What You Should Know About Your Child’s Headaches from Intermountain Primary Children’s Hospital

If your child is experiencing severe headaches, they could be related to migraine. Whether the episodes are rare or happen often, there are preventive strategies and rescue plans that can help you ease their pain.

“There are options out there to help your child with frequent or severe headaches,” said Dr. Meghan Candee, pediatric neurologist with Intermountain Primary Children’s Hospital and University of Utah Health. “For the majority of children who have migraines, your primary care provider can confirm the diagnosis based on a specific set of clinical criteria, and most of the time, provide interventions to help with prevention and rescue.”

Diagnosis criteria include nausea or vomiting, light and noise sensitivity and worsening with routine physical activity, Dr. Candee said. Other neurological symptoms, known as aura, can include seeing spots in your vision, difficulty speaking or tingling in one’s face or arm.

Dr. Candee is the only pediatric neurologist in Utah and many surrounding states to be certified by the United Council for Neurologic Subspecialties, and is the co-founder and director of the Pediatric Comprehensive Headache Program at Primary Children’s Hospital.

The headache program includes doctors and advanced practice providers who specialize in headache diagnosis and management. Every new patient to the headache program is seen by a neurologist, a psychologist and a nurse educator, all of whom work together to help patients and families take on a multi-faceted approach to headache care. Patients can be referred to the clinic by their primary care provider.

Migraines are more common in children than one might think. With 10 percent of children having at least one migraine episode, the clinic receives nearly 500 referrals for headache every year, Dr. Candee said.

Many families want to know why their children has migraine. Genetics play a major role in predisposing some children and not others.  If one parent gets them, there’s about a 70 percent chance the child will too. If both parents get migraines, the child’s chances rise to 90 percent.

Migraines can affect young children in ways that are much different from teens or adults, including colic, cyclic vomiting, or abdominal migraine, which is similar to classic migraine but with abdominal pain as the main symptom.

It’s also challenging to understand the symptoms a young child is experiencing if they’re under age 5 years and may not have the language or awareness to express themselves clearly.

Parents can help children by watching for contextual clues, keeping a log and looking for potential triggers, which are difficult to isolate but helpful to providers when they do. This includes recalling what the child has had to eat, if they have been drinking enough water, how much sleep they have had, and any acute stressors they have had in the prior 24-48 hours.

Specific symptoms or early signs of an acute episode, like frequent yawning, specific cravings, excessive sleepiness or decreased appetite, may become more apparent to patients and their parents over time, Dr. Candee said.

“Often, until you ask kids what’s going on before and during the migraine, they won’t offer the information,” Dr. Candee said. “Ask kids during these episodes to point to what’s strange or hurting. Even asking little kids to draw it out can help.”

Similarly, it’s important for families to assess their child’s habits as clearly as possible. For example, are they consistently getting 8-9 hours of sleep? Are they skipping meals? Not drinking any water? Playing video games for hours on end?

If a child is experiencing concerning headaches, parents are encouraged to keep a log of episodes, and talk to their child’s primary care provider. Often, providers help parents create a plan, which may include:

1. Preventive measures, including consistent sleep (without naps, which can throw off the child’s nighttime sleep schedule), adequate hydration, a varied diet, and daily exercise.
2. Limiting recreational screen time to no more than 1-2 hours per day, depending on age and content.
3. Over-the-counter pain relievers to use early on during an episode.
4. If those don’t work, physicians may prescribe prescription migraine rescue medication, such as triptans or anti-nausea agents, which can be supported by over-the-counter caffeine or antihistamine use.

Additional interventions may be needed if:

1. A child is younger than 3 years old
2. There is no known family history of migraine
3. Symptoms are persistent or atypical for migraine
4. The rescue plan established with the primary care physician is not working
5. Headaches are interfering with school attendance or regular activities.

For more information, visit primarychildrens.org.

About Intermountain Health

Headquartered in Utah with locations in six states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 34 hospitals, 400 clinics, medical groups with some 4,600 employed physicians and advanced care providers, a health plans division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is committed to improving community health and is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes at sustainable costs. For more information or updates, see https://intermountainhealthcare.org/news.