Migraine in kids and teens

Migraine isn't only an adult problem. It's common in children and teens, and it often looks different from migraine in adults. A child may have shorter attacks, pain on both sides of the head, or attacks of belly pain and vomiting. This article covers how to spot migraine in kids, common triggers, how parents and schools can help, medicine basics, and warning signs that need a doctor.

How common is migraine in kids and teens?

A 2023 review of 48 studies from around the world found that about 11% of children and teens ages 8 to 18 have migraine. In a class of 25 students, that's 2 or 3 kids. In US data, migraine becomes more common in girls than in boys from about age 10. Migraine also runs in families. Most children with migraine have a relative who has it, even if that relative was never diagnosed.

Most headaches in children are harmless and go away within a few hours. But headaches that keep coming back can lead to problems at school, problems with behavior, and depression.

How migraine can look different in kids

Young children often can't describe their symptoms. They may look pale, stop playing, and want to lie down. What you notice during an attack tells the doctor a lot.

Belly pain and vomiting

Some children, especially younger ones, have attacks of belly pain instead of headache. This is called abdominal migraine. The pain is moderate to severe, usually around the belly button, with nausea, vomiting, loss of appetite, or a pale face. It lasts 2 to 72 hours, and the child is completely well between attacks. Doctors first make sure there is no stomach or kidney problem. Most children with abdominal migraine develop migraine headaches later in life. Repeated bouts of intense vomiting, with healthy stretches in between, can be a related condition called cyclic vomiting syndrome.

Common triggers in kids

Triggers differ from child to child, but these come up often:

• Sleep. Too little sleep, or a schedule that shifts a lot. Children 6 to 12 need 9 to 12 hours of sleep a day, and teens 13 to 17 need 8 to 10 hours.
• Skipped meals and going too long without eating.
• Not drinking enough. Dehydration can bring on an attack.
• Stress, such as tests, a new school, or problems with friends or at home.
• Screens late at night, which can push back bedtime and cut into sleep.
• Caffeine. In teens, caffeine use is linked to recurring headaches. It's in soda and energy drinks, not just coffee.
• Periods. For teen girls, the days around a period can be a trigger. See menstrual migraine.

What parents can do

• Keep sleep regular. Aim for the same bedtime and wake-up time every day, including weekends.
• Don't skip meals, including breakfast.
• Keep water handy. A water bottle at school helps.
• Stay active. Regular exercise is part of healthy habits for headaches.
• Help with stress, especially before big tests or changes. A school counselor can help too.
• Act early in an attack. Rest in a dark, quiet room, and follow the plan from your child's doctor.

Keep a simple diary

For each headache, note the date and time, how long it lasted, other symptoms, what helped, what made it worse, and anything unusual that day, like a big test or poor sleep. Also note any medicine and any missed school. At first, it's often easiest for a parent to keep the record. As kids get older, they can take over parts of it. For more tips, see how to keep a headache diary.

A parent can keep the record in Zutsu Note: log headaches and medicines in a few taps, and see the monthly counts on a chart. You can also show a 30-day summary at the appointment on your phone, or print it or save it as a PDF if you use Zutsu Note in a web browser.

Medicines: work with your child's doctor

Migraine medicine works best when it's taken early in an attack. Studies support some over-the-counter pain relievers for children and teens, and some prescription migraine medicines, mainly for teens. Some migraine medicines are FDA-approved for children or teens starting at certain ages, and many are approved only for adults. Your child's doctor will choose a medicine and dose based on your child's age, weight, and attack pattern, so ask before giving any medicine, including over-the-counter products.

Don't give aspirin to children or teens unless their doctor tells you to. Aspirin taken during a viral illness, such as the flu or chickenpox, has been linked to Reye's syndrome, a rare but serious illness that affects the brain and liver. Some other over-the-counter products, including some stomach remedies, contain aspirin-like ingredients called salicylates, so read labels and ask a pharmacist if you're not sure.

Preventive treatment

If attacks are frequent or keep your child from school and activities, the doctor may talk with you about preventive treatment. US guidelines from 2019 note that in many studies of daily preventive medicines for children, those who took a placebo (a pill with no medicine) also improved a lot. So the doctor will go over the pros and cons, and you'll decide together. Talk therapy can help too. In a US study of children and teens with chronic migraine, those who had cognitive behavioral therapy (CBT) plus medicine were more likely to cut their headache days in half than those who had headache education plus the same medicine.

