Migraine in children and adolescents - causes, symptoms and treatment

10-15% of the population suffers from migraines. Unfortunately, it also affects children of all ages. Although it does not pose a serious threat to health and life, it causes a lot of suffering and prevents normal functioning. Migraine in children and adolescents.

Migraine in children and adolescents - what could be the causes?

Migraine is a chronic neurological disease with severe headache. Pain is usually located in the temporo-frontal area and is accompanied by other symptoms such as photophobia, nausea and vomiting. 10-15% of the general population suffers from migraine. It may appear already in infancy. Among children and adolescents, its prevalence is estimated at 2.7-10.6% on average, and depending on age:

• 2-3.2% in children up to 7 years old,
• 4-11% in children between 7 and 11 years of age,
• up to 23% of teenagers.
• Every fourth adult suffering from migraines declares that their first attacks appeared in childhood.

For headaches in children

Often times, a child's migraine headaches become a lifelong problem, only changing the severity and frequency of the attacks. A long-term study of 30 years was conducted that monitored the condition of children suffering from migraines. It turned out that in adulthood as many as 71% of them were still suffering from this ailment. It is more common for boys than girls to "grow out" of migraines.

Migraine is a spontaneous headache. This means that it is not a symptom of any particular disease, and the causes of its occurrence are complex and not fully understood. It is probably caused by a predisposition to neurovascular hyper responsiveness. However, there are a number of factors that can increase your risk of a seizure:

• Stress,
• Sleep disturbances (too long or too short sleep, change of the daily rhythm),
• Dehydration,
• Long breaks between meals (glucose levels drop),
• Certain food ingredients (e.g. tyramine, caffeine, monosodium glutamate),
• Atmospheric conditions (e.g. pressure change),
• Overheating,
• too intense physical effort,
• drug abuse,
• hormonal changes (e.g. in girls during adolescence, the increased frequency of seizures occurs in the middle of the menstrual cycle and is associated with a decrease in estrogens),
• Intense smells, loud noises and strong light.

Probably the predisposition to the development of this disease has a genetic basis. The vast majority of children suffering from migraines also suffer from this problem by their parents (usually the mother) or grandparents. Interestingly, children who suffered from colic or febrile seizures as infants are at an increased risk of migraine headaches. Moreover, in the course of migraine, the coexistence of allergies, especially asthma and allergic eczema, is statistically more common.

Migraine headaches in a child - symptoms

Common symptoms of a migraine in a child include:

• severe headache, which may occur unilaterally or bilaterally
• the pain is throbbing, distressing or rushing,
• it is located in the temporo-frontal area (in children it rarely includes the occiput),
• seizures last an average of several hours (from 4 to 72 hours),
• migraines are usually accompanied by nausea and vomiting,
• hypersensitivity to light, sound and smells,
• a migraine attack may precede the so-called aura, which manifests itself in disorders in the form of paresthesia, scotoma in front of the eyes, defects in the field of vision, etc. (in the youngest, the aura is extremely rare, more often in children over 10 years of age),
• the child is distracted and has difficulty concentrating,
• dizziness may appear,
• pain worsens with physical activity.

After the migraine attack has stopped, your child may not feel well for up to 12 hours. These so-called persistent symptoms affect 71% of children. In this age population they are of moderate intensity and present with general weakness, psychomotor retardation, pallor, nausea and excessive sleepiness.

Migraine in children - how often can it happen?

Migraine is a chronic, paroxysmal disease. More than half of sick children have pain episodes at least 1-2 times a month, usually several times a month. Pain attacks in children are more frequent than in adults, but are also shorter.

Sometimes migraine attacks are repeated and severe, which is of great concern to parents. You should always consult your doctor for any headaches you have in your child. A detailed medical history is usually sufficient to correctly diagnose a migraine. Knowing that the condition is not life-threatening will lower the parents' stress levels and help them deal with the condition more easily.

Diet and migraine in children

Certain dietary components have been shown to trigger migraine attacks. Which ingredient causes adverse symptoms is very individual. What can trigger a migraine?

