Migraines in kids: How to recognize triggers and manage pain

Many people think that migraine headaches are not very common in kids – or that they only happen in older kids or adults.

"I tell parents that even young kids can get migraines – and that up to 15% of kids will have migraines at some point," says Ishani Kumar, M.D., Pediatric Neurologist at Children’s Health℠ and Professor at UT Southwestern. "Migraines are the most common reason to see a pediatric neurologist, and they’re just as common as ADHD or asthma in kids."

Dr. Kumar educates parents about how to recognize potential triggers for migraines and how to help a child through a migraine – so they can get back to their activities as soon as possible.

Understanding migraine pain and symptoms

Migraines are different from tension headaches in a few ways.

• They tend to last longer – anywhere from 2 to 72 hours

• They often run in families (genetic)

• The level of pain is usually greater

"We use a traffic light scale to help kids and families rate their pain," says Dr. Kumar. "Migraines are generally in the yellow or red category."

• Green headaches: You can go to school, do after-school activities and still help out around the house.

• Yellow headaches: You’re not able to do some of your regular activities. For example, it may take you longer to complete assignments at school or keep up during recess.

• Red headaches: You can’t talk to anyone. You can’t be at school. You can’t do anything but lie down.

The location of the pain can also be different from non-migraine headaches, or from adult migraines. Kids experiencing migraines often describe a throbbing or pulsing pain:

• Around their eyes

• On one or both sides of their head

• On the back of their head

• In their neck and shoulders

"Younger kids often say that a migraine feels like someone is knocking on a door in their head – or someone is hitting their head constantly," says Dr. Kumar. "Most kids with a migraine want to lie down and sleep – and pull away from any kind of stimuli."

In addition to pain, other migraine symptoms in kids can include:

• Light sensitivity

• Sound sensitivity

• Nausea

• Vomiting

• Visual auras

About 25-30% of kids experience "visual auras" with a migraine. These auras are when a child sees spots, sparkles or colored areas that are not actually there. They can last anywhere from 5 minutes to an hour.

Related podcast
Learn more about how to support kids with sensory challenges by listening to this episode of Children’s Health Checkup podcast.

Identifying your child's migraine triggers

A key to helping your child overcome migraines is to figure out what's triggering them. Dr. Kumar recommends using an app called Migraine Buddy to keep track of when a headache starts and what your child is doing at the time. Then you can share your log with your child’s doctor to help you better identify triggers.

In general, the top four triggers for migraines in kids are:

1. Not drinking enough water

2. Skipping meals

3. Not getting enough quality sleep

4. Stress

"These are all things that most kids can work on. But when you're trying to identify your child's biggest triggers, try changing only one variable at a time," Dr. Kumar says. "If you change your eating schedule, the amount of water you drink and your bedtime all at once, you won’t know what specifically helped."

Dehydration migraine

If a child is prone to migraines, it becomes extra important to stay hydrated throughout the day and to hydrate before all activities. It's also important for your child to keep drinking water if they’re active in the sun and likely to sweat.

"It can’t hurt to try giving an active child electrolytes to see if it might help prevent both dehydration and migraines," says Dr. Kumar.

Irregular meal or hunger migraine

Eating a well-balanced diet and having a set eating schedule is very important for kids who get migraines.

"Focus on eating more whole foods that are good for kids' brains, getting three to five servings of fruits and veggies per day and eating fewer processed or greasy foods," says Dr. Kumar.

Dr. Kumar also recommends less snacking and set meal times – even on the weekends.

"If a kid normally eats breakfast at 7 a.m. on weekdays but waits until 10 a.m. on the weekend, that can trigger a migraine."

Sleep deprivation migraine

The American Academy of Pediatrics provides recommendations on how much sleep kids of different ages need.

• Pre-schoolers (3-5 years): 10 to 13 hours

• School-aged children (6-12 years): 9 to 12 hours

• Teens: 8 to 10 hours

Learn more about how sleep affects your child's brain.

Stress migraine

For some kids, stress or anxiety are clear triggers for migraines. If you think that's true for your child, there are several things you can try to reduce stress:

• Mindfulness. Try downloading an app like Headspace or Calm to practice mindfulness exercises with your child.  

