Migraines are still too often associated with adults, but about 10 % for children and up to 20 % Among Adolescents in Quebec suffer from migraines, which can sometimes be debilitating [1]. When diagnosed early, the Migraines in Children is easy to treat, and the’school absenteeism The problems it causes can largely be avoided. This article helps parents recognize the signs, identify the triggers, and know when to seek help—without overreacting or downplaying the issue.
On this page
- Characteristics of Migraines in Children
- Signs to Look For in Adolescents
- What are some common triggers?
- How is the diagnosis made?
- Non-pharmacological approaches
- Medications — A Discussion with Your Doctor
- Migraines and School: How to Support Your Child
- When should you seek immediate medical attention?
- Myths and Misconceptions
- Frequently asked questions
- Sources
Characteristics of Migraines in Children
Visit pediatric migraine does not always resemble that of an adult. Several factors distinguish it and can delay diagnosis.
Typical symptoms in children
- Shorter episodes than in adults—sometimes less than 2 hours
- Pain that is often bilateral (frontal or frontotemporal), not just on one side
- Severe digestive symptoms : nausea, vomiting, abdominal pain
- Paleness, drowsiness, and sometimes dizziness
- In Search of Calm and Dim Light — The child wants to lie down
- Quick Recovery after a nap, in most cases
Specific pediatric variants
- Abdominal Migraine — recurrent abdominal pain, without obvious headache, especially in school-age children
- Cyclic Vomiting — stereotyped episodes of vomiting with no digestive cause
- Benign Paroxysmal Vertigo in children—brief episodes of dizziness, common before age 5
- Benign Paroxysmal Torticollis infant
These shapes often develop into a classic migraine during adolescence or adulthood. Recognizing these signs can help avoid unnecessary tests.
Signs to Look For in Adolescents
During adolescence, the Migraine is gradually progressing to the adult form. Girls are gradually affected more than boys, due to hormonal changes associated with the menstrual cycle.
Typical Presentation
- Recurrent headaches — several times a month
- Possible visual aura — bright spots, zigzag lines, blurred vision
- Photophobia and phonophobia — sensitivity to light and noise
- Nausea, loss of appetite during the crisis
- School Absenteeism or a decline in performance
- Seizures Often Linked to the Menstrual Cycle among young girls
- Severe fatigue after the crisis
Some Key Figures to Know
- Environment 10 % for children and up to 20 % in Adolescents have migraines [1]
- Before puberty, both boys and girls are affected in equal parts
- After puberty, the Girls are 2 to 3 times more likely to be affected [2]
- Migraine is one of the leading causes of school absenteeism column
- 30 to 50 % of children with migraines have at least one parent who suffers from migraines
What are some common triggers?
Identify the personal triggers The child's treatment is a key step in reducing the frequency of seizures. Several factors are commonly found in young people.
Main Triggers
- Irregular or insufficient sleep — the leading cause in pediatrics
- Skipping Meals or Hypoglycemia — especially in the morning before school
- Dehydration, especially in hot weather or after exercising
- Screens and intense visual stimuli (video games, rapid scrolling)
- School-related stress, anxiety, academic performance
- Hormonal changes during adolescence (menstrual cycle in girls)
- Certain foods in some children: chocolate, aged cheeses, MSG, food additives
- Travel, Time Zone Differences, changes in routine
- Noise, crowds, strong scents
The Headache Journal
Hold a log over 6 to 8 weeks is the most useful tool for identifying actual triggers. Note:
- Date and Time the beginning and end of the crisis
- Intensity (scale of 0 to 10) and location of the pain
- Associated symptoms : nausea, photophobia, aura
- Time of the last meal and sleep
- Business Activity Before the Crisis (screen time, sports, school, meals)
- Medications Taken and efficiency
- For young girls : phase of the menstrual cycle
How is the diagnosis made?
Visit Diagnosis of pediatric migraine is based primarily on the’clinical history and a physical examination. Imaging tests are indicated only if there are warning signs.