• Tyramine - is a compound that is formed from the breakdown of proteins as a result of their fermentation or long storage. The most tyramine can be found in long-ripening cheeses, blue cheeses, processed fish (smoked, marinated), cold cuts, pates, long-stored liver, soy sauce, meat stocks, overripe avocado and bananas, chocolate, yeast-based supplements, and wines.
• Fatty meals - Studies have shown that migraine sufferers consumed statistically more fat in their food.
• Low food temperature - e.g. ice cream, water with ice cubes. According to studies, migraine sufferers who consumed very cool foods experienced more frequent headaches compared to controls.
• Other foods, such as citrus fruits, nuts, pumpkin seeds, are healthy foods, but some people may be particularly sensitive to them. Before eliminating them, it should be confirmed that they are responsible for the headaches. In order to efficiently catch a possible causative factor, it is worth keeping a diary in which you record your daily menu and highlight episodes of headache.

A proper diet is therefore of great importance in the prevention of migraine attacks. Above all, you should:

• Ensure that all food is fresh (prolonged storage will increase the tyramine content of some foods).
• Provide adequate fluid intake (1.5-2 liters per day), increasing this amount in hot weather and during physical activity. The main drink should be pure water, but you can also give your child fruit teas, compotes, diluted fruit and vegetable juices, milk and soups. Coffee, strong tea and sweetened cola drinks are not recommended because they do not hydrate the body, increasing the risk of migraines due to the presence of caffeine.
• Avoid highly processed foods that contain many chemical additives
• Remember to eat 4-5 meals a day regularly, including breakfast. Remind your child to eat second breakfast or even a healthy snack at school.
• Include in your diet complex carbohydrates with a high content of fiber, which slowly and gradually release glucose without causing fluctuations in its concentration in the blood. Their source is whole meal bread, dark pasta, various groats, brown rice and vegetables,

especially legumes.

• Limit your consumption of sweets.
• Increase the proportion of vegetables and fruits in your diet - Several studies have shown a positive effect of a vegan diet on the severity and frequency of migraine episodes. Probably because it is based primarily on vegetables and fruits, which contain beneficial antioxidants and anti-inflammatory compounds.
• Reduce the amount of meat and offal - they have pro-inflammatory properties, therefore their reduction has a beneficial effect on reducing inflammation. In addition, cold cuts and sausages contain a lot of tyramine.
• If the child is overweight or obese, a gradual body weight normalization is recommended under the supervision of a doctor or dietitian. Excessive adipose tissue is pro-inflammatory and increases the risk of developing chronic migraine.
• Ensure an adequate supply of magnesium, vitamin B2 and vitamin D supplementation.

Migraine in children - how to treat it?

Any case of acute or chronic headache in a child should be consulted with a pediatric neurologist, especially when accompanied by other neurological symptoms. His physical examination and possibly ordered imaging tests (tomography, magnetic resonance imaging) will make it possible to exclude more serious neurological diseases, such as, for example, tumors, aneurysms, and hemangiomas. Migraine headaches in children require appropriate treatment, especially when they occur frequently. Effective treatment is believed to reduce the risk of another seizure. In addition, episodes of severe pain that prevent normal functioning negatively affect emotional development. A child suffering from migraines may become impulsive, aggressive and experience impaired concentration. This has a negative impact on family life, interactions with peers and school performance. The main goals of treatment are:

• minimizing pain during a seizure,
• reducing the frequency of seizures and their duration,
• prevention of subsequent episodes of pain,
• lowering the stress level in a child,
• reduction of accompanying symptoms (nausea, vomiting, anxiety).

Pharmacotherapy should be prescribed by a physician to avoid the risks of over-the-counter pain medication overuse. Their side effects (including drug-induced headaches) may become apparent, especially when they are taken more than twice a week.

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The pharmacological treatment of migraine can be divided into:

Temporary pain relief - it is best to administer the preparations at an early stage of pain, not waiting for its greater intensity. This will maximize the therapeutic effect of drugs.

