When Lyz Lenz got her first migraine headache 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 migraine headaches 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 migraine. 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 migraine as teenagers and having trouble getting diagnosed. Learn why this is and how you can help your teenager get the help they may need.
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.
Migraine attacks generally last from 4 to 72 hours, but can last much longer.
Migraine often includes the following symptoms:
- visual disturbances
- nausea
- vomiting
- dizziness
- extreme sensitivity to sound, light, touch, and smell
- tingling or numbness in the extremities or face
Sometimes, migraine attacks are 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.
“Migraine headaches can impact school performance and attendance, social and family interactions, and quality of life in general,” says Eric Bastings, MD, deputy director of the Division of Neurology Products in the U. S. Food and Drug Administration’s Center for Drug Evaluation and Research.
According to the Migraine Research Foundation, up to 10 percent of school-aged children have migraine. By the time they turn 17, up to 8 percent of boys and 23 percent of girls have experienced a migraine headache.
“It’s important that people realize that children and adolescents have migraine,” says Amy Gelfand, MD, a pediatric neurologist at the University of California San Francisco Headache Center. “It’s one of the more common problems for children.”
She continues, “There’s a lot of stigma around children and migraine. People think they’re faking, but for some children and adolescents it can be quite a disabling problem.”
In adolescents, migraine affects young women more than young men. This may be because of a change in estrogen levels.
“It is fairly common for migraine to begin in puberty,” Gelfand says. “A migraine [attack] can be activated any time there’s a lot of change going on.”
Eileen Donovan-Kranz says that her daughter had her first migraine attack when she was in eighth grade. She says her daughter spent much of her 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 migraine attacks have decreased in frequency, they still occur.
For children and teens, sensitivity to light and sound are two telltale symptoms of impending migraine.
Migraine headaches also tend to be bilateral at this age. This means that the pain is present on both sides of the head.
Generally, migraine attacks are also shorter for people in this age group. The average length for adolescents lasts about 2 hours.
Adolescents may experience chronic daily migraine, which is one of the most disabling types. This means that they experience
This recurrence must happen for more than 3 months for the condition to be considered chronic.
Chronic migraine can lead to:
- sleep disturbances
- anxiety
- depression
- difficulty concentrating
- fatigue
Although researchers haven’t figured out what exactly causes migraine, they’ve identified several potential triggers.
The most common triggers are:
- inadequate or altered sleep
- skipping meals
- stress
- weather changes
- bright lights
- loud noises
- strong odors
Common reported food and drink triggers include:
- alcohol, especially red wine
- caffeine withdrawal or 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 some 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 migraine attacks include:
- chocolate
- tannins and phenols in black tea
- bananas
- apple skins
Ask your teen to record the frequency and intensity of their migraine symptoms in a journal.
They should also take note of what they were doing at the time the migraine attack started and the previous day or so, 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 may contain inactive ingredients that can trigger migraine.
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Because of this, your family history may be able to help guide your doctor to a diagnosis.
Before diagnosing migraine, your doctor will perform a full physical and neurological exam. This includes checking your teen’s:
- vision
- coordination
- reflexes
- sensations
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
- possible triggers
- medication or action taken to relieve the pain
- the time and nature of 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
A parent’s migraine history can be helpful in saving an adolescent from not being believed.
Selkirk’s daughter Maia, 14, started getting migraine headaches 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 migraine pain. These include nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil, Motrin) and pain relievers such as acetaminophen (Tylenol).
Prescription pain medications
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 migraine attacks. 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.
Natural remedies
People with migraine may also seek relief from many natural remedies. This isn’t recommended for children or teenagers due to potential toxicity and limited evidence that they help.
A multivitamin may be recommended for daily use.
If you want to try natural remedies, speak to a doctor about these options:
Biofeedback
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 migraine attacks are accompanied by depression or anxiety.
The best way to decrease the chance of a full-blown migraine attack 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 migraine headaches.