A migraine attack, whether as an adult or a child, can stop someone in their tracks. From pain to the accompanying symptoms and the sensory overload, a migraine is nothing short of debilitating. So, what really differentiates a migraine episode from a headache? And how can you help your child with a migraine diagnosis? We’ve brought in our expert Marcy Yonker, MD, Director of the Pediatric Headache Program, to help answer frequently asked questions and explain some newly available treatments.

How to tell if it’s a migraine or a headache 

Headaches and migraines can both be tough for kids and for the grown-ups who care for them. A headache is a general term for pain in the head and can have lots of different causes. A migraine, on the other hand, has more specific symptoms, like sensitivity to light or nausea. While both can be intense, there are clues that can help tell them apart, which can make a big difference in how you support your child.

“I see kids as young as 2 years old get migraines,” Dr. Yonker says. “Migraine episodes can range in severity, and some people often reserve the word migraine for only the worst of the worst. Some kids have a high pain threshold, so it’s important to figure out the difference.”

Dr. Yonker explains that when your child says their head hurts and goes back to their daily activities without any other symptoms, it probably isn’t a migraine. But if you notice them stopping their activities or if the pain is impeding their day, there may be a larger problem.

What are the signs and symptoms of migraine

"Migraine is associated with other symptoms," Dr. Yonker explains. "Light and sound sensitivity, nausea, often vomiting. Sometimes there's an aura, blind spots, changes in sound and vision, or tingling in the hands or limbs, but not always. It's usually made worse by doing daily activities." 

While adults usually feel pain from a migraine episode on one side of the head, children usually feel it on both. That pain can go hand in hand with other signs and symptoms including:

• An aura, or a visual, sensory, motor or speech problem, up to an hour before or during the migraine
• Blurry vision
• Light, touch, smell or sound sensitivity
• Nausea
• Weakness or numbness in the face or body
• Neck pain

Migraine and neurodivergence

Doctors and researchers are learning more about how migraines might be connected to other neurodevelopment conditions like  ADHD and autism spectrum disorder.

“I've seen kids who stopped having so many migraine episodes when they were placed on a stimulant for their ADHD because they weren't stressing out about having to try so hard to pay attention,” Dr. Yonker explains. “So, it wasn't the cause of their migraine problem, but it was the trigger.”

It’s important to talk to your pediatrician if your child is having migraine attacks and has similar symptoms to another condition such as ADHD or autism spectrum disorder. While migraine may be a separate issue, treating one condition may help another.

What might be causing your child’s migraine

Sometimes, a migraine attack is just one part of a bigger health picture. Other times, migraine can be brought on by specific things called “triggers”. Triggers are things that can set off a migraine in some kids, but don’t cause migraine. While everyone’s triggers can be different, there are some that are common among children with migraine.

Kids may crave certain foods before a migraine hits and not because the food causes the migraine, but because the brain is already starting the migraine process. It’s a bit like the body sending mixed signals. A child might eat the food, get a migraine the next day, which makes it easy to think the food was the cause. But in reality, the migraine may have already been on its way.

“Sometimes, people blame a child’s choices for what’s really a biological issue,” Dr. Yonker says. “I see 9-year-olds whose parents say, ‘This wasn’t a problem last year,’ but I promise they were eating the same foods as most kids. It’s not always about food. Sometimes, a migraine just happens.”

Lifestyle factors

Lifestyle factors are everyday habits and routines that can play a role in triggering migraine attacks. These can include:

• Intense physical activity without proper fueling
• Too little or too much sleep
• Skipping meals
• Before, during or after a stressful situation
• Looking at screens for prolonged periods of time

Dr. Yonker also shares that school schedules can trigger migraine, as from summer to fall, sleep schedules and stress levels change drastically.

“During the school year, they must get up earlier which is not always something the child can control,” Dr. Yonker explains. “Teens brains are programmed to stay up late and sleep late so sometimes not getting enough sleep isn’t their fault.”

