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Migraine

child; migraine; head; headache; pain; ache; aura; nausea; vomiting; stomach; tummy; banging; sinus;

 Migraine is the name given to a type of headache that can be severe, often felt on one side of the head (behind the eye) and lasting a couple of hours or up to a few days. People with a migraine headache often feel sick, and many will vomit during the headache. When the headache stops they may feel unwell for a few hours, but then they are completely well again.

Migraine headaches can occur a couple of times a week, a couple a month or even quite rarely. Most people with migraine will have other family members who also get it.

Young children who get migraine may feel sick and vomit, but may not complain of a headache, and migraine tends to get less frequent and less severe as a person gets older.

More to read

As well as the content of this topic there is more to read on these sites:

Headache Australia (Brain Foundation)
http://www.headacheaustralia.org.au/

Better Health Channel (Victorian Goverment) 
http://www.betterhealth.vic.gov.au/ 

Raising Children Network

NSW Multicultural Health Communication Information in languages other than English
http://www.mhcs.health.nsw.gov.au/  

Contents of this topic

Any person who gets a severe headache for the first time, or a severe headache that is different to his or her usual headaches needs to be seen by a doctor urgently, because some major health problems such as meningitis or bleeding inside the head can cause a severe headache.

What is migraine?

  • The cause of migraine is unclear, but there is clearly a genetic factor. Most people who get migraines have other family members with migraine.
  • Migraine headaches are thought to have some connection to changes in blood flow to the brain and to the tissues covering the brain (the meninges). While these changes in blood flow do occur in people who have a classical type of migraine headache, it now seems clear that this is not the only cause for the pain and the changes that occur in the brain during a migraine.
  • Changes in the activity of brain cells which start in the lower part of the brain and move to the frontal part of the brain also appear to play a part. Chemicals called neurotransmitters (chemicals which transmit a message from one nerve cell to the next), such as tryptamine and dopamine are also involved.
  • The pain of a migraine is often so severe that the person is not able to continue to do normal activities such as working, reading or school activities.

Who gets migraine?

  • Migraine is common (some sources say it occurs in up to 20% of the population, others say about 5%).
  • People usually get their first migraine before they are 40 years old, often when they are under 20 years, and sometimes much younger.
  • Most people who have migraine will have a 'family history' of migraine (that is there will be other people in their family who have migraine, or repeated headaches).
  • Before puberty, about the same numbers of boys and girls get migraines, but, after puberty, girls and women are affected about three times as often as men.
  • For some women and girls, migraines tend to happen in the few days before they get their period (and many girls will have their first recognised migraine after they have started having periods). Migraines tend to happen less often during pregnancy -  but not always.
  • Migraine has been diagnosed in children as young as two years old. Some researchers believe that babies as young as 6 weeks old may have begun having migraines. In the very young head-banging may be a sign of migraine, but head banging is very common, and only rarely is it caused by a headache.
  • Children who get migraine may suffer attacks more often than adults. They may get weekly attacks and a very few children have up to four attacks a week.
  • It appears that migraine may be happening more often now than 20 years ago. It has been suggested that this is because of increasing exposure to things which can trigger migraine.
  • An Australian Bureau of Statistics survey in 1995 found that 14% of people surveyed took medication for a headache in a two week sample (not all, but many, of these would have been for migraine).

Types of migraine

There are several different patterns of migraine.

'Common migraine' affects about 80% of people who get migraines.

  • There is no 'aura' (see below) but there may be some (often vague) signs that the person will get a migraine, such as mood changes, irritability, increased sensitivity to light, sound or smells, difficulty concentrating. These can start several hours or up to a day before the migraine pain begins.
  • The headache usually starts on one side of the head, but sometimes spreads to both sides. Sometimes the pain is on both sides of the head from the beginning.
  • The pain is usually throbbing, and it is usually made worse when the person moves.
  • Feeling sick and vomiting is common, as is sensitivity to light and sound.
  • The person with this type of headache usually needs to lie down in a dark room.
  • The headache can last for a few hours up to 3 or more days, and may go if the person can get to sleep.

Migraine with aura (also known as Classical migraine).