Prevention of migraine attacks - this treatment is used when the attacks occur more than twice a month or last for a very long time (eg for several days). Prophylactic pharmacotherapy is also justified when emergency treatment is contraindicated or ineffective. Although we have a wide range of medications to help prevent migraine attacks in adults, the positive effects of flunarizine in treating children have so far been confirmed. It should only be used as a last resort as it is not devoid of side effects. The most common of these are excessive sleepiness and weight gain. Other medications that may be considered for the prevention of migraine in children are propranolol and topiramate.

In the acute phase of a migraine attack, the following are used to relieve pain:

Acetaminophen - is commonly used in children to treat various types of pain and reduce fever. It is relatively safe, but overdosing can lead to severe liver damage. The maximum daily dose for children is 60 mg / kg body weight.

ibuprofen - belongs to non-steroidal anti-inflammatory drugs. In addition to the analgesic and antipyretic effect, it also has an anti-inflammatory effect and inhibits platelet aggregation. It has been shown to be more potent than acetaminophen in relieving migraine pain, but the maximum effect comes a little later. It can be used in children over 3 months of age. The maximum daily dose is 30-40 mg / kg body weight. Ibuprofen should be administered in divided doses of 10 mg / kg body weight, 6 hours apart. The combination of ibuprofen with triptans enhances their therapeutic effect.

Sumatriptan - belongs to the triptan group. It works by selectively stimulating specific serotonin receptors and reducing the activity of the trigeminal nerve. Relief in migraine is probably caused by the constriction of pathologically widened blood vessels and inhibition of the release of pro-inflammatory neurotransmitters. In addition to their analgesic effect, triptans also alleviate the symptoms associated with migraine (nausea, vomiting, photophobia). They should be taken as soon as pain occurs, but not during the aura itself - then they may prove ineffective. In Poland, sumatriptan is registered for the treatment of adults, but according to current scientific reports, it can be successfully used on an ad hoc basis also in children from 12 years of age. It is recommended to choose the nasal form of the preparation in a dose of 5-20 mg.

Mild to moderate pain episodes can be successfully treated with ibuprofen or other prescription NSAIDs (naproxen). Severe migraines often require the administration of triptans, which are highly effective in each phase of the attack. It may happen that preparations acting on one patient do not work for another person with similar symptoms, therefore drugs should be selected individually. In extreme cases, when the above drugs do not bring relief or the migraine is prolonged, turning into the so-called migraine, it may be necessary to hospitalize the child.

In the elimination of symptoms accompanying migraine, the following are also helpful:

• Antiemetic drugs (metoclopramide, prochlorperazine, domperidone),
• Sedatives to help you sleep (diazepam, hydroxyzine),
• Anti-edema drugs (mannitol, dexamethasone).

Acetylsalicylic acid (aspirin) must not be used to treat pain in children under 12 years of age, as this may lead to the development of Rey's syndrome - a life-threatening disease. The use of egrotiamine is also not recommended in children.

Home remedies for migraine in children and adolescents

To help your child survive a migraine at home and reduce the risk of subsequent attacks, you can use:

• Cool compresses on the forehead,
• Placing the child in a lying position on the bed in a quiet, darkened room,
• Administration of over-the-counter painkillers (paracetamol, ibuprofen),
• Avoiding seizure triggers, if they have been identified,
• Prophylaxis, which consists of an appropriate diet, care for the correct amount of sleep and daily active rest in the fresh air,
• Limiting the amount of time spent in front of the TV, computer and smartphone, especially before going to bed,
• Maintaining a healthy body weight,
• Acupuncture and acupressure,
• The use of relaxation techniques, mental support and avoiding stressful situations.

Migraine headaches in children are by no means uncommon. Proper treatment is essential to firstly ease suffering and secondly to reduce the risk of another seizure. In the treatment of childhood migraine, paracetamol, ibuprofen and intranasal sumatriptan are of the greatest importance. Prevention should also not be forgotten, which plays an important role in reducing the frequency of pain episodes.