Fact sheet: Migraine information for children and teenagers

A migraine is not just an ordinary headache: your head hurts a lot and it can make you feel very ill. If it feels worse when you move and you cannot bear the light or noise, then you probably have a migraine. You might still get other kinds of headaches that are not as bad too.

If you have a migraine just once in a while, that is bad enough. But if you get them a lot, then they can make you feel generally unwell and miserable. You are not alone. Many young people get migraines that are so bad that they just cannot go out. They have to miss out on school and all sorts of things that their friends are doing. What many people do not know is that about 1 in every 10 teenagers has migraines sometimes.

The good news is that there is a lot that you can do to reduce your migraines and manage them when you do have them. There is a very good chance that the migraines will go away completely as you get older. Read on to find out how you can look after yourself so that you do not get migraines as often, and how you can handle them when they hit.

What is the difference between a migraine and ordinary headaches?

You can get several types of headache. If you are getting bad headaches, your doctor will want to make sure that there is not something else causing them. Most of the time headaches are not caused by another condition. But sometimes, for example, a problem with the joints in the jaw causes headaches. Or you might get headaches because you are taking too many tablets. So the doctor will want to check that everything else is okay with you before he or she can be sure that migraine is the main problem. Migraines are not caused by another health problem.

Ordinary headaches are mostly tension headaches. Most of us get these and you probably know what they are like. You feel as though it is pressing inside your head and it is really tight. With this kind of headache, the pain goes all the way through your head. It can happen when you are under a lot of stress or if you have not had enough sleep.

A migraine is different. Some people get what is called an "aura" before a migraine starts. If that happens, they may see lights or things might start to get blurry, or look wavy or wobbly. But some people who have migraines do not get auras at all. This means that although having auras is a sign of migraine, not having auras does not mean it is not migraine.

These are other tell-tale signs that a headache is a migraine:

• Really bad throbbing, pounding pain - especially at the front of your head
• It is usually one-sided: only one side of your head hurts, and it is not always the same side
• The headache lasts from a couple of hours to 3 days
• Moving around makes your headache worse
• Light and noise might really bother you or even be unbearable
• You feel nauseous or queasy, and sometimes you might even throw up (vomit)

If the pain is so bad that you really need to lie down somewhere dark and quiet, and this has happened a few times, then you may have migraines. A migraine could give you a belly ache too.

Click here if you want to see our quick guide that shows the signs and symptoms of the different types of headaches.

What causes migraines and how do I know what is setting my migraines off?

You might already know quite a lot about migraines if other people in your family get them too. In fact, more than half of the people who get migraines have them because migraines run in their family.

Researchers are still not sure about exactly what causes migraines. An allergic reaction could be involved, or perhaps sometimes a deficiency (when your body is not getting enough of an important vitamin or other substance). Stress is probably always an important factor when it comes to pain: being tense can make pain worse or more likely to happen. Having very hectic days without enough breaks in them can really make life stressful so that you are more likely to have headaches too.

One thing is certain: once girls start having their periods (menstruation), the hormones from their monthly cycle can cause migraines. Because of this, from the teenage years onwards, many more girls have migraines than boys. In childhood, there is really no big difference in migraines between boys and girls.

For both children and adults, irregular sleep and eating habits might make migraines more likely if you are prone to having them anyway. Many experts also believe that there is a link between diet, exercise and migraines, but researchers cannot say for sure whether that is really true or not.

Something that starts a migraine off, like something you eat or something you do, is called a "trigger". It is easy to jump to conclusions about what is triggering your migraines, but it is better to try to make sure there really is a link before you make big changes in your diet or life. Making sure you have a balanced diet is particularly important while you are still growing.

Some of the things you might want to look out for because they are thought to be triggers for migraines in some people include:

• cheese, milk and chocolate
• eggs
• food additives (chemicals that are added to certain food products), like the sweetener called aspartame and flavour enhancers called glutamates

The best known way to find out what is triggering your migraines is to try to keep a diary about your migraines and headaches for a few weeks or months. A headache or migraine diary means that you write down:

• what was happening around the time you got a migraine
• when the migraine started and when it was over
• how bad the migraine was
• whether you had taken medication (if so, what and how much?)

Then if you think that something in particular is causing your migraine - eating chocolate, for example - you also start keeping track of what happens whenever you eat chocolate. It is a bit like doing a science experiment in school. Before you decide to never eat cheese or chocolate again, or never drink cola again, for example, you might want to be sure that it was not just a coincidence that happened once or twice.