ICHD-3 Pediatric Criteria
According to the International Classification of Headache Disorders (ICHD-3) [3], migraine without aura in children requires at least 5 attacks that meet the following criteria:
- Duration : 2 to 72 hours (sometimes less in young children)
- At least 2 of the characteristics : unilateral or bilateral, pulsatile, moderate to severe in intensity, worsened by exertion
- At least 1 associated symptom : nausea/vomiting OR photophobia + phonophobia
- No other cause identifiable
Further tests
- No routine imaging if the examination is normal and the history is typical
- Brain MRI Recommended if warning signs are present (see the «When to Seek Immediate Medical Attention» section)
- No scanner Routine — Radiation exposure to be avoided in children
- Blood tests rarely necessary
Key Takeaways
- Visit Pediatric migraines are common and clinically well-defined
- Crises are often shorter and bilateral than in adults
- Visit digestive symptoms are evident in children
- Visit irregular sleep is the main modifiable trigger
- Visit non-pharmacological approaches are the first line
- A medical evaluation allows us to rule out other causes and propose an appropriate plan
Non-pharmacological approaches
In children and adolescents, the Non-pharmacological approaches are the first line of treatment preventive treatment. When properly implemented, these measures often reduce the frequency of attacks by half or more.
Healthy Living First
- Sleep Regularity — Set hours, even on weekends; duration appropriate for the child's age
- Regular meals — a protein-rich lunch, and a snack as needed between meals
- Constant Hydration — water bottle at school
- Reducing Screen Time, especially before bedtime (at least 1 hour without screen time)
- Regular, moderate physical activity — 30 to 60 minutes a day
- Visual Breaks while doing homework and playing video games (the 20-20-20 rule)
Psychobehavioral Approaches
- Cognitive Behavioral Therapy (CBT) — proven effectiveness in children and adolescents with migraines [4]
- Mindfulness
- Biofeedback and relaxation techniques
- Managing School Anxiety or social when it is at issue
- Family Support — Avoid being overprotective or downplaying the situation
Additional fees to be discussed
- Magnesium — Adjust the dose according to age
- Riboflavin (vitamin B2) — helpful for some teenagers
- Coenzyme Q10 in some patients
Any supplements should be discussed with a doctor, especially for young children.
Medications — A Discussion with Your Doctor
When seizures are frequent, severe, or disabling, a drug treatment is added to non-pharmacological treatments. Prescribing this medication for children requires specialized expertise.
Acute Treatment (During a Crisis)
- Acetaminophen at an appropriate dose (15 mg/kg), early in the seizure
- Ibuprofen (10 mg/kg) — often more effective than acetaminophen
- Triptans Approved for Use in Adolescents : sumatriptan nasal spray, rizatriptan, zolmitriptan (depending on age and weight) [5]
- Antiemetics (domperidone, metoclopramide) in cases of severe vomiting
- Resting in the Twilight and hydration
Preventive treatment
- For common or disabling forms (≥ 4 episodes per month or significant absenteeism)
- Split decision with the teenager and the family
- Options: amitriptyline, topiramate, propranolol, flunarizine — depending on the patient's profile
- Assessment of effectiveness after 2 to 3 months processing
- Visit anti-CGRP are currently reserved for specific situations involving adolescents
Pitfalls to Avoid
- Overuse of Medications — Taking pain relievers for more than 10 to 15 days a month can cause overuse headaches
- Insufficient dose — the main cause of apparent failure of acute treatment
- Started too late — A triptan or NSAID taken several hours later is less effective
- Combinations containing codeine — should be avoided in children and adolescents
Does your child or teenager suffer from recurring migraines? Omicron Clinic offers pediatric care, evaluation of migraines in children and adolescents, adjustment of treatment plans, and referrals to pediatric neurology as needed. Make an appointment at one of our service locations in Quebec or consult teleconsultation.
Migraines and School: How to Support Your Child
Visit pediatric migraine has a direct impact on a student's academic progress. A clear partnership Working with the school helps reduce absenteeism and prevent stigmatization.
Practical Tips for Parents
- Notify the school the diagnosis, ideally accompanied by a letter from the doctor
- Plan for a crisis protocol : access to a quiet room, the ability to take the medication, contact with parents
- Keep a supply of medication on hand at school, in accordance with current policy
- Make sure the child drinks enough and eats during recess
- Avoid downplaying pain, but also to make it a source of anxiety
- Discuss’school facilities in the event of frequent disruptions (breaks, postponed exams)
Adults' Attitudes Matter
Children can quickly tell whether or not we believe them. A calm and empathetic acknowledgment Understanding pain, combined with practical strategies for managing it, gives children a sense of control. Conversely, downplaying it («it’s just a headache») or showing excessive concern can worsen anxiety and attacks.
