What are migraines?
A migraine typically has 3 of the following:
- Pain on one side of head
- Throbbing
- Belly pain, nausea or vomiting
- Relief with rest
- Sometimes has a warning aura (see below)
- Family history in close relative
- Act sick with the headache
- Headache the goes away with vomiting
Tension headaches usually consist of muscle soreness in the back of the head, whereas migraine headaches typically start in the front of the head on one side. Migraines also classically go away with rest.
The most common types of migraines are common and classical. Common migraines usually don’t have an aura, but have nausea and vomiting. Classical migraines often have an aura, but usually don’t have nausea or vomiting. There are other less common migraine variants that may have cyclic vomiting, confusion, visual changes, sensory or muscle strength changes.
Are migraines inherited?
Approximately 80% of children with migraines have a family history of them. Many parents who think they have regular headaches actually have migraines. Parents, please see above definition of migraines for yourself. Migraine headaches are more common in kids who experience motion or travel sickness.
What is an aura?
Auras are a warning sign that you are about to get a migraine. Sometimes they are the only sign of the migraine. Auras usually last 5 to 20 minutes and precede the migraine by up to 60 minutes. Auras are usually visual and may be seeing: flashing lights, zigzag lights, black dots, colored lights, scotoma (black or missing spot of vision), and rarely distortions in size of objects. Occasionally, auras are just different feelings or emotions. If you, or your child, has auras preceding headaches, then this is a great advantage to you. If you recognize that an aura is occurring, you can probably prevent the migraine by taking medicine and / or resting.
How common are migraines?
While migraines only occur in 5 to 7% of children below 10 years of age. Of children whom have migraines, 40% of children have chronic headaches by 7 years of age and 75% by 15 years of age.
What symptoms should I tell the doctor about?
Assuming you have had a visit to discuss the headaches and no problems were found at that time, you should tell your doctor if anything changes or new symptoms arise, such as;
- Different kinds of headaches
- Visual changes (seeing things)
- Sensations: unusual tingling, numbness, weakness associated with a migraine
- Worsened by: raising up quickly, bending over, bright lights, noise, valsalva maneuver (pushing on stomach like trying to have a bowel movement)
- Headaches that awakens the child in the night or he / she wakes up with them in the morning
- Headaches relieved by vomiting
- Headaches in the late afternoon (could be due to low blood sugar)
- Headaches increasing in number or severity (especially 2 or more per week)
What things can trigger migraines?
Certain foods, stress, menstrual cycle, lack of sleep, excitement, low blood sugar (rarely) and exertion can all bring on a migraine headache. Experience shows that 80-90% of childhood migraines are related to certain foods or how the child handles stress. Keeping a diary of the headaches can reveal patterns and help you manage, or possibly eliminate, the migraine headaches.
What should I record in a migraine diary?
There are two basic types of diaries, complete and focused. The first is to help reveal possible causes and patterns, and should include as much information as possible. Once you learn what causes you’re child’s headaches, then you can reduce the amount of information you record just to monitor or further reduce the headaches. You can stop the diary once you have the migraines controlled.
▪ When the migraine occurred
▪ How long it lasted
▪ Describe the migraine if unusual symptoms occur
▪ Severity of migraine
▪ What the child eats at every meal
▪ Any unusual stress the child may experience
▪ What medicines you are taking (occasionally taking too much pain medicine can actually cause migraines)
▪ Hours of sleep per day
When you keep the diary, please also do it in 2 ways. First, make a graph with the date on the bottom and the time across the side. Record one color dot for meals and another color dot for migraines. With this type of graph / diary, you will easily be able to see migraines associated with timing of the day, timing of the week, and timing related to a meal. The second type of diary is just a running list of meals and migraines. You especially want to note what foods were eaten the meal before a migraine, and stress level about the time of the start of the migraine. With this type of diary you will be able to notice what specific foods or combinations of factors is likely to precede a migraine.
What foods can trigger migraines?
Any food can be linked to migraines, but certain foods affect more people than others. This list is by no means complete:
▪ Caffeine (Sodas, coffee, tea)
▪ Chocolate (contains caffeine)
▪ Red food coloring
▪ Nuts, peanut butter
▪ Nitrates (preservative in processed meats, such as; bacon, hot dogs, spiced meats, smoked meats)
▪ Monosodium Glutamate (Chinese food, soy sauce)
▪ Aspartame (Nutrasweet)
▪ Beef concentrates
▪ Cheese
▪ Some fruits: Oranges, bananas, plums, pineapples
Important notes about foods: It may not be just the food, but the amount of it, that may induce a migraine, such as; 4 bites of chocolate gives a migraine, but not 3. It may also be a combination of factors, such as; stress with 2 hot dogs will cause one, while no stress and 4 hot dogs won’t.
What should we do when a migraine starts?
- The first thing is to recognize that rest will usually relieve the migraine. Therefore, continuing your activity hoping the headache will improve is not a good idea, as the migraine will probably worsen. This is where an aura can really help out. If you recognize the early onset of an aura or the actual migraine, then seek a dark quiet room where you can rest.
- Second, take any medicines we have discussed. Typically, we start with acetaminophen (Tylenol) and / or ibuprofen (Motrin). Some people respond better to one or the other first.
- Third, if you have taken the first medicine and rested, and the headache is not improved after 30-60 minutes, then take the other medicine (if you took acetaminophen, then take ibuprofen or vise-versa).
- Finally, if you’re still not better after 30-60 minutes after the second medicine, then call the doctor or go to the emergency room.
How are migraines medically treated?
Thankfully, by keeping a diary and looking into stress management, 80-90% of our patients have either complete resolution of their headaches, or they are reduced to the point where chronic medicines are not necessary. If we can’t get the migraines down to less than 2 per week, then there are preventative medicines we can give. We now also use triptan type medicines to abort migraines in children that are known to have severe migraines.
Will my child grow out of it?
Obviously, that depends on the specific causes and type of migraine your child has. Most migraines will reduce in severity and frequency during the late adolescence and early adult years. Rarely, some women have worse migraines just before or during their cycles. In these cases, birth control often helps prevent them.
