Rising to the Challenges of Pediatric Headache Disorders

By Ashley Hattle , author, Cluster Headaches: A Guide to Surviving One of the Most Painful Conditions Known to Man

Adults are not the only people who live with migraine. Children, too, are subject to the disease. Yet children with headache disorders are often overlooked, underdiagnosed, and poorly treated.

“Children with migraine miss an average of seven days or more of school than their non-migraine peers,” says Frederick Godley, MD, a practicing ear, nose, and throat (ENT) specialist and founder of the Association of Migraine Disorders. In his practice as an ENT, he sees patients who were previously misdiagnosed with sinus headache, when in fact they have migraine.

Diagnosis, impossible

Migraine can be diagnosed in infants and toddlers. Since they can’t voice their pain, out of frustration and severe pain, children often resort to banging their head during an attack as a coping mechanism. Colic is one of the most common migraine-related conditions among babies 1-3 months old, says Godley.

Boys and girls are equally affected by migraine disease until puberty hits. The occurrence of migraine attacks typically increase in females during and after puberty. However, the incidence of attacks in male children tend to decrease as they grow older.

Aversion to noise, light, smells, and exercise are universal warning signs of an impending attack. Unique variations of how a child experiences migraine can make diagnosis and early intervention challenging.  

“Some of the most difficult ones to diagnose are those that have no head pain but have abdominal pain,” says Dan Henry, MD, board certified in family practice and founder of the Danielle Byron Henry Migraine Foundation. “I see a new child or teen at least once a week who has had abdominal pain for years… but if [we] take a very careful history, this teen often has a very strong suggestion of abdominal migraine.”

Abdominal migraine may or may not include head pain with the most bothersome symptoms consisting of: nausea, vomiting, loss of appetite, and pale skin. Abdominal migraine can be difficult to diagnose because some symptoms also appear in those with irritable bowel diseases.

“Most clinicians are not trained to recognize migraine disorders in children,” Godley says. “On average, children have a delay in diagnosis of more than five years.”

Treating headache in children & teens

Treating migraine or other headache diseases in a child or adolescent requires an accurate diagnosis to determine the appropriate course of treatment. While some kids find relief by resting until the attack passes, others may need medication to help manage an attack.

Medication or therapies often prescribed to children with migraine can help stabilize the frequency and intensity of attacks. Until recently, the most widely used preventive medications had been prescribed “off-label.” This means a drug that was developed and approved by the FDA for one disease state also contains ingredients that have been proven to help manage symptoms of different diseases, including migraine.

Sadly, limited options exist for younger populations as many of the new, innovative treatments on the market have not yet received FDA approval for use in pediatric care. The treatments that are available range from nonsteroidal anti-inflammatories, such as ibuprofen, to abortive or rescue medicine, such as triptans and ergotamine. These come in tablet, nasal, and injectable options. Other options include anticonvulsants, antihistamines, and nerve pain medications. Three newer, noninvasive neuromodulation medical devices are FDA-approved for use in children aged 12-17.

Emotional effects of pediatric migraine

Childhood and adolescence comes with an intense need for social interaction and building solid relationships. Pediatric headache disorders severely limit the ability to develop a social network due to the unpredictable nature of an attack. Feelings of guilt, thoughts of missing out, blaming themselves for causing a migraine attack, and being dismissed by the medical community or loved ones takes a mental toll on children with migraine.

“Cognitive therapy and mindfulness programs play a key role in treatment of pediatric migraine,” says Henry. “This is a multifactorial treatment plan—also, lifestyle modifications, ensuring good sleep, eating a clean [healthy] diet on a regular schedule, staying well-hydrated, [and] having a regular exercise routine.”

The good news is that there are new medications and treatments being studied for pediatric use. Hope is on the horizon. Innovative, effective, and safe medications and devices could help children lead full lives and focus on simply being a kid. 

“Children with migraine disease just want to be normal kids,” says Henry. “One of my patients recently told me, ‘No one wants to be friends with the sick kid.’ It breaks my heart.” 

Nonprofit organizations have created a variety of programs designed to help children and teens with headache disorders including:   

  • Migraine at School: A program created by CHAMP (Coalition for Headache and Migraine Patients) provides resources for students, parents, and educators about migraine disease and other headaches affecting kids.
  • Migraine University: The National Headache Foundation created this outlet for young adults in college facing headache disorders to offer resources, advice, and help for those struggling with new-onset or increased headaches due to the stress, fatigue, and lifestyle changes many college students experience.
  • Miles for Migraine Youth Events: From weekly virtual “Teen Talks” to meetings for parents and other caregivers of children with headache disorders, Miles for Migraine youth events provide support and information about new treatment options to manage life with pediatric migraine disease.
  • Pediatric Pain Warriors: The U.S. Pain Foundation developed this program to assist children and their families in finding a network of support and resources. The program offers in-depth retreats and events for families to learn more about pediatric pain and how to navigate health, school, and social life.