I have had a problem with migraines for some years now, but I have dealt with it for the most part. Now my 5-year-old son is experiencing severe migraines two to three times a week. They just seem to come on without warning. What's the best form of treatment for migraines in a child so young?
Michael, although your son most likely does have migraine headaches, my first recommendation is that you take him to be evaluated by his pediatrician and/or a pediatric neurologist. Any child with new, frequent, severe headaches should be seen by a doctor.
Headache symptoms not consistent with typical migraines or tension headaches include pain that wakes a person up in the middle of the night, headaches that are worse in the morning upon waking, and neurological problems such as difficulty walking. If your son has any of these symptoms, he should be seen by a doctor immediately.
Although it may surprise people to learn, migraines can occur in young children. Migraines run in families, and most people with migraines have a parent with a history of migraines. Doctors can sometimes diagnose a patient with migraines just based on the description of the headache.
Other times, doctors might order tests such as imaging of the head or recommend a patient keep a "headache journal." A headache journal can help identify the triggers of headaches and assist doctors with managing a patient's headache.
The headache journal should include specifically:
- Date and timing of symptoms. Include relation to activities, stress, etc.
- Description of symptoms. Does your son sense the headache coming on? (This is called an aura.) Where is the headache pain? (On one or both sides? In the front or back of the head?) Is the pain throbbing, sharp, etc.? Also, take note of any associated symptoms, such as nausea, vomiting, visual, or neurological changes.
- What makes the headaches better? For example, does sleep help?
- What makes the headaches worse? Do bright light or noise intensify the headache?
As for managing migraine headaches in children, about half of migraines improve within six months after evaluation by a pediatric neurologist regardless of treatment. Multiple studies have shown this improvement in headaches, though the cause of this improvement is unknown. Although migraines often improve with time, most people with migraines will have these headaches for life.
As someone who suffers from migraines, you may know that we categorize migraine medications in two groups. The first group of medications is considered "rescue medication." These are medications you take when you have a migraine or when you sense a migraine is about to occur. Ibuprofen (Advil, Motrin) and triptans, such as sumatriptans, are the most commonly used medications in this category.
The other group of medications is called preventive medication. Patients with frequent migraines take this type of medication every day to prevent a migraine from occurring. Propranolol is a type of preventive medication that is sometimes used in children.
Many pediatric neurologists will begin management with having their patients keep a headache journal to identify triggers of migraines so patients can avoid triggers. The diary can also help you and your son recognize what improves his headaches, like possibly resting or sleeping in a dark room. If you can help your son identify his headache symptoms when they are just starting, you can give him a rescue medication like ibuprofen and have him immediately rest to help improve his symptoms more rapidly. However, the best management of your son's symptoms will likely occur with the input of a pediatric neurologist.
Learn more in the Everyday Health Kids' Health Center.