Helping Kids and Teens Manage Migraine

Migraine is often thought of as an adult condition, yet it affects millions of children and teenagers worldwide. In fact, about 1 in 10 children experience migraine, and the condition can significantly impact their school performance, friendships, emotional health, and overall quality of life.

In this Migraine World Summit session, pediatric headache specialist Dr. Christina L. Szperka, director of the Pediatric Headache Program at Children’s Hospital of Philadelphia, explains how migraine appears in children, why early diagnosis is critical, and how families can support young people through treatment, prevention, and daily life challenges.

How Migraine Appears Differently in Children

Migraine in children does not always look like the classic migraine described in adults. While adults often experience one-sided head pain lasting many hours, younger children may present with very different symptoms.

In early childhood, migraine symptoms may include:

• Stomach pain

• Vomiting

• Cyclic vomiting episodes

• Episodic torticollis (head tilting)

• Colic-like symptoms in infancy

Some children experience sudden vomiting and rapid recovery rather than prolonged headache pain. As children grow older, migraine patterns tend to evolve toward more typical adult features.

School-age children may experience:

• Head pain on both sides of the head

• Shorter migraine attacks than adults

• Light or sound sensitivity

• Nausea or dizziness

By adolescence, migraine often begins to resemble adult migraine more closely, with additional symptoms such as brain fog, vertigo, and difficulty concentrating becoming more common.

Why Pediatric Migraine Is Often Underdiagnosed

Despite being relatively common, migraine in children is frequently underdiagnosed or misdiagnosed.

Several factors contribute to this problem:

• Many parents and caregivers do not realize children can develop migraine.

• Some children never seek medical care for their headaches.

• Emergency departments may treat a single attack without confirming a diagnosis.

• Clinicians may hesitate to diagnose migraine during a child’s first visit.

Studies suggest that fewer than half of children with chronic migraine have seen a healthcare provider within the previous year, highlighting the gap in care.

Without a diagnosis, families may miss opportunities for effective treatment and support.

What Parents Should Watch For

Parents and caregivers play a critical role in recognizing migraine patterns in children.

One of the most important clues is the pattern of recurring attacks. A migraine attack typically appears, resolves, and then returns later rather than remaining constant.

Parents should observe:

• How often headaches occur

• How long attacks last

• Associated symptoms such as nausea, vomiting, or light sensitivity

• Triggers or patterns that precede attacks

Children may not always recognize or describe their symptoms clearly. For example, instead of saying that light bothers them, they may ask for the lights to be turned off or become irritable around noise.

Tracking these patterns can help doctors identify migraine more easily and develop an appropriate treatment plan.

Why Treating Migraine Early Matters

One of the most important lessons for families is the importance of treating migraine attacks early.

Many parents hesitate to give medication until a child’s pain becomes severe. However, waiting too long can make migraine attacks harder to stop.

Early treatment can:

• Shorten the duration of the attack

• Reduce pain severity

• Prevent prolonged disability

• Help children return to normal activities more quickly

For example, treating migraine at the first sign of symptoms may resolve the attack within a few hours, whereas delayed treatment may allow the migraine to persist for days.

Common Acute Treatments for Children

Treatment for pediatric migraine often begins with medications that are safe and widely used.

First-line treatments typically include:

• Ibuprofen

• Acetaminophen

Among these options, ibuprofen currently has the strongest research evidence for effectiveness in children.

If these medications are not sufficient, doctors may prescribe triptans, which are migraine-specific medications designed to stop attacks.

One commonly used medication is rizatriptan, which is FDA-approved for children as young as six years old.

These medications have been used for decades and are generally considered safe, though mild side effects such as jaw tightness or tingling sensations may occur.

Emerging Treatments for Teens

As migraine treatments continue to evolve, newer options are becoming available for adolescents.

Doctors may sometimes prescribe:

• Gepants (CGRP-targeted medications) in older teenagers

• Neuromodulation devices, which use electrical stimulation to reduce migraine symptoms

One neuromodulation option, remote electrical neuromodulation (REN), has shown promising results in pediatric migraine and may be used alongside medication or as an alternative in certain situations.

These treatments are still expanding within pediatric care as new research and approvals emerge.

Preventing Migraine in Children

Preventive strategies focus heavily on lifestyle stability, since the migraine brain tends to be sensitive to disruptions in routine.

Key preventive habits include:

• Maintaining consistent sleep schedules

• Staying hydrated throughout the day

• Eating meals regularly

• Exercising consistently

• Managing stress levels

The brain of someone with migraine tends to respond poorly to sudden changes. Maintaining regular routines helps stabilize the nervous system and reduce attack frequency.

When Preventive Treatment Is Needed

Preventive treatments may be considered when migraine attacks occur about once per week or more, or when attacks cause significant disruption.

Doctors may first recommend supplements such as:

• Magnesium

• Riboflavin (vitamin B2)

These options are generally well tolerated and may help reduce migraine frequency for some children.

If migraines remain severe or frequent, prescription preventive medications may be introduced.

Hormonal Migraine in Teen Girls

Hormonal changes can influence migraine patterns, particularly in adolescent girls.

For some teens, migraine attacks occur consistently around the menstrual cycle.

Possible treatment approaches include:

• Preventive medication taken before menstruation

• Long-acting NSAIDs or triptans during the menstrual window

• Hormonal contraceptives in certain cases

Doctors carefully consider factors such as migraine with aura when choosing hormonal treatments because of potential stroke risk associated with estrogen-containing contraceptives.

Supporting Mental Health

Migraine in children often intersects with emotional and psychological challenges.

Children with migraine may experience:

• Anxiety about upcoming attacks

• Depression related to missed school or activities

• Stress about falling behind academically

At the same time, anxiety or stress can also trigger migraine attacks.

Because of this connection, many headache clinics include psychological support as part of migraine care.

One effective treatment approach is cognitive behavioral therapy (CBT), which has strong evidence supporting its ability to reduce migraine frequency in children—even when anxiety or depression are not present.

Helping Children Succeed in School

Migraine can create significant challenges in the classroom.

Common school-related difficulties include:

• Missing class due to migraine attacks

• Difficulty concentrating during migraine

• Falling behind on assignments

Many children benefit from formal school accommodations, such as 504 plans, which allow adjustments like:

• Access to medication during school hours

• Flexible test scheduling

• Reduced homework during severe attacks

• Permission to rest in a quiet space

Organizations such as Migraine at School provide resources to help families advocate for these accommodations.

Supporting the Whole Family

Migraine affects not only the child but also the entire family.

Parents may feel stress or frustration when migraine disrupts important events, such as birthdays or school activities.

Experts recommend maintaining balance by:

• Supporting the child during attacks

• Encouraging participation in normal family responsibilities

• Avoiding letting migraine dominate family dynamics

Children with migraine can still contribute to family life through chores and responsibilities, helping them maintain a sense of normalcy and independence.

Helping Teens Take Ownership of Their Health

As children grow into adolescence, developing independence in migraine management becomes increasingly important.

Clinicians often encourage teens to:

• Track their own symptoms

• Take responsibility for medication schedules

• Communicate directly with healthcare providers

This gradual shift helps prepare teenagers to manage migraine independently as adults.

Looking Ahead: Hope for the Next Generation

Advances in migraine research, awareness, and treatment are creating new opportunities for children living with migraine.

Early diagnosis, better education, and expanding treatment options—including CGRP therapies and neuromodulation devices—are improving outcomes for young patients.

Perhaps most importantly, increased awareness means that children with migraine today are far more likely to receive proper care than previous generations.

With the right support, many young patients can learn to manage migraine effectively and grow into adulthood with far fewer limitations from the condition.