A searing, pulsing a pain in the head. Nausea. Sensitivity to light.
These painful symptoms can plague people with migraine headaches for hours and days. Migraines can strike people of any age, but most people experience their first one by adolescence.
What are the symptoms and phases of these extreme headaches? How do they express themselves when present in children?
New research is helping patients and doctors better understand the answers to these questions.
Separate Stages
Migraine headaches typically strike in four stages, though these stages may be more noticeable for some patients and less for others.
The prodrome phase starts one or two days before the migraine itself, and signals that a migraine is coming. According to the Mayo Clinic, the changes can be subtle and include things like depression, neck stiffness, food cravings, constipation or diarrhea.
The second phase is called aura, and includes visual or sensory disturbances. Not everyone with migraines experiences this phase. Aura can include seeing bright spots, vision loss, speech issues, or a “pins and needles” sensation.
The attack phase follows next, and it is during this phase that the actual migraine occurs. The Mayo Clinic reports that an untreated migraine will usually last from four to 72 hours. For some, migraines can occur several times monthly, but for others, they can be far more rare events.
The symptoms include a pulsating pain, sensitivity to light and sounds, vomiting, blurred vision, lightheadedness and a pain in one side of the head.
After the attack itself, there may be a postdrome phase during which the patient feels drained from the experience.
Symptoms in Children
When a migraine is present in a child, it can express itself in slightly different ways and with different rates.
For example, while women are more likely to have migraines as adults, boys are more likely to be affected by headache troubles as children.
According to Migraine Action (a United Kingdom based non-profit) nausea, vomiting and abdominal pain are more common among children suffering from migraines than adults. However, these attacks are usually shorter than those of adults, and usually last between one and two hours.
Children are also more likely to display pallor, or a pale look to their face, sometimes with dark circles near the eyes. Children suffering from a migraine may also display symptoms like confusion, dizziness or non-specific body aches.
Migraine Action recommends that children and parents create a “migraine diary” so that a pattern for the attacks can be noticed over time and potential triggers for a migraine headache avoided.
A common trigger for children is long gap periods without food in between meals.
“Migraine attacks can often be minimized by eating small or regular meals containing slow release carbohydrates; migraines caused by a long overnight fast can often be overcome with a snack at bedtime (e.g. a bowl of cereal) and a big breakfast,” reports Migraine UK.
Behavior Issues
New research is suggesting that migraine headaches in children may cause more difficulty than the pain and discomfort of the attack itself.
A study by Marco Arruda, PhD, from the Glia Institute in São Paulo, Brazil and Marcelo Bigal, PhD, from the Albert Einstein College of Medicine in New York explored this idea in a study published in the journal Cephalagia in September 2012.
The study looked at 1,856 children between the ages of 5 and 11 in Brazil and utilized surveys related to both headache symptoms and emotional symptoms (through the Child Behavior Checklist). Their parents completed the survey response.
Results showed that 23 percent of the children had migraines, and 29 percent had tension-type headaches (TTH).
These children were shown to be more likely than their non-headache peers to have behavior problems, including anxiety, depression, social problems and issues with attention. (Results among the TTH children were higher than the non-headache groups, but less marked than among the migraine group.)
For example, 17.1 percent of the children with migraines were found to have attention problems, compared to 6.4 percent of the non-headache group. Fifteen percent of the those with migraines displayed ”anxious-depressed” characteristics, while this was true in only 3.5 percent of the non-headache group
The most common issues seen were “internalizing behaviors,” in which emotions are directed inward. This category of issues can include behaviors like social withdrawal, sadness and complaints of aches and pains.
While 19.1 percent of the sample as a whole showed problems with this type of behavior, 51.3 percent of the migraine group were found to display such.
In contrast, no large difference was seen in terms of externalizing behaviors (breaking rules, acting out, aggression) between those with migraines and those without.
According to Arruda, "As previously reported by others, we found that migraine was associated with social problems. The 'social' domain identifies difficulties in social engagement as well as infantilized behavior for the age and this may be associated with important impact on the personal and social life."
It is important to note that the children themselves were not interviewed directly in this study, as the parents completed the survey responses, which could have affected the outcome. Also, this was the first study to utilize the particular headache survey in children under ten.
This potential connection between specifically internalizing behavior issues and migraines in children needs to be examined and researched further. Further research into how to curb these behavior issues potentially associated with migraines will also need to be completed.
Regardless, Arruda did note that "Providers should be aware of this possibility in children with migraines, in order to properly address the problem.”
According to the Mayo Clinic, “up to 90 percent of people with migraines have a family history of migraine attacks,” so it may be wise for migraine sufferers to watch for signs and symptoms in their children.
For people of any age suffering from migraine headaches, treatment options are available. Talk with your doctor if you or your child have experienced trouble with migraines.
