Throbbing pain on both sides of the head, nausea, even passing out.
When their children have such symptoms, many parents jump to worst-case scenarios such as brain tumors or serious illnesses. However, these symptoms can indicate something more common: migraines.
Though many parents think these headaches affect only adults, children as young as age 6 or 7 can get them.
Approximately 2 percent to 5 percent of elementary school children and roughly 15 percent of adolescents experience migraine headaches. Fifty percent get their first migraine before age 12.
Before puberty, boys suffer from migraines more frequently than girls. After the onset of adolescence, the reverse is true.
Prior to age 17, about 23 percent of girls and 8 percent of boys have had migraine headaches.
“Headaches are more common in children than we thought, and migraines are usually what bring them to the doctor,” said Dr. Winslow J. Borkowski, a pediatric neurologist at Boys Town Pediatric Neurology. “They can be a significant form of disability. Children can lose time from school.”
Though medical research does not explain the specific reasons why children experience migraine pain, there are many triggers.
“It's complicated,” said Dr. Heather Zimmerman, a pediatrician at Boys Town Pediatrics. “There are multiple factors such as nutrition, sleep, stress or dehydration.”
Some factors are beyond parents' control, specifically barometric pressure shifts.
“I'm really intrigued by weather changes,” Borkowski said. “In Nebraska, there really seems to be a correlation. I've heard that quite a lot anecdotally.”
Life events can cause the onset of a child's first migraine.
“Just a stressful event like a divorce or the death of a loved one can trigger migraines,” Borkowski said. “They can also be associated with depression or problems sleeping. A bump on the head can also be very important, even if it's a mild one.”
The most significant predictor is family history. If both parents have migraines, there is a 90 percent chance their children will.
“We look for a family history that supports that,” Borkowski said. “Sometimes parents may not make the connection if the headaches are not ongoing. People forget.”
Parents should pay attention to headaches that last up to 24 hours and happen two to four times a month. Borkowski suggests keeping track with a headache diary.
“It can tell you how often they're occurring and for how long,” he said.
Zimmerman also recommends recording when daytime headaches occur, sleep patterns and diet, and any other factors surrounding headache onset.
Usually, children do not need diagnostic tests such as MRIs because pediatricians can identify migraines during office visits.
“Ninety-nine percent of the time, we can diagnose them by a thorough history and physical examination,” Zimmerman said.
Most children respond to simple treatments, including over-the-counter medicines such as children's ibuprofen or acetaminophen.
However, both doctors caution against giving these medications to children too often. If over-the-counter medicines are not helping, pediatricians can prescribe daily preventive medications.
Lifestyle changes can also help control migraines. Getting enough sleep, for example, is critical.
“I always ask what the sleep patterns are. Sleep is very, very important,” Borkowski said.
Regular exercise, staying hydrated and maintaining a healthy diet also can help. If parents notice that consumption of a certain food (such as chocolate) precedes a migraine, they can work to avoid or limit them.
Zimmerman notes that making such changes can be more difficult for teenagers, who don't always tell their parents that they are having headaches.
“They tend to drink a lot of caffeinated soda and coffee, and they need to stabilize their caffeine intake,” she said. “They may also be having depression or anxiety, and we can treat those with therapy.”
Ultimately, the best first step a parent can take is to call their child's pediatrician.
“Parents always need to be aware of headaches,” Borkowski said. “When headaches are reoccurring, it's time to seek medical attention.”