When Lyz Lenz got her first migraine at age 17, her doctor’s failure to take her seriously was almost as crushing as the pain itself.
“It was horrible and scary,” Lenz says. “No one believed how bad it hurt. I was told it was my period.”
When Lenz sought emergency medical care, she still couldn’t get a proper diagnosis.
“When my mom finally took me to the ER, the doctors were convinced I was on drugs,” she says. “Almost every doctor until my current one had me chart my periods and my migraines. There was never a correlation.”
Now in her 30s, Lenz says she has her migraines under control.
Diane Selkirk experienced something similar with her doctors. She says they thought epilepsy was at the root of her headaches. “I used to bang my head on the crib,” she says. “My parents were told kids don’t get headaches.”
Selkirk was later put under the care of a doctor who also experienced migraines. Selkirk says she was finally diagnosed around age 11.
Still, they took a toll in her teen years, causing her to miss school and social activities. “If I got overly excited or stressed, I tended to get a headache and often ended up vomiting,” she recalls. “I also had trouble with dances and plays, because the lights tended to trigger me.”
Lenz and Selkirk aren’t alone in having migraines as teenagers and having trouble getting diagnosed. Learn why this is and how you can help your teenager get the help they may need.
What Is a Migraine?
A migraine isn’t just a headache. It’s a debilitating collection of neurological symptoms that usually includes an intense, throbbing pain on one side of the head. It generally lasts from four to 72 hours, but it can last much longer.
Migraines are often accompanied by the following symptoms:
- visual disturbances
- extreme sensitivity to sound, light, touch, and smell
- tingling or numbness in the extremities or face
Sometimes, a migraine is preceded by a visual aura, which may include losing part or all of your vision for a short period. You may also see zigzags or squiggly lines.
Other types of headaches are generally less severe, are rarely disabling, and usually aren’t accompanied by nausea or vomiting.
How Do Migraines Affect Teenagers?
“Migraine headaches can impact school performance and attendance, social and family interactions, and quality of life in general,” says Eric Bastings, M.D., deputy director of the Division of Neurology Products in the U. S. Food and Drug Administration’s Center for Drug Evaluation and Research.
It’s estimated that up to 10 percent of school-aged children have migraines. By the time they turn 17, up to 8 percent of boys and 23 percent of girls have experienced a migraine. More than 50 percent of people report migraines after age 30.
“It’s important that people realize that children and adolescents have migraines,” says Amy Gelfand, M.D., a pediatric neurologist at the University of California San Francisco Headache Center. “It’s one of the more common problems for children.”
She says, “There’s a lot of stigma around children and migraines. People think they’re faking, but for some children and adolescents it can be quite a disabling problem.”
In adolescents, migraines affect young women more than young men. This may be because of a change in estrogen levels.
“It is fairly common for migraines to begin in puberty,” Gelfand says. “A migraine can be activated any time there’s a lot of change going on.”
Eileen Donovan-Kranz says that her daughter had her first migraine when she was in eighth grade. She says her daughter spent much of time after school lying down in her room.
“We were able to put her on a 504 plan for school, but individual teachers were not always helpful,” Donovan-Kranz says. “Because she was well much of the time, and very out of it or sick and in pain at other times, she was sometimes penalized for inconsistency.”
Her daughter is now 20 years old. Although her migraines have decreased in frequency, they still occur.
What Are the Symptoms of a Migraine in Children and Teens?
For children and teens, sensitivity to light and sound are two telltale symptoms of an impending migraine. Migraines also tend to be bilateral at this age. This means that the pain is present on both sides of the head.
Generally, migraines are also shorter for people in this age group. The average adolescent migraine lasts about two hours.
Adolescents often experience chronic daily migraine, which is one of the most disabling types. This means that they experience 15 or more “headache days” per month. Each headache day is characterized by a migraine that lasts more than four hours.
This recurrence must happen for more than three months for the condition to be considered chronic.
Chronic migraines can lead to:
- sleep disturbances
- difficulty concentrating
What Triggers Migraines?
Although researchers haven’t figured out what exactly causes migraines, they’ve identified several potential triggers.
