and symptoms of migraines

Toddlers and young children may experience headache with nausea/vomiting and they may go pale quite suddenly.

Older children and teenagers experience more adult-like migraines. The symptoms commonly include a headache, which lasts six to 12 hours, and may be:

• severe
• dull or throbbing
• all over the head, or worse on the sides of the head
• on only one side of the head.

Your child may also:

• lose their appetite, have nausea (feel sick) or vomit
• feel tired
• have stomach pain.

Some children experience an aura (visual or sensory changes that happen just before the headache starts). These can be quite distressing for children, as they may see spots or zig-zag lines; be sensitive to light, sound or smell; develop tingling of the lips; or lose part of their vision. An aura typically lasts for a few minutes before disappearing when the headache begins.

Some children may experience certain rare features of migraine, such as dizziness or fainting (basilar migraine), tingling around the face and arms (hemiplegic migraine), or they may be suddenly confused and disorientated (acute confusional migraine). However, these symptoms may be signs of a more serious condition, such as stroke. If your child has a headache and suddenly develops any of these symptoms, call an ambulance immediately.

Regardless of your child's age, migraines usually get better or go away altogether with sleep.

What causes migraines?

It's not exactly clear what causes migraines, but they are likely to happen when blood vessels of the head and neck spasm or constrict (become narrow). Minutes to hours later, the blood vessels dilate (get larger). When they dilate, they fill with blood, which causes more pressure in the skull and a headache develops.

Many things can trigger (start) migraine headaches, including:

• being tired
• bright lights, including phone, tablet or TV screens
• loud noises
• relaxation after physical or mental stress (e.g. after exercise or extended periods of study)
• muscle tension over a long time
• smoking, or breathing in second-hand tobacco smoke
• missing meals
• drinking alcohol
• caffeine (found in coffee, many energy drinks and some medicines)
• menstruation
• using oral contraceptives (the Pill)
• heat.

For a few children, migraines can be triggered by certain foods, such as:

• food with the amino acid tyramine (e.g. aged cheese, smoked fish, chicken livers, figs, some beans)
• chocolate
• nuts or peanut butter
• fruits (especially avocado, banana, citrus fruit)
• onions
• dairy products (milk, yoghurt, cheese)
• baked goods
• meats with nitrates (e.g. bacon, hot dogs, salami, cured meats)
• foods containing monosodium glutamate (MSG)
• any processed, fermented, pickled, or marinated food.

When to see a doctor

If your child experiences frequent or severe headaches, see your GP.

There are no specific tests to diagnose migraine, but doctors can usually make the diagnosis after considering the description of your child's headaches, and examining your child. In a very small number of children, tests may be done to rule out other causes of headache, but most children do not need any tests.

You should also take your child to see the GP if:

• you are worried about their headaches or they are getting worse
• your child's headache lasts for more than two days
• the headaches begin to disrupt your child’s school, home or social life
• they are having a headache more than once a week
• your child is under three years of age and experiencing headaches
• the headaches are waking your child up from sleep or they are worse in the morning.

Take your child to the nearest doctor or hospital emergency department if your child's headache is associated with:

• neck stiffness, vomiting or high fevers
• increasing confusion, behaviour change or loss of balance
• a head injury.

There is no cure for children who experience regular migraines. However, children who get very frequent migraine headaches may be prescribed preventative medication (prophylaxis) to reduce the frequency of the headaches. Your child's doctor will discuss what treatment is appropriate with you.

Care at home

There are a number of ways to help your child while they are having a migraine:

• Be understanding about their distress.
• Give pain medication right at the start of the headache – before it builds up to becoming severe. Your doctor may have prescribed specific medications to take in the event of a migraine, or you can use pain relievers such as paracetamol or ibuprofen. See our fact sheet Pain relief for children.
• Offer fluids or a small amount of food if they can tolerate it.
• Encourage the child to sleep or rest in a cool, dark, quiet room – sleep is the best reliever of migraine headaches. 
  

The following may help to control your child's symptoms and prevent further migraines.

• Anything that has triggered a migraine in the past should be avoided if possible.
• Regular meals and sleep patterns are very important.
• Alternative therapies, including relaxation techniques, can help some children.

When your child first starts getting migraines, a headache diary can help to work out the triggers. The headache diary should include:

• when the headache started and what seemed to trigger it
• how long it lasted
• which part of the head hurt
• how bad it was on a scale of 1 (mild) to 10 (severe)
• if anything helped to soothe the headache
• the time of going to bed the night before
• if there were any other symptoms 
• if school was missed because of the headache.

Key points to remember

• Migraine headache is very painful, but it is not usually a serious problem.
• There is no cure for migraine – treatment is about controlling symptoms and preventing further headaches.
• Anything that has triggered a migraine in the past should be avoided if possible.
• Good pain management at the onset of headache can prevent the build-up of headache and help in relatively quicker relief.
• Children with frequent migraines may be prescribed a preventative medication.

For more information

• Kids Health Info fact sheet: Headaches
• Kids Health Info fact sheet: Pain relief for children
• Kids Health Info fact sheet: Head injury – general advice
• See your GP. 

Developed by The Royal Children's Hospital Neurology department. We acknowledge the input of RCH consumers and carers.

Reviewed May 2018.

This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.