Migraine headaches in children can begin as young as three years of age. The prevalence of migraine ranges from 1% to 3% in children younger than age seven and up to 11% from age seven to puberty. Prior to puberty, migraine is more commonly seen in boys. This finding is reversed following puberty, when migraine predominates in girls.
The criteria for diagnosing migraine in children are very similar to those used in adults. However, the more atypical types of headache are more often seen in children. The headache need not last as long in a child as in an adult to warrant a diagnosis of migraine.
Children may present with dizziness and vertigo with vomiting as a variant of migraine. These children may appear pale and unsteady. Intermittent abdominal pain that is without any other cause may also be a migraine variant. Abdominal migraines in children may be related to cyclical vomiting. All of these variants may occur in children of migraineurs, and these children may or may not go on to develop migraine with or without aura as teenagers or adults.
Other children may have primary eye manifestations of their migraine, with blurred vision and paralysis of the nerves and muscles controlling eye movements. In fact, children tend to manifest some of the more alarming variations of migraine, such as hemiparesis (weakness on one side of the body) and acute confusional state. It is important to rule out other more dangerous etiologies of these types of symptoms; if no other etiology is discovered, however, migraine may be diagnosis of exclusion.
Before prescribing migraine medications for children, it is important to understand the triggers and frequency of the headaches. This requires the effort to understand the home and school situation and any potential stressors as well as to obtain a careful family history.
Migraine medications for children is similar to that for adults, with perhaps a greater emphasis on the first-line use of nonsteroidal anti-inflammatory drugs (NSAIDs). Triptans are often used in lower doses in the pediatric population. When these drugs have been studied in children, the appeared to have safety and efficacy profiles. Many pediatricians and pediatric neurologists are comfortable using them because NSAIDs are quite effective in providing migraine relief for children. Because many children experience abdominal symptoms with their migraines, antinausea medications – which help both the headache and nausea – are often prescribed.
Preventive medicines are given to children as well. These medications are generally the same as those given to adults. Commonly used medications include valproic acid (an anticonvulsant), amitriptyline (an antidepressant), and propranolol (a blood pressure medication which works as an antihypertensive). All of these medications are effective in preventing migraine in children. As with all medications given to children, dosages are adjusted to their size and age.