The most common triggers are:
- inadequate or altered sleep
- skipping meals
- weather changes
- bright lights
- loud noises
- strong odors
Common food and drink triggers include:
- alcohol, especially red wine
- caffeine withdrawal
- too much caffeine
- foods that contain nitrates, such as hot dogs and lunch meats
- foods that contain monosodium glutamate, which is a flavor enhancer found in fast foods, broths, seasonings, spices, Chinese food, and Ramen noodles
- foods that contain tyramine, such as aged cheeses, soy products, fava beans, and hard sausages
- sulfites, which are chemicals that are commonly used as preservatives
- aspartame, which is found in sweeteners such as NutraSweet and Equal
Other foods sometimes considered to trigger migraines include:
- tannins and phenols in black tea
- apple skins
Ask your teen to record the frequency and intensity of their migraines in a journal. They should also take note of what they were doing at the time the migraine started, whether that’s playing in the snow or eating fast food. By taking note of their surroundings or current behavior, they may be able to identify patterns or triggers.
Your teen should also track any supplements and medications that they take. These often contain inactive ingredients that can trigger migraines.
How Are Migraines Diagnosed?
A study of teens with frequent migraine headaches showed that depression is the strongest risk factor for headache-related disability. Stress is also viewed as a headache trigger but a manageable one.]
If one parent has migraines, there’s a 40 percent chance a child will, too. If both parents have migraines, this chance rises to 90 percent. Because of this, your family history may be able to help guide your doctor to a diagnosis.
Before diagnosing a migraine, your doctor will perform a full physical and neurological exam. This includes checking your teen’s:
Ask your teen to keep a migraine journal for at least a few weeks before the appointment. They should record:
- the date
- the time
- a description of the pain and symptoms
- medication or action taken to relieve the pain
- the time and nature of the relief
This may be helpful because the doctor will want to know:
- a description of the pain, including the location, nature, and timing
- the severity
- the frequency and duration of episodes
- identifiable triggers
How to Treat Migraine Pain
A parent’s migraine history can be helpful in saving an adolescent from not being believed. Selkirk’s daughter Maia, 14, started getting migraines at the onset of puberty. Selkirk says she was able to help her daughter by recognizing early symptoms and treating them based on her own experience.
“When she gets a migraine, I give her an electrolyte drink, put her feet in hot water, and ice the back of her neck,” she says. Although this isn’t a medically recognized treatment, she says it’s helpful.
If this doesn’t help, she says Maia will take an Advil and lay down in the dark until she feels better.
“I think having a variety of tricks and skills does really help,” Selkirk says. “I've learned not to let a migraine get entrenched but to deal with it as soon as the first symptoms start to appear.”
Over-the-Counter Pain Relievers
Over-the counter pain medications usually work for milder migraines. These include non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Motrin) and pain relievers such as acetaminophen (Tylenol and others).
Excedrin Migraine, which is a combination of acetaminophen, aspirin, and caffeine, may also ease moderate migraine pain. Some NSAIDS are also available by prescription.
Prescribed Pain Relievers
In 2014, the FDA approved topiramate (Topamax) for prevention of migraine headaches in adolescents ages 12 to 17. This is the first FDA approved drug for migraine prevention in this age group. It was approved for migraine prevention in adults in 2004.
Triptans are also effective for more severe migraines. These work by promoting constriction of blood vessels and blocking pain pathways in the brain.
Gelfand says the following triptans are approved for children and adolescents:
- almotriptan (Axert) for ages 12-17
- rizatriptan (Maxalt) for ages 6-17
- zolmitriptan (Zomig) nasal spray for ages 12-17
- sumatriptan/naproxen sodium (Treximet) for ages 12-17
You’ll need to weigh the side effects of these drugs when discussing them with your doctor.
People with migraines may also find relief from many natural remedies. This practice isn’t recommended for children or teenagers due to potential toxicity. A multivitamin is recommended for daily use.
If you want to try natural remedies, the options include:
- coenzyme Q10
- vitamin B-6
- vitamin C
- vitamin D
- vitamin E
Biofeedback involves learning how to monitor and control the body's responses to stress, such as lowering heart rate and easing muscle tension. Other methods, such as acupuncture and relaxation, may also help relieve stress. Counseling also can help if you think your teen’s migraines are related to depression or anxiety.
The best way to decrease the chance of a full-blown migraine is to take pain medications when symptoms begin.
You can also talk to your teen about the pitfalls of overscheduling, which creates pressure and cuts into sleep. Keeping a regular sleep schedule, getting regular exercise, and eating regular meals without skipping breakfast can help prevent migraines.