• Biofeedback. You can experiment with biofeedback through videos on YouTube (try channels like The Steady Coach and the American Migraine Foundation). Biofeedback helps children learn to control certain body functions, like muscle contractions, breathing and heart rate.

• Cognitive behavioral therapy (CBT). CBT has been proven to be highly effective for treating stress-based migraines. Ask your child’s doctor to recommend a good therapist in your area.

• Medical acupuncture. There is emerging evidence to support medical acupuncture for migraines in kids and it is considered safe. But be sure to find someone who's certified in medical acupuncture so they have proper training and qualifications.

• Craniosacral therapy, osteopathic manipulation and physical therapy. All three of these treatments can help when headaches are triggered by neck or shoulder tension (which tends to be more common in kids who are very active).

Weather-related migraine

Weather changes can also trigger a migraine, like a cold front or a rainstorm.

There's not much to do about weather changes, but it's still good to be aware that big shifts in weather can trigger a migraine, similar to how weather changes can also trigger allergies or asthma.

School-related migraine

If a child seems to always get migraines at school and not at home on the weekends, it's important to dig a little deeper and ask:

• Is it the stress of schoolwork?

• Is it the bright lights?

• Is it a loud cafeteria?

• Is it being on a screen for several hours at a time?

"Being a detective about what the specific trigger at school is very important because there are several possibilities. That's where logging exactly when the migraine started and what your child was doing becomes helpful," says Dr. Kumar.

Screentime-related migraine

Screentime recommendations for kids who get migraines are:

• After school: No more than one additional hour of screentime

• Weekends: No more than two hours per day

• At night: No screens of any kind for one hour before bedtime

Managing the pain of a migraine

At the very beginning of a migraine, the best things for a child to do are to:

• Drink a big glass of water

• Take some ibuprofen (Advil) or acetaminophen (Tylenol)

• Turn off the lights and go to sleep – either at the school nurse’s office or at home

Over-the-counter pain relievers for migraine relief

When a migraine starts, go ahead and give your child the maximum amount of Tylenol or ibuprofen listed for their age on the packaging. There's no need to "underdose."

"Studies have gone back and forth, but most of the time ibuprofen works better than Tylenol. So we tell people to try both and see which one works better for them," says Dr. Kumar.

After one dose of the maximum amount of over-the-counter pain medication, a child will often feel better within 30 minutes – and can go back to class or their normal activities.

Natural methods for migraine relief

Some kids also find relief from cold compresses like a "migraine cap" – a reusable ice pack that wraps around the head and covers the eyes. And some find more relief from a hot shower.

Rubbing peppermint oil on the feet or temples is also something that can be helpful.

"I tell families to experiment with all of these things – heat, cold or aromatherapy – because they really can help – and they can't hurt," says Dr. Kumar.

Long-term migraine treatment

When kids have migraines that fall in the green to yellow zone (not the red zone), vitamin supplementation can also be a good treatment option. Some of the vitamins to talk to your child’s doctor about include:

• Magnesium

• Vitamin B2 (riboflavin)

• Coenzyme Q10

• Omega 3s

And when a child is not getting enough control over migraine frequency, it may be time to talk about prescription medications.

Low doses of different medications can help prevent migraines, including:

• Antidepressants

• Anti-seizure medications

• Blood pressure medications

"I always tell parents that just because we are starting your child on a daily preventative medicine, does not mean they'll be on it for life," says Dr. Kumar. "After a child is having fewer migraines, we can take them off the prescription medication."

When to get more help

It's time to contact a doctor or headache specialist about your child's migraines if:

• You've given them a full dose of ibuprofen or Tylenol and they're not feeling better after an hour – or they're not pain-free after two hours.

• They're consistently having migraines more than once a week.

• They're missing a lot of school due to migraines.

• They're having visual auras that last longer than an hour.

Many parents don't realize their child's symptoms are related to migraines at first – and that's OK. It's common to explore other possibilities like vision problems, sinus issues, or allergies before connecting all the dots.

"Our goal is to raise awareness about the symptoms, triggers and treatments for migraines in kids. We want to do everything we can to help kids feel better faster, so they can get back to doing what they love," says Dr. Kumar.

Learn more

Children's Health offers expert, compassionate care for kids of all ages coping with headaches and migraines. Learn more about our headache clinic and services.