If you cut something out, and your migraines are just as bad and come just as often, you can write that in your diary too. Just relying on your memory can be risky because, for example, you might not remember all the times you ate chocolate without having a migraine.

What can help to prevent migraines?

If you are sure that something is triggering your migraines, and you can avoid that trigger, you might be able to prevent some of your migraines - or they could be less painful or be over more quickly.

Getting good sleep regularly can help. Some things could be stopping you sleeping well enough and long enough at night. Too much excitement just before bedtime can make it hard to sleep - that includes listening to loud music or having long phone conversations with friends just before going to sleep. Drinks with caffeine in them, like cola, tea or coffee, could also make it harder to get to sleep.

If you would like to get a better night's sleep, going to bed at the same time every night might help. A comfortable room temperature (not too hot or too cold) could help too. You might find that lying in bed reading something exciting or watching TV actually makes it harder for you to get a good night's sleep.

Learning how to relax your body and mind could help you sleep better - and it has also been proven to help children and teenagers have less painful migraines. To learn how to relax, you might get training in certain techniques that can help you manage stress and muscle tension better. Your doctor and parents could help you find someone who can teach you these kinds of techniques. This is one of the best proven ways to reduce migraines. If you would like to read more about these techniques and how researchers tested whether they work, click here.

Are there any medicines or vitamins that can prevent migraines?

Sometimes people take dietary supplements or herbal products to try to prevent their migraines. None of these have been proven to work in children or teenagers. There are some medications that have been proven to prevent migraines in adults. But young people's migraines are a bit different to adults' migraines and, because their bodies are still growing, they react differently to these medications too. That means that what works for your parents will not necessarily work for you.

If a child or teenager has really bad migraines several times a month, sometimes certain drugs are used to try to prevent them. None of these have been licensed for use in Germany for children and young people, because there is not enough evidence that they are both safe enough and effective. If things are really bad for you, though, your doctor might talk with you about the possibility of carefully trying out one of these medicines. If you do take one, then he or she will want to see you a few times a year to see how you are getting on with it. You could be growing out of your migraines, so it is important to have regular check-ups.

If you are interested in learning more about the research on the different medicines and products that have been tried for migraine prevention, you can read about that here.

What can I do when I have a migraine?

When you have a bad migraine, you will probably need to lie down in a quiet and dark place until you can get to sleep or the migraine is over. If you can get to sleep, the migraine will probably be gone when you wake up again. A cold pack of some sort for the side of your head that hurts could help reduce the throbbing.

The painkillers that have been shown to help the most in children and teenagers who have a migraine are called ibuprofen and acetaminophen (or paracetamol). They can help reduce the pain and the throbbing. Side effects are not very common if you do not take a lot of the medicine, but sometimes it can cause stomach problems. Ibuprofen might work for a little longer against migraine pain than acetaminophen.

There are no special anti-migraine drugs that have been proven to work well for children under the age of 12. If you are 12 years old or older, you can try a nasal spray that has the medication called sumatriptan in it. You just use a single squirt in one nostril with this drug. However, it is not certain that it is any more effective than ibuprofen, and it has more side effects (also called adverse effects). The spray often leaves an odd taste in your mouth. Other adverse effects are less common, and include drowsiness and a stiff jaw.

Some migraine tablets have a drug in them called metoclopramide. That drug is meant to make you feel less sick, but it has not been proven to work for children and teenagers with migraines.

If you would like to read more about the research on these drugs, we have summarised it here.

Adults have more drugs to choose from, because more medications have been tested in adults. But, again, we cannot know if they are safe enough and effective for children and young people. If ibuprofen, acetaminophen and sumatriptan do not work for you, then your doctor might talk with you about other possible options.

It is very easy, though, to end up taking too much medication if you have a lot of headaches. It is better to try not to rely on them, and only take them when you really need them.

Most children and teenagers will get through their migraines if they lie down quietly, use a cold pack for where it hurts the most, and take ibuprofen or acetaminophen if it gets really bad. Support from your parents is also important. Remember, there is a very good chance that you will outgrow your migraines over time.


Author: German Institute for Quality and Efficiency in Health Care (IQWiG)

© IQWiG (Institute for Quality and Efficiency in Health Care)