Environmental factors

Environmental factors are the things around us in our surroundings that we may or may not be able to control, such as:

• Drastic weather changes or sudden climate changes
• Bright or overwhelming lighting
• Loud sounds
• Smells, such as strong perfumes, cleaning chemicals, or smoke
• Busy stores, concerts or other overstimulating events

Ways to help your child during a migraine episode

Dr. Yonker says the first line of defense is always a weight-based dose of ibuprofen and a nap, if available.

“So, 10 milligrams per kilogram is the correct dosing, but nobody’s parent knows how many kilograms their child weighs,” Dr. Yonker jokes. “It can help to reach out to a pediatrician for advice on the correct and most effective dosing for your child.”

It’s also important to minimize triggers such as light, sound or other stimuli that is bothering your child. While it’s hard to see your kid in pain, Dr. Yonker notes that it isn’t dangerous and it’s a good idea to let them take a break or giving them the option to not participate in certain activities.

Besides over-the-counter medication, sleep and creating a calm environment to relax, these tips may further help your child cope with a migraine episode:

• Cold or warm compress on their forehead or neck to soothe the pain
• Offering water if they can tolerate it
• A gentle massage on the temples, neck or shoulders to ease tension
• Some children use screens to distract from their pain, while limiting screen time such as TVs, tablets or phones can be helpful for others
• Giving other medication as needed if prescribed by your child’s doctor
• Reassuring and comforting your child and letting them know that it’s healthy to rest and the pain will pass

Migraine and school

One place where migraine episodes can affect children more than adults is school. That’s because school often comes with stress, loud environments and less sleep. And while kids can sometimes say they have a headache as a reason to avoid activities, Dr. Yonker finds that with chronic migraine sufferers, that isn’t always the case.

“My experience with these kids is that they are often accused of wanting to avoid school, so it really becomes a struggle to get the school to accommodate properly for them,” Dr. Yonker notes. “They would rather be there. It’s really an inherited problem.”

In some cases, setting up a 504 plan with your child’s school can help kids get accommodations to do their best, even when their pain is at its worst.

When to see a doctor

If your child’s headaches are worsening, more frequent, are accompanied by other symptoms and don’t go away with typical methods, it may be a good time to see your pediatrician. It’s especially important to see a doctor when headaches or migraine are affecting your child’s daily life and activities.

And while the pain of a migraine attack is scary and can seem like something more serious like a brain tumor, Dr. Yonker wants parents to know that’s often not the case.

“One of the big mythologies is the longer it goes on, the more you should be concerned,” Dr. Yonker says. “It's quite the opposite. The longer it goes on, the less you should be concerned, because it's much less likely to be something serious if something's been going on for years.”

New treatments for migraine in children

While ibuprofen and a nap can go a long way toward addressing migraine attacks in the moment, chronic migraine sufferers may need other medications or long-lasting treatments to ensure a healthy daily life.

The treatment of migraine has made a lot of progress since Dr. Yonker started treating headaches more than 20 years ago. They use an array of medications from antidepressants to blood pressure reducers, to newer methods, including biofeedback. Each patient gets a personalized treatment plan based on their individual condition and needs. 

Specifically, Dr. Yonker mentions Calcitonin gene-related peptide (CGRP) medications. These are a newer class of drug specifically used to prevent and treat migraine by blocking the effects of the CGRP protein that can cause pain and inflammation.

"We know for certain that levels of a chemical called CGRP are elevated during migraine attacks," Dr. Yonker says. "It's the first treatment ever developed specifically to target what's going on in migraine. It's potentially revolutionary."

Currently, these medications have been approved for adults and are in clinical trials for children, with one of them just approved for migraine prevention in children. Dr. Yonker is hopeful this new approval could change the lives of children living with migraine.

Featured expert

Marcy Yonker, MD

Director of the Pediatric Headache Program