There are certain headache symptoms that a person must have for a headache to be diagnosed as a migraine. A doctor or health care provider decides what type(s) of headache a child is having.
Migraines have some or all of the following features:
To be diagnosed with migraines, a child needs to have at least five headaches that meet these criteria. Some children’s headaches that almost fit the criteria do not (yet). We often diagnose ‘probable’ migraine in these children.
Some children have migraine headache with an aura. An aura is a warning symptom that happens before the headache begins. An aura may last 5 to 60 minutes. A visual aura is one that the person sees. It can involve colored or flashing lights, wavy lines, blind spots or blurry vision. Other auras can be described as an odd feeling, or tingling in the face, arm or leg. A few people with migraine may have muscle weakness, a loss of coordination, stumbling or trouble speaking. Your healthcare provider needs to know if your child or anyone else in the family has migraines that cause muscle weakness.
Migraines can run in families. Most people who have them probably have other family members with migraine, but it may be hard to know the complete family history.
Less than half of all people with migraines have been diagnosed by a healthcare provider because:
Many specialists feel that certain forms of belly pain and vomiting that recur are a kind of migraine. For some children, the headache part of a migraine is missing. Sometimes these problems can be treated with the same medicines that are used to treat typical migraines.
Medical tests should be done to check for other gastrointestinal (GI) problems. If these tests are normal, abdominal migraine or cyclic vomiting may be diagnosed.
Medicines that prevent or treat headaches may help with these conditions. Many children with abdominal migraine or cyclic vomiting develop migraine headaches as they grow older.
Benign Paroxysmal Vertigo of childhood happens in children, often between 2 and 6 years of age. Symptoms start all of a sudden. They include difficulty with balance, feeling dizzy or feeling like the room is spinning (vertigo). This only lasts a few minutes. It resolves on its own in otherwise healthy children.
This migraine causes weakness of the arm or leg that you can see on one side of the body. Usually the weakness comes before the head pain begins, but it may also become noticeable during the headache. This is a true loss of muscle power that clearly reduces movements on only one side of the body. The weakness usually passes within 24 hours. There may also be drooping of the face or eye and garbled speech. The child should be brought to the emergency room the first time this happens to see if anything more serious is happening.
Tension headache is the most common headache type in children. Tension headaches are often mild headaches that stop with medicine and rest. This type of headache has also been called a muscle-contraction headache, stress-related headache and “ordinary headache.”
There are certain symptoms that are necessary for diagnosis of a tension-type headache. It is best for a doctor or practitioner to decide what type(s) of headache a child is having.
Tension-type headaches usually have these features:
Headaches are considered episodic if:
Headaches are considered chronic if:
If headaches meet these criteria, the patient is diagnosed with Chronic Daily Headache (CDH). This may be either Chronic Tension Type Headache or Chronic Migraine. Often there is a combination of headache types. Other types of chronic headaches include Medication Overuse Headache (MOH) and New Daily Persistent Headache (NDPH).
This is a chronic headache that becomes daily within 3 days. Patients often remember the exact date and time that the headache began. The headache then continues, usually without real breaks in pain, for more than 3 months. The way the headache feels can change during the day and during the month. An MRI (imaging of the brain) is often recommended for patients with NDPH due to the sudden start to the headache, and the way it continues without relief. These headaches are very unusual. Sometimes they begin after a stressor, minor illness, head injury or surgery. Sometimes the headache can continue for a long time.
Medication Overuse Headache (MOH) is a kind of chronic daily headache. It is caused by taking too many or too much pain medicine. MOH is also called rebound headache, drug-induced headache and medicine-misuse headache.
Using pain medicine too often can actually lead to more headaches. MOH is likely if your child’s headaches are getting worse and the child has been taking pain medicines most days over a period of 2 months or longer. Overuse is possible even with simple over-the-counter pain medicines such as Tylenol (acetaminophen), Motrin, Advil (ibuprofen) and Aleve (naproxen). Using migraine medicines such as Imitrex (or other Triptans) too often can also cause Medicine Overuse Headache.
Medication Overuse Headache can be a hard diagnosis. We know that families want the headaches to go away. The first instinct is to take pain medicine for each headache. Unfortunately, most medicines designed to treat pain right away can add to the rebound effect.
Your provider will tell you to stop taking all pain medicines for at least several weeks. This is to break the cycle of rebound headaches. Stopping the pain medicines may make headache symptoms worse for a short time. However, after that short time, headaches usually start to improve.
When pain medicines are taken too often, a chronic form of rebound can occur in some people. This chronic rebound causes a daily headache. Not everybody gets a daily headache when pain medicines are overused. We do not know why some people develop this response and others do not. Unfortunately there are no quick fixes for this type of headache. Stopping the overused medicine is necessary and, in most patients, effective. Do not replace one form of pain medicine with another. Gradually, as the body recovers, headache frequency will often improve. Your child’s provider may prescribe a daily medicine that can help with this process.