  • Before the pain starts some people will get some signs that a migraine is coming (an 'aura'). It may be that they suddenly notice they cannot see clearly (often there is a blurring of something they are looking directly at), and they may have flashing spots (sometimes in a semicircle which slowly gets larger). Sometimes the aura may be a feeling of weakness or tingling on one side of the body, or difficulty talking.
  • The aura usually lasts less than 40 minutes, then it clears and the headache starts.
  • The pain and other effects (including feeling sick, vomiting) are the same as a common migraine, but may not last as long (usually less than 24 hours).

Menstrual migraine

  • This type of migraine happens between 2 days before the beginning of a period up to the end of a period.
  • It is thought that menstrual migraines are triggered by drops in the levels of oestrogen in the body that occur during a menstrual cycle.
  • It is usually a migraine without an aura.
  • It can be more difficult to manage than other types of migraine.

Migraine in children

  • Young children, as young as 6 months old sometimes, up until early adolescence, seem to have many of the symptoms of migraine (such as feeling sick and vomiting, needing to lie still in a dark quiet place, feeling better after a sleep) without having a headache.
  • In some cases this may be due to them not being able to say that their head hurts, but sometimes they genuinely seem not to have a headache.
  • They may instead complain of 'tummy ache'.
  • Often there is a family history of migraine.
  • No other cause can be found for these symptoms.
  • This is often called 'abdominal migraine'.
  • They are completely well between the 'attacks', and the attacks may occur once a week or less often.
  • Children's descriptions of visual auras, such as flashing lights and bright shapes, or complaints of dizziness, may be dismissed by adults unfamiliar with migraine auras, especially if they are the only symptoms mentioned.

Other types of migraine or severe recurring headache.

There are several other patterns of severe headache such as:

  • 'basilar migraine' (where there can be some temporary paralysis of some muscles)
  • 'cluster headaches' where the person (more often male) will have frequent severe one sided headaches which may last an hour or so, but recur several times a day or over the following days up to several weeks. These headaches may start at the same time of the day (often at a particular time at night).

Migraine attacks

A migraine attack can pass through up to four phases (different stages). Not all phases will be present in every attack, and less than 20% of people have phase 2 (auras).

The first phase, the prodromal (beginning) stage.

  • This phase is an 'early warning' stage, where some people may have some unclear but different feelings which they may recognise as meaning they will get a migraine headache within a few hours, up to a day later. Not all people get these feelings or become aware of their meaning. Sometimes other people will be more aware of the signs than the person who experiences the headaches.
  • These feelings may include mood changes such as irritability, moodiness, food craving or loss of appetite, tiredness, hypersensitivity to (being very sensitive to) light, sound, touch and smell.

Phase 2, the aura.

  • Only about 20% of people get a clear aura, usually a change in their vision, which is due to the changing blood flow in their brain.
  • The aura usually lasts for about 20 minutes to 40 minutes. Then vision (or other sense) may become quite normal before the headache starts, or aura goes as the headache starts.
  • Migraine auras (or 'focal cerebral disturbances') can affect all the senses, not just the eyes, but often the visual aura is the most obvious one.
  • Types of aura can include:
    • visual (seeing, eyes) - eg flashes of light, blind spot, semicircle of light and dark shapes or spots
    • tactile (touch, feeling) - eg pins and needles, numbness (often of part of the face)
    • olfactory (smell) - eg unpleasant or strong smells that are not 'real'
    • oral (taste) - eg strange tastes, or food tastes different to usual, often unpleasantly different
    • aural (hearing, sound) - eg ringing in the ears.
  • There are other forms of aura, including: poor concentration, unclear and slurred speech, mental confusion, forgetfulness, sleepiness, poor co-ordination and sense of balance, dizziness, hallucinations (seeing or hearing things that are not there), sweats, muscle jerks or spasms. These may not be recognised as an aura, but may be recalled by a person after the headache is over or when they learn that these things can be part of the aura.
  • The aura, especially the first one experienced, can be distressing or even terrifying to children and adults who may be very concerned that they could be having a stroke.
  • Sometimes people experience an aura without getting pain after it. When they have previously had the more usual pattern of aura followed by pain, this aura that is not followed by pain is still probably a 'migraine episode' but is would be a good idea to talk with your doctor about this change.

