Migraine often goes undiagnosed in kids and teens.

In childhood migraine, head pain may be less severe than other symptoms, like unexplained nausea or vomiting, abdominal pain, or dizziness. These non-headache symptoms are referred to as migraine equivalents. Like adults, children may experience migraine with or without aura, a visual disturbance which can occur about an hour prior to the headache. But migraine without aura is more common.

Before a migraine begins, parents may observe changes in their child’s behavior, including loss of appetite, irritability, yawning, food cravings, lethargy, withdrawal, and mood swings. Sensitivity to light, touch, smell, and/or sound is also common. Other indicators may include sleep walking, sleep talking and night terrors. Infant colic and motion sickness may be warning signs of a predisposition to childhood migraine or an early form of it.

The most common migraine triggers in children are inadequate or changed sleep, skipped meals, stress, weather changes, bright lights, loud noises, strong odors, and hormonal fluctuations. Contrary to popular belief, there is little evidence linking specific foods to migraine.

Diagnosing Migraine in Kids and Teens

Diagnosis is made through a patient history, physical exam, and by ruling out other explanations for the symptoms. Sometimes diagnostic tests, such as blood tests, EEG, lumbar puncture, and neuroimaging are also used to assist in the diagnosis. Migraine tends to run in families, so family history of migraine is a risk factor.

A history, preferably conducted with both the child and the parent, should include:

• description of the pain (including location, nature, and timing)
• severity
• frequency and duration of episodes
• identifiable triggers
• symptoms at the onset, such as aura, lethargy, or nausea
• impact on quality of life (disability)
• previous treatments
• thorough family history

It’s important to explore whether there’s a pattern to the attacks. For example, attacks may occur after a car ride or when the weather changes. Girls may have attacks associated with their menstrual cycle. Parents and kids should keep a joint headache diary to assist the doctor in diagnosis and treatment.

Learn more about treating migraine in kids and teens.