Types of children’s migraines

Migraine with aura: This type of migraine, also known as classic migraine, is characterized by a visual aura followed by a unilateral (one-sided), throbbing headache, which may later spread to both sides. It lasts from half an hour to 48 hours.

Common migraine: Common migraines lack an aura. Migraine without aura in children is traditionally described as a recurring (happening over and over), bilateral (two-sided) headache disorder with a throbbing and/or pulsating pain quality, moderate-to-severe intensity, and severe stomach symptoms. Common accompanying symptoms in children are irritability and paleness with dark circles under the eyes. In younger children, the pain is more often on both sides and around the eyes and temples. Migraine without aura occurs in 60-85% of migrainous children.

Chronic migraine: Persons with chronic migraine have headache attacks at least 15 days of every month for at least 2 months. Chronic migraine may affect up to 4% of teenage girls and 2% of teenage boys.

Status migrainosus: This is a severe form of migraine headache in which the attack is continuous over 72 hours. People who have such an attack usually have a history of migraine. In those who vomit, rehydration (restoring adequate fluid levels) is often the necessary first step.

Complicated and variant migraines: These are classified as migraines because they often have the same triggers. They are brief, recurrent, episodic disorders that are made worse by physical activity and relieved by deep sleep or typical antimigraine medications. 

• Complicated and variant migraines cause some of the same symptoms as typical migraines, including pain, stomach problems, autonomic symptoms (for example, abnormal sweating, changes in pupil size), neurologic symptoms (for example, tingling, numbness, weakness), and changes in mood or emotion. These benign (relatively harmless) disorders are frightening because they often seem to be life-threatening emergency situations.
• Migraine equivalents are underrecognized and underreported expressions of childhood migraine. They are often forerunners of the typical migraine, and complicated and variant migraines occasionally alternate with typical migraines.

Migraine without aura (formerly called a common migraine):

The child must have experienced at least five attacks meeting the following criteria:

         a. headache lasts from four to 72 hours—duration decreased to two hours in children less than 15 years old

         b. two of the following characteristics

                                                   i.                  unilateral (meaning on one side of the head)

                                                 ii.                  pulsating

                                                iii.                  moderate to severe intensity

                                                iv.                  aggravated by physical activity (becomes worse with physical activity)

c. associated problems with the headache

                                                  v.                  nausea or vomiting

                                                vi.                  photophobia or phonophobia (abnormal sensitivity to light or sound)

Migraine with aura (formerly called a classic migraine):

An aura is a sensation of light or warmth that is caused by the nervous system and may precede a migraine. Visual changes are the most common aspect of an aura and may include flashing lights, double vision, partial vision loss, zig-zag lines, or size distortions. The aura also may cause tingling in an arm or leg or a peculiar smell; weakness in an arm or leg or an inability to speak; or even abdominal pain.

The child must have experienced at least two attacks meeting the following criteria: 

a.       one or more reversible auras

b.       gradual development of the aura over more than four minutes

c.       no aura lasts more than 60 minutes

d.       headache follows the aura within 60 minutes

 

Migraine Headache in Children Causes

The exact cause(s) of migraine headaches is unknown. Some migraines are thought to be due a temporary deficiency of the brain chemical serotonin. Many of the drugs effective in treating migraines target this chemical. Some migraineurs know that their headaches are triggered by something they eat or drink or do. Most know who they are and what it is. The most common triggers are alcohol, chocolate, cheese, nuts, shellfish, Chinese food, sugar, and caffeine. Migraines most likely have several trigger factors and multiple internal causes. Although many migraine disorders do not develop until middle age, early recognition of migraine risk factors may help a child adopt a healthy lifestyle.

Migraine Headache in Children Symptoms

A headache may be a symptom of a benign (relatively harmless) condition, or it may be a life-threatening symptom. A person’s medical history and physical examination results are often enough to identify or rule out serious underlying problems or conditions.

Since there is no specific diagnostic test for migraine headache, doctors make the diagnosis through medical history, physical examination findings, and clinical judgment. When considering a diagnosis of migraine headache, doctors will ask about a child’s medical history, previous tests, allergies, and current and previous medications. Children will be asked to describe how the headache feels (for example, throbbing, pounding, squeezing, pressing, pulsating, aching, burning, stabbing, dull). They will also be asked about the headache’s location, timing, severity, causal events (for example, concussion, falling down), duration, and whether any relatives have migraine headaches. Other common symptoms include sensitivity to light and sound, tenderness in the scalp, usually where the pain is most severe, and a strong desire to lie down.

 

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