We may think of migraines as an adult problem, but about 10 percent of school-age children experience migraines as well, the throbbing pain of these serious headaches causing impairment to a host of activities including learning in school. The incidences of migraines especially rise in girls as they enter the teen years, with nearly 25 percent of all girls having experienced a migraine by the time they turn 17.

So what causes a migraine? Medical experts don’t know for sure, but they are believed to be linked to electrophysiological and neurotransmitter changes in the brain. They can be triggered by factors such as fatigue, bright lights, and weather. Migraines can also be inherited, and if one parent has a history of migraines, the child has a 50 percent chance of developing them.

Vijaya L. Atluru, MD, chief of the Division of Pediatric Neurology at NYU Winthrop Hospital, counts headaches among the top 10 neurological conditions that she treats. Seizure disorders, neurodevelopmental delays, attention deficit hyperactivity disorder (ADHD), and concussions are among others. Fortunately, she says that headaches in children are rarely linked to more serious underlying conditions. Still, they can be debilitating, so in addition to Dr. Atluru examining an impacted child, taking a good medical history, and possibly ordering an MRI, she recommends that the child or parent keep a headache log.

“We provide patients with a log, not just to record the date and time of headaches and medications taken in response, but we also want the family to record possible triggers,” says Dr. Atluru. “There can be emotional stress triggers such as issues at school or among family or friends. There may be physical stress triggers such as a lack of sleep, bright lights, loud noise, exercise, or menstruation. There are also food and drink triggers, for example, a child skipping a meal or eating too much chocolate or foods with MSG. Most people are also unaware that the amino acids in foods such as cheeses and citrus fruits can trigger migraines. 

By regularly recording the circumstances surrounding the onset of a migraine, we can often segregate out the triggers specific to an individual child. This in turn, can help mitigate the onset of migraines in addition to leading to healthier habits that can continue on into adulthood, since there is a risk of migraines becoming a chronic condition.”

Dr. Atluru describes three categories of treatment:  observation to identify and avoid triggers; rescue medications that include the anti-inflammatory Aleve®, which should be taken when there is a hint of a migraine coming on, along with medications in the triptan family that help relieve the pain; and preventive medications that need to be taken daily.

There are also common sense actions that can help. “A child needs to take care of the body, like you would a car engine,” says Dr. Atluru. That means maintaining a regimen of good sleep hygiene with eight or more hours per night; reducing screen time since that often takes away from sleep and the physical activities that make a child tired; staying well hydrated by drinking six to eight glasses of water per day; and making sure to not skip a meal.

For more serious cases of childhood migraines, Dr. Atluru notes that additional measures may be taken that include biofeedback, cognitive behavior therapy, hypnosis, and acupressure.