When should you seek immediate medical attention?
Warning Signs — Seek Medical Attention Promptly
- A headache that gradually gets worse over the course of days or weeks
- New neurological symptoms : weakness, speech difficulties, double vision, loss of balance
- Headache Following a Head Injury
- Fever, stiff neck, rash skin — suspected meningitis
- Waking Up at Night by pain, morning sickness repeated
- Personality Change or a marked decline in academic performance
- Headache triggered by coughing, physical exertion, or a change in position
- First migraine in a child under 5 years of age
Scheduled Consultation Recommended
- Recurrent headaches (several per month)
- School Absenteeism or impact on operations
- Over-the-counter treatments insufficient or too frequent
- Parental Concern legitimate, family history
- Aura or unusual symptoms
- Links to the Menstrual Cycle among teenage girls
Myths and Misconceptions
«Children don't really get migraines»
False. Pediatric migraine is a well-documented condition that affects up to 1 in 10 children and 1 in 5 adolescents in Quebec. It can begin as early as preschool age and warrants the same thorough diagnostic approach as in adults.
«It's just to get out of school.»
False in the vast majority of cases. A migraine is a real, often debilitating pain that forces a child to stop what they’re doing. Of course, school-related stress or anxiety can contribute to it, but these are triggers, not signs of feigning.
«You should always order a CT scan when a child has a headache.»
False. A typical clinical history and a normal physical examination do not warrant imaging. MRI is preferred over CT when imaging is required, due to the absence of radiation. The specific indications are determined by the evaluating physician.
«Triptans are not allowed for children»
False. Several triptans are approved for use in adolescents in Canada (sumatriptan nasal spray, rizatriptan, zolmitriptan), depending on age, weight, and clinical situation. They can be very effective when prescribed properly.
«My child is going to have to take medication for the rest of his or her life.»
False. Most children with migraines do not need daily preventive treatment. Lifestyle changes, trigger management, and effective acute treatment are often sufficient. When preventive treatment is initiated, it is usually temporary (6 to 12 months) and is regularly reevaluated.
Frequently asked questions
At what age can migraines begin in children?
Migraines can begin as early as preschool age, but they are most often diagnosed between the ages of 7 and 12, and then during adolescence. In young children, they often take atypical forms (abdominal migraine, cyclic vomiting). A very early or unusual first migraine warrants a medical evaluation.
What is a safe dose of ibuprofen for children with migraines?
The usual dose is 10 mg per kilogram, taken early in the seizure. Many parents give a dose that is too low or too late, which reduces the medication’s effectiveness. Talk to your doctor or pharmacist to adjust the dose based on your child’s current weight and medical condition.
My child gets migraines from screen time: Should we ban it?
Not necessarily. Reducing screen time, taking regular breaks (the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds), and turning off screens 1 hour before bedtime often improve the situation. A total ban is rarely necessary and can be counterproductive.
Should I see a pediatric neurologist?
Not always. Family physicians or pediatricians treat the majority of pediatric migraines. Consultations with a pediatric neurologist are reserved for atypical cases, refractory migraines, warning signs, or when specialized preventive treatment is being considered.
Will my child's migraines go away as he or she gets older?
About half of children with migraines find that their attacks resolve or diminish significantly by the time they reach adulthood. The other half continue to experience migraines, which may change in intensity or frequency. Proper management during childhood improves the long-term prognosis.
Can my child play sports during a seizure?
No, not during an active attack. Physical exertion usually makes the pain worse. However, regular physical activity between attacks is an excellent way to reduce their frequency. It is safe to gradually resume exercise once the attack has subsided.
Sources
- Canadian Paediatric Society (CPS). Migraines and Headaches in Children and Adolescents.
- Migraine Canada. Resources for Youth and Pediatric Migraines.
- International Headache Society. International Classification of Headache Disorders (ICHD-3) — Pediatric Chapter.
- American Headache Society. Guidelines for Pediatric Migraine.
- Canadian Headache Society. Pediatric Guidelines on Migraine.
- Quebec College of Physicians (CMQ). Clinical Management of Headaches in Children.
- Ministry of Health and Social Services (MSSS). Pediatric Health Care in Quebec.
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