Story by: Norton Children’s Reviewed by Elizabeth S. Doll, M.D., pediatric neurologist with Norton Children’s Neuroscience Institute, affiliated with the UofL School of Medicine on August 4, 2023
Migraine in teenagers is relatively common. It can be a disabling neurological condition that can interfere with school attendance, academic performance and other important obligations, like work and sports. Nearly 10% of children and teens deal with migraine, and more teenage girls will experience migraine, compared with teenage boys. Overall, increasing amounts of stress on teens, including pressure with academics, extracurricular activities, jobs and a social life, can make kids more susceptible to triggers that can cause migraine.
If you think your child is experiencing migraine or headaches, start their treatment with a pediatrician. Book an appointment by location. If your child already has received treatment from their pediatrician, and you would like to meet with a specialist, request an appointment with a pediatric neurologist.
Effective prevention strategies are needed when it comes to management and prevention of migraine in teens. While a variety of medications are available, perhaps the most effective treatment for migraine includes a combination of healthy behavioral habits and lifestyle factors, according to Elizabeth S. Doll, M.D., pediatric neurologist with Norton Children’s Neuroscience Institute, affiliated with the UofL School of Medicine.
Migraine is a complicated neurological disease, with throbbing head pain and other symptoms including nausea and vomiting, dizziness, and sensitivity to touch, sound, light and odors.If your child experiences headaches 15 or more days per month, they are considered to have chronic migraine. Headaches for fewer than 15 days per month puts a child in the episodic migraine category.Sometimes a child will have a migraine with aura, which can include vision or sensory disturbances before a migraine attack occurs.Risk factors include a family history of migraine. If one parent has them, the child has a 50% chance of inheriting the condition. The risk goes up to 90% when both parents have a history of migraine. Environmental factors also can contribute to migraine. Changes in barometric pressure with storm systems can trigger a migraine, along with extreme heat or cold temperatures, bright sunlight, and excessive humidity or dry air.
Common migraine symptoms in teens include:
Best treatments for migraine in teens
To refer a patient, visit Norton EpicLink and open an order for Pediatric Neurology.
Every child has different triggers for migraine, which highlights the importance of working with a provider to establish an individualized treatment plan.
Current treatment options for migraine in teens include the use of both pharmacological and nonpharmacological options, such as lifestyle factors, which are discussed below. Other alternative therapies include acupuncture and Botox injections into affected muscles in the head, plus neurostimulation devices.Both over-the-counter and prescription medications are available to help treat migraine in teens. These include ibuprofen, acetaminophen, triptans, amitriptyline, topiramate, cyproheptadine and propranolol.
A healthy lifestyle lays an important foundation when it comes to treatment and prevention of migraine. Taking account of your teen’s lifestyle, including adequate sleep and nutrition, could help avoid the onset of a migraine attack. Sleep hygiene, including a regular sleep schedule and adequate amounts of sleep; minimizing caffeine intake; drinking plenty of water; eating regular meals and snacks throughout the day; getting exercise on a regular basis; and stress management are important habits when it comes to managing migraine.A list of common triggers for migraine in teens may include:Lack of sleep. Too little, too much or changes in the amount of sleep all can trigger migraine. Aim for at least eight hours every night.Eating schedules and nutrition. Missing meals or eating at inconsistent times is a big trigger. So are certain foods, like excessive caffeine, but each individual is different. Your child should stick with eating whole foods, including fruits, vegetables, whole grains and lean proteins. Eat regular meals and snacks throughout the day.Lack of hydration. Your child should drink plenty of water throughout the day and not just when they feel thirsty. The daily water goal for most teenagers is 60 to 100 ounces per day.Stress. Stress can exacerbate symptoms. If your child gets anxious over big tests or life events, or they struggle with emotions, find resources to learn how to manage stress. Stay alert to what’s going on in your child’s life so you can help them navigate it.Hormone changes. Natural fluctuations that happen during puberty or menstruation can trigger migraine headaches. Take note of these times to ensure your child is avoiding other migraine triggers.Physical exertion. Sometimes physical activity can trigger migraine, but regular, moderate exercise is usually helpful when it comes to healthy lifestyle and stress management benefits that can aid in the prevention of migraine attacks.
Behavioral interventions for migraine prevention in teens
Cognitive behavioral therapy and relaxation techniques have been proven to help with migraine prevention and reducing the severity of headaches. Because stress can exacerbate migraine, relaxation and breathing techniques are great tools to have in your teen’s toolbox to practice on a regular basis. These techniques can be practiced during an episode and on a regular basis for stress reduction.Progressive muscle relaxation and deep belly breathing also can reduce stress and aid with headache tension. Biofeedback can be used as a “rescue” technique to help soothe the body’s nervous system/stress response before a migraine attack can occur. According to the National Headache Foundation, taking 10 minutes to warm one’s finger to 96 degrees Fahrenheit while listening to relaxing music is an effective biofeedback method for those who experience migraine.Mindfulness and meditation techniques can help with pain associated with migraine. Practicing these techniques regularly can strengthen the mind’s resilience to pain by redirecting focus on the present moment and accepting the pain without judgment — which surprisingly can help with pain reduction through the avoidance of overly focusing on it.
Several over-the-counter supplements have shown to help prevent migraine, including magnesium oxide, coenzyme Q10 and riboflavin. Learning how to manage stress through techniques such as biofeedback and controlled breathing can be helpful as well.
Consider keeping a migraine diary. By keeping tabs on your teen’s sleep, diet and stress patterns, this will help you notice triggers and help guide your provider to offer the best course of treatment available. If your child has migraine regularly, it may be helpful to review the Migraine Disability Assessment Test questionnaire to help your provider get a more comprehensive idea of what is going on.
If your teen is experiencing migraine headaches regularly, it shouldn’t be dismissed as “normal.” The sooner that migraine headaches, especially those that won’t go away, are addressed, the better. Lifestyle changes combined with different medications or therapies can help. Working with a health care provider can help find the best course of treatment for teens with migraine.
Help is available for children who experience migraine on a regular basis. First, check in with your child’s pediatrician. They can start treatment for migraine. If the headaches persist, your pediatrician can refer your child to Norton Children’s Neuroscience Institute for migraine treatment and prevention. Your health care provider can work with your child’s unique needs to develop a comprehensive prevention plan.