Headache and migraine in children

Migraine

Migraine in children differs from migraine in adults: an attack can be short (sometimes 1–2 hours), the pain is often in the forehead and on both sides, and it comes with nausea, vomiting, and sensitivity to light and sound. The child stops playing and wants to lie down in a dark room; after a short sleep the pain goes away. Some children see flashes or blind spots before an attack (aura). A family history of migraine makes it more likely.

Tension-type headache

A squeezing, “band-like” pain, usually during the day, after school or after long screen time. There is no vomiting, and the child can keep doing what they were doing. Lack of sleep, stress, and sitting in one position for a long time make the pain worse.

Other causes

Sinusitis, vision problems, dental and jaw problems, infections with fever, and taking painkillers too often (more than 2–3 times a week, known as “medication-overuse headache”). In rare cases, raised pressure inside the skull, bleeding or a tumor; the warning signs below are there for these.

In these cases the evaluation is done urgently, and imaging (MRI) is ordered when indicated. With typical migraine or tension-type headache and a normal neurological exam, a routine MRI and EEG are not indicated.

We start with a conversation: where the pain is, what it feels like, how long it lasts, how often it comes, at what time of day, what triggers it (lack of sleep, skipped meals, screens, stress, certain foods), what relieves it, and whether anyone in the family has migraine. A headache diary kept for 4 weeks makes the diagnosis much easier. The exam includes blood pressure, head circumference (in younger children), the back of the eye, and a neurological status check. Often no further tests are needed; when indicated, an MRI, blood tests or an eye doctor's opinion are added.

Non-drug measures: the foundation for every child

A regular sleep schedule (the same bedtime and wake-up time every day), never skipping breakfast, enough water, daily physical activity, and limited screen time with regular breaks. These measures alone often reduce how often migraine attacks occur.

During an attack

As soon as the pain starts, without waiting, ibuprofen or acetaminophen (paracetamol) at a dose suited to age and weight; a quiet, dark room; a short sleep. For teenagers with migraine, the doctor may prescribe specific medicines (triptans). Taking a painkiller more than 2–3 times a week can make the headache chronic, so this is always explained to parents.

Prevention

If attacks occur on 4 or more days a month, cause missed school, or the attack medicines do not help, preventive treatment is discussed. According to international guidelines, the choice of medicine is individual, its effect is assessed after several weeks, and the plan is built together with the family. Behavioral methods (relaxation, biofeedback) are also effective.