Migraine often begins earlier than many people think
Migraine is often perceived as an adult condition. In reality, however, many children and adolescents regularly experience migraine attacks. Studies show that around 4 to 5 per cent of primary school-aged children and up to 10 per cent of adolescents are affected. Before puberty, boys and girls are affected roughly equally, after which girls clearly predominate – a hormonal influence is likely.
For parents, it is often difficult to tell whether recurring headaches are in fact migraine. This makes it all the more important to be aware of the typical features seen in childhood.
How migraine presents in children
Migraine in children often runs a different course than in adults. The attacks are usually shorter – frequently only one to two hours – and, according to current diagnostic criteria, must last at least two hours to be classified as a migraine attack. The location of the pain also differs: while adults typically describe one-sided headaches, children often experience pain on both sides, often across the forehead or temples.
Typical symptoms in childhood
- Throbbing or pulsating headache, usually bilateral
- Nausea, vomiting or abdominal pain
- Pallor, sensitivity to light and sound
- Strong need for rest, retreat to darkened rooms
- Tiredness and difficulty concentrating after the attack
In younger children, so-called "migraine precursors" sometimes occur: cyclical vomiting, abdominal migraine or benign paroxysmal vertigo. These complaints may indicate a later tendency to migraine, even if they are not initially recognised as a headache disorder.
Headaches in adolescents: a growing burden
Headaches in adolescents have increased markedly in recent years. Long screen times, lack of sleep, pressure at school, irregular meals and emotional strain are among the common triggers. During puberty, attacks increasingly resemble the adult picture: they last longer, more often occur on one side and may be accompanied by an aura with visual disturbances or tingling sensations.
Parents should take notice when headaches occur regularly, interfere with school attendance or leisure activities, or when painkillers are being taken more and more frequently. Overuse of pain medication can itself trigger headaches – a vicious circle that should be avoided.
Diagnosing migraine in children: careful and sensitive
Diagnosing migraine in a child is based primarily on a thorough discussion and a careful physical and neurological examination. Imaging procedures such as MRI or CT scans are only necessary in certain cases, for instance when warning signs are present or the course is atypical.
Helpful for making a diagnosis
- Headache diary: record duration, frequency, accompanying symptoms, possible triggers and medications taken
- Family history: migraine often runs in families
- Everyday factors: sleep, nutrition, fluid intake, screen time, stressful situations
Warning signs that require prompt medical assessment include sudden, very severe headache, headache after an injury, fever, neurological deficits, changes in behaviour or waking up at night due to pain.
Age-appropriate therapy: more than medication alone
Treatment of migraine in children and adolescents follows a multi-step approach. In addition to relieving acute pain, prevention plays a central role. Non-pharmacological measures are often prioritised.
Non-pharmacological strategies
- Regular sleep-wake rhythm: keep it as consistent as possible, including on weekends
- Balanced nutrition: regular meals, do not skip meals
- Adequate fluid intake: water rather than sugary drinks
- Outdoor exercise: moderate physical activity can reduce attacks
- Limiting screen time: especially before going to bed
- Relaxation techniques: progressive muscle relaxation, breathing exercises or age-appropriate biofeedback
- Stress management: conversations and, if needed, psychological support when there is pressure at school or in the family
These measures can make an important contribution to relief and help many of those affected to reduce the frequency of attacks.
Medication for acute attacks
In an acute attack, well-tolerated painkillers in age-appropriate doses are preferred for children, for instance active ingredients such as ibuprofen or paracetamol. It is important to take them early at the first signs – and at the same time to clearly limit the number of days per month on which they are used, in order to prevent medication-induced headache.
In adolescents in whom standard painkillers are not sufficient, triptans in a suitable formulation may be used under medical supervision. The choice, dose and duration of treatment should always be individually tailored and medically supervised.
Preventive treatment
Preventive medication is usually only considered when attacks are very frequent or significantly impair daily life. Before such long-term treatment is started, non-pharmacological approaches are generally exhausted first. In some cases, physiotherapy, supportive osteopathic treatment or cognitive-behavioural approaches may also be a sensible addition.
When should parents seek medical advice?
As a general rule, recurring headaches in children are not a normal phenomenon and should be investigated. A consultation is particularly urgent in the following situations:
- More than two to three headache episodes per month
- Significant impairment of school, sport or leisure activities
- Accompanying neurological symptoms
- Increasing frequency or intensity
- Rising consumption of painkillers
The earlier migraine is recognised and treated, the better it is possible to avoid chronification and psychological strain.
Conclusion: understanding and structure help
Migraine in children and adolescents is a condition that should be taken seriously, but it responds well to treatment. A structured daily routine, attentive observation and a tailored therapy can contribute significantly to improving the quality of life of young patients. Parents play an important role here – as observers, companions and supporters on the way to a day-to-day life with as few symptoms as possible.
This article does not replace medical advice.