Migraine headache in children

Last reviewed: 26 Apr 2022
Last updated: 07 Jul 2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • age >2 years
  • gradual onset of headache
  • normal physical examination
More key diagnostic factors

Other diagnostic factors

  • aura
  • nausea and/or vomiting
  • visual disturbance
  • phonophobia
  • occipital headache, ataxia, diplopia, blurred vision, vertigo, and tinnitus
  • unilateral motor or sensory signs and headache
  • ptosis
  • generalised seizure
Other diagnostic factors

Risk factors

  • positive family history of migraine
  • chocolate, cheese, and citrus fruits
  • stress
  • hormonal changes
  • alcohol and caffeine
  • volume depletion
  • overuse of analgesics
  • sleep disturbance
  • bright or flickering lights
  • periodic syndromes
More risk factors

Diagnostic investigations

1st investigations to order

  • no initial test
More 1st investigations to order

Investigations to consider

  • brain CT/MRI
More investigations to consider

Treatment algorithm

ACUTE

acute episode

ONGOING

frequency and severity of attack has an impact on quality of life and school attendance

Contributors

Authors

Nick Barnes, MBBS, BSc, MRCP, MRCPCH

Consultant Paediatrician

Northampton General Hospital

Northampton

UK

Disclosures

NB declares that he has no competing interests.

Peer reviewers

Kenneth Mack, MD, PhD

Medical Director

Mayo Clinic Pediatric Center

Rochester

MN

Disclosures

KM declares that he has no competing interests.

Tony McShane, MBBS

Consultant Paediatric Neurologist

John Radcliffe Hospital

Oxford

UK

Disclosures

TM declares that he has no competing interests.

Sandeep Jayawant, MBBS

Consultant Paediatric Neurologist

John Radcliffe Hospital

Oxford

UK

Disclosures

SJ declares that he has no competing interests.

Howard S. Jacobs, MD

Associate Professor

Co-Director Pediatric Headache Clinic

University of Maryland School of Medicine

Baltimore

MD

Disclosures

HSJ declares that he has no competing interests.

  • Differentials

    • Cluster headache
    • Tension headache
    • Post-traumatic headache
    More Differentials
  • Guidelines

    • Headaches in over 12s: diagnosis and management
    • Practice guideline update: pharmacologic treatment for pediatric migraine prevention
    More Guidelines
  • Patient leaflets

    Migraine in children

    Migraine in children: medicines to prevent attacks

    More Patient leaflets
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