Phase 3, headache.

  • The headache often starts on one side (unilateral), and may be felt in or behind the eye or the temple. It may then spread to involve the whole head.
  • It often throbs, and is made worse by moving around.
  • Many people also feel sick and some vomit with the headache.
  • A small number of people also experience diarrhoea or the need to pass urine often.
  • During this phase the person is hypersensitive to (will be very sensitive to) light and/or sound and will want to lie down in a dark quiet room.
  • Children too young to say that light or sound is hurting them may squint or close their eyes, or cover their eyes or ears with their hands.
  • The pain may be there when the person wakes up. (Most other types of headache are not there first thing in the morning.)
  • The headache may last an hour or two, but can last all day or for up to 3 days (or sometimes longer).
  • Often the headache will stop after a sleep (for an hour or two, or over night).
  • Some people who have had 'classical migraine', get only the aura and some of the other symptoms (irritability, not thinking clearly) without significant headache as they get older.

Phase 4, the 'hangover'.

  • This phase may last for several hours or sometimes for a day or more. It can be thought of as a time of recovery.
  • The person often feels weak and tired and may have a mild headache.
  • The person may still feel unwell enough to need to stay away from school or work.

Migraine triggers

While the underlying cause of migraines is genetic, the cause of each attack may be an identifiable 'trigger'.

  • Hormone changes (eg before a period),
  • missing a meal,
  • missing sleep,
  • alcohol,
  • stress, although most headaches triggered by stress are not migraine headaches (have a look at the topic headache )
  • excitement,
  • exercise,
  • heat,
  • some smells, some foods, some food additives
  • some medicines,
  • bright lights, flashing lights
  • changes in the weather (eg thunderstorms).

Theese have all been identified as being able to trigger migraine in some people. Some people regularly get a migraine on the day after stressful times, such as the day after an exam (sometimes called a 'let down' migraine).

  • Although food triggers are often spoken about, they affect only a small number of people who get migraine. The most likely food causes are usually considered to be chocolate, hard cheeses, citrus juices (orange or lemon) and red wine. Others include food additives such as aspartame (Nutrasweet**), monosodium glutamate (MSG), nitrates and nitrites used to preserve meats.
  • Missed or inadequate meals probably trigger more attacks than all the food triggers combined.
  • If children or adults often wake up during the night with a migraine, or wake in the morning with one, the trigger may be low blood sugar levels (hypoglycaemia). In such cases a snack before bed may prevent attacks. The snack should contain mainly complex carbohydrates (eg a wholemeal sandwich) and not 'pure' sugars such as white or raw cane sugar, honey or fructose.

Sometimes vision difficulties such as being long sighted and having to try to focus on close work - such as reading - can trigger migraine.

In the prodromal (first phase) time, a person can be sensitive to bright lights, certain foods or smells and may link them to the migraine, even though they did not trigger the migraine.

Note: Anxiety and stress may be caused by problems at school or with friends but the headaches themselves can cause anxiety. You need to explain as much as you can to your children about migraines to help them not to be too worried about them. In particular it is important to explain that migraine is not a kind of punishment for bad behaviour or not doing as well as children think they should.

Diagnosing migraine

  • If a person has had several or many severe headaches with the pattern described above, and a family history of migraine or recurrent headaches, it is usually clear that this is migraine, although some people do not realise that their headaches are migraine (they may call them 'sinus headaches', or some other name).
  • If the headache is the first one that a person has had like this, and the headache is severe, it is much more difficult to be sure that it is migraine because there is no test to prove it is migraine. Diagnosing migraine is done by making sure that the headache is not caused by anything else.
  • Other things that can cause severe headaches include infections which cause a fever, infections of the brain (including mumps, meningitis), head injuries (including concussion), bleeding within the head (including some forms of stroke), tumours within the head.
  • 'Tension' type headaches, often due to muscle tightness (including tightness of muscles in the neck), do not have the same pattern as described above, although they can occur repeatedly. They usually affect both sides of the head, and the pain is often felt at the back of the head. People often notice they have these headaches when stressed or overtired.
  • 'Rebound' headaches, are the headaches caused by stopping taking something, eg by stopping some medicines (including headache treatments such as aspirin), stopping caffeine or alcohol, or other drugs. Many people who suddenly cut down the amount of coffee they drink will get headaches which improve quickly when they drink a cup of coffee. A careful history will usually indicate whether the headache is a rebound headache.

