To diagnose a migraine in children, experts suggest looking for clues in their behavior. They might point at or grab their head, climb into bed and hide under the covers, or ask to retreat to a dark, quiet room. A loss of appetite may be a sign of nausea. Family history is another sign: About 60 to 70 percent of people with migraines have a parent or sibling who has had them or may have had them, according to the Cleveland Clinic.
Babies and toddlers can get migraines, which surprised Katrina Swenson, a mental health professional in Washington State and mother of a migraine sufferer who is 5. Looking back, she said, her son started showing symptoms of migraines before he turned 2. Out of nowhere, he would get upset and lie on the floor, then vomit, act tired and fall asleep. Because he has a motor speech disorder, which makes it hard for him to talk, he couldn’t explain how he was feeling, though he would occasionally hit his eye or claw at the side of his face. Eventually, he learned to sign that his head hurt. But it wasn’t until he was nearly 4 that an occupational therapist mentioned migraines as a possibility. He was diagnosed a few months later. “For over four years, migraines never even occurred to me,” Swenson said.
If you suspect migraines in a young child, health experts recommend scheduling an appointment with a pediatrician, who may suggest that you keep a headache diary, visit a specialist or get an imaging test to rule out other potential issues that can cause headaches, such as stroke, a congenital brain problem or meningitis. Red flags that suggest something else include weakness or numbness on one side of the body, seizures, or confusion during a headache, Dr. Gelfand said.
Diagnosing migraines in young children can require creativity, and many clinics supplement evaluations by asking children to draw their headaches — a technique that, studies suggest, can accurately predict diagnosis 90 percent of the time. In pictures drawn by his young migraine patients, Dr. Powers said he sees a lot of crying and other visual representations of intense pain. “You’ll see kids draw stick figures with something like a knife pounding the head,” he said. “It kind of gives you that sense that it’s a pounding, throbbing pain.”
For children of any age, ibuprofen (Advil) or acetaminophen (Tylenol) work best when given as soon as a migraine starts. If your child is older, a doctor might recommend other medications, including anti-nausea medications, a liquid antihistamine called cyproheptadine, or a class of medication called triptans, which are often used to treat migraines in adults and some of which are approved to treat children. Laying in a dark room, putting a cold washcloth on the child’s forehead and other comfort measures can also help.
If your child gets migraines frequently, certain regular habits might stop them before they start. Ensure your child is: receiving three square meals (plus one or two snacks) per day; getting the recommended daily activity levels for their age; hydrating enough; and sticking to a predictable sleep schedule. Some evidence suggests that certain relaxation and cognitive behavioral techniques, like deep-breathing exercises, can help too, Dr. Powers said.