Medication overuse in teens

Children and teens can get medication overuse headache, where taking pain medicine too often makes headaches more frequent. The American Academy of Pediatrics suggests calling your child's doctor if your child needs pain medicine more than 3 times a week. As teens start managing their own medicine, talk with them about how often they take it, and keep track in the diary. Learn more about medication overuse headache.

Missing school and how schools can help

Migraine can make children miss school or struggle in class. Start by talking with the teacher and the school nurse. Share the plan from your child's doctor, and ask about the rules for taking medicine at school.

If migraine affects your child's schooling, ask about a Section 504 plan. Section 504 of the Rehabilitation Act of 1973 is a federal civil rights law. It protects students with disabilities in public schools and other schools that receive federal funding. A student can qualify if a condition substantially limits a major life activity, such as learning, concentrating, or brain function. A condition that comes and goes, like migraine, can count if it would substantially limit a major life activity when it's active. A diagnosis alone doesn't qualify a student automatically. The school evaluates first, and a doctor's diagnosis is one part of that.

A 504 plan lists supports that fit your child. Examples that doctors may ask for include:

• Carrying a water bottle during the school day
• Getting migraine medicine quickly when an attack starts, then resting for a short time, for example in the nurse's office
• Tinted glasses for light sensitivity, or a break from loud places during an attack
• Breaks during tests and more time for homework

It also helps for school staff to know that vomiting during a migraine attack isn't contagious. If headaches affect learning so much that a child needs special education services, the child may qualify for an Individualized Education Program (IEP) under the Individuals with Disabilities Education Act (IDEA). IDEA includes a category called “other health impairment” for chronic health problems that affect a child's schoolwork.

When to see a doctor

See your child's pediatrician or family doctor if:

• Headaches keep coming back, get worse over time, or happen every day.
• Headaches make your child miss school or activities.
• Your child needs pain medicine more than 3 times a week.

Call the doctor soon if headaches:

• Wake your child from sleep, or are there on waking with vomiting
• Come with a change in personality, behavior, or thinking
• Come with trouble walking, clumsiness, or balance problems
• Start with coughing, sneezing, or straining, or get worse when lying down
• Follow a head injury that was more than a light bump

Get emergency care right away. Call 911 or go to the nearest emergency room for:

• A sudden, severe headache that is the first of its kind, especially with double vision, confusion, unusual sleepiness or trouble waking, numbness, or forceful vomiting
• A headache with a stiff neck or neck pain, especially with a fever
• After a head injury: a headache that keeps getting worse, repeated vomiting, confusion or unusual behavior, slurred speech, weakness or numbness, trouble walking, a seizure, passing out, or being hard to wake

Most of the time, brain scans and blood tests aren't needed to diagnose migraine. Your child's doctor will decide. If headaches are frequent or hard to treat, your child may see a pediatric neurologist or a headache specialist. See how to find a headache specialist, or try the American Migraine Foundation's doctor finder.

Studies and guidelines we used

• Onofri A, et al. Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis. Journal of Headache and Pain. 2023;24:8.
• Victor TW, et al. Migraine prevalence by age and sex in the United States: a life-span study. Cephalalgia. 2010;30:1065-1072.
• Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38:1-211.
• Szperka C. Headache in children and adolescents. Continuum (Minneapolis, Minn.). 2021;27:703-731.
• Oskoui M, et al. Practice guideline update summary: acute treatment of migraine in children and adolescents. Neurology. 2019;93:487-499.
• Oskoui M, et al. Practice guideline update summary: pharmacologic treatment for pediatric migraine prevention. Neurology. 2019;93:500-509.
• Powers SW, et al. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA. 2013;310:2622-2630.
• American Academy of Pediatrics. Headaches: when to call the pediatrician (2019); Head injury in children (2024). HealthyChildren.org.
• American Academy of Pediatrics, Council on Communications and Media. Media use in school-aged children and adolescents. Pediatrics. 2016;138:e20162592.
• Centers for Disease Control and Prevention. HEADS UP: signs and symptoms of concussion; About sleep.
• National Institute of Neurological Disorders and Stroke. Reye's syndrome. MedlinePlus. Reye syndrome.
• U.S. Department of Education, Office for Civil Rights. Frequently asked questions: Section 504 and free appropriate public education. Individuals with Disabilities Education Act regulations, 34 CFR 300.8.
• American Migraine Foundation. Pediatric migraine: a primer for teachers and school nurses (2020); Understanding pediatric migraine (2018); Treatment of migraine in children (2017); Experts answer FAQ on migraine in children (2022).