Sometimes, to be sure that the pain is 'only migraine' extensive tests will be done including computerised tomography (CT) scans or magnetic resonance imaging (MRI) scans, but most people will not need this because the pain will stop and the person will feel quite well again.

Anyone who has a severe headache which is different to their usual pattern of headache needs to be seen by a doctor.

Preventing migraine attacks

  • Avoiding migraine triggers, such as being very careful not to miss meals (especially not skipping lunch at school), may help reduce migraines. But many triggers cannot be avoided. It is virtually impossible, for example, to avoid the excitement of longed-for events such as children's birthday parties, holidays or Christmas.
  • Glare and bright light can be reduced by wearing polarised glasses, especially wraprounds, and wide-brimmed hats.
  • If it seems that there may be underlying problems such as vision problems get the eyes checked.
  • Fear of having a migraine, especially in front of one's peers and/or at a party or other much longed for event, can become so great as to trigger attacks. For some children learning relaxation techniques may help reduce the number and possibly the severity of attacks.
  • If attacks are frequent and severe, the daily taking of preventive medication may have to be considered. Discuss this with a doctor.
  • If the migraines are happening most of the time at the same stage of a menstrual cycle, use of hormones such as the ones in some types of the Pill may help avoid a headache. (Note: for some women, some types of the Pill can make the headaches more common).
  • Using self hypnosis has been found by some researchers to help decrease the number of severe headaches.

One of the important things to do, if migraines are happening often, is to keep a diary of headaches to see if there is a pattern to the headaches, which might help to find the triggers. For example, to see at what stage of a menstrual cycle they might be happening, or whether there are early signs of the headache which might allow the tablets to be taken before the pain starts.

Treating the attack

  • If the child or adult gets a warning (aura), the headache may be avoided or much reduced by taking medication immediately, before the pain starts. Simple pain relievers such as paracetamol, ibuprofen may work if taken early.
  • There are other medications that are also often effective if taken early in an attack. These usually need to be prescribed by a doctor. Many of the drugs used to treat older adolescents and adults are not approved for treating children.
  • Once the pain becomes severe, medicines taken orally (swallowed) often do not work because one of the effects of migraine is to stop the passage of food out of the stomach into the rest of the bowel (causing the 'sick' feeling and vomiting). When this happens medication given by mouth is not absorbed. If the attack is severe, medication may need to be given by injection.
  • If possible the child or adult needs to stop other activities, and lie down in a cool, darkened, quiet place.
  • Cold packs placed on the forehead, and hot packs on the back of the head and neck may help.
  • Self-hypnosis has also been shown to help when headaches are bad.

It is important to get advice from a doctor if your child gets migraine or similar symptoms.

Migraine and school

  • Teachers' attitudes to children with migraine and to taking medicine at school vary a lot from school to school.
  • Talk to the teachers about your child's migraine and what needs to be done, before choosing a school if possible.
  • If a child has migraines the teachers should be told. If medicines are needed when an attack occurs, the child needs to be able to take the medicines as soon as possible.
  • It is very important that the teachers realise that treatment needs to be given early in the attack, when the child may be reporting rather vague sounding symptoms eg a 'fuzzy eye', and that they should not hold off until the pain is bad.
  • School can be very stressful for some children and attacks can be triggered by things that happen at school. It is important that children, especially those who get migraines, do not feel "pushed" to achieve more than they comfortably can.

Further reading

Headache Australia (Brain Foundation)
http://www.headacheaustralia.org.au/

Better Health Channel (Victorian Goverment) 
http://www.betterhealth.vic.gov.au/ 

Raising Children Network

Information in languages other than English

NSW Multicultural Health Communication 
http://www.mhcs.health.nsw.gov.au/  

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

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