Apr
27

Migraine in the Adolescent Patient Overview

Learn about the diagnosis, symptoms and treatment of migraine specifically for your adolescent patients.

Although migraine is a common chronic disease among adolescents, recognizing and diagnosing migraine can be difficult for this population. That’s because teenagers sometimes experience a shorter duration of migraine with symptoms different from those found in adult patients. However, adolescent migraine can still be disabling and prevent teens from being able to attend and participate in school and perform daily physical and social activities.

Primary care providers will need to recognize the signs of migraine in teens and select proper treatment options to eliminate head pain. They can apply lifestyle modifications and therapeutic interventions to reduce the frequency and severity of migraine attacks to maximize adolescent patients’ quality of life. This overview provides information about the diagnosis, symptoms and treatment of adolescent migraine.

Diagnosing Migraine in Teens

Diagnosing migraine in adolescent patients is especially challenging because symptoms can vary between individuals and at different ages. Head pain may not be the strongest indication of adolescent migraine. Symptoms like vomiting and abdominal pain may be more severe and recognizable. A useful way to recognize migraine in teens is to talk to the patients and observe their behavior. Primary care providers can look for clues of migraine by observing whether adolescents’ behavior corresponds to some symptoms of migraine and talking to them about how they feel, how they react to treatments and how the pain affects their daily lives.

Because adolescent migraine can occur with symptoms like abdominal pain, vomiting and vertigo, it is hard but important to distinguish between migraine and differential diagnoses such as tumors, metabolic disorders and gastrointestinal disorders. When necessary, refer the patient to a neurologist or headache specialist for diagnosis.

Recognizing the Symptoms of Adolescent Migraine

To assist the diagnosis of migraine, primary care providers will need to identify adolescent migraine symptoms. In general, migraine attacks in teens tend to have a shorter duration than migraine in adults. Adolescent migraine attacks normally continue for two to 72 hours but can be as short as one hour. Teens often experience bilateral headaches, sensitivity to light and loud sounds, nausea, vomiting, abdominal pain and vertigo. Other possible symptoms include lightheadedness, difficulty thinking and focusing, and fatigue.

Aura symptoms can occur before the head pain. Teens can experience visual, sensory and hearing disturbance, loss of muscle control and difficulty speaking. Learn more about the diagnosis and symptoms of adolescent migraine.

The Treatment of Adolescent Migraine

Migraine often requires long-term therapy that includes both therapeutic medications and behavior modifications to control migraine pain and reduce the frequency of migraine episodes. This overview will briefly introduce acute therapy, preventive therapy and lifestyle techniques that are helpful to eliminate head pain and improve life quality.

Acute Therapy

Acute medications, also known as rescue medications, can reduce the duration and severity of migraine attacks and prevent the progression of symptoms. Ideally, acute therapy will eliminate the head pain and other symptoms of migraine within one to two hours. Individuals with migraine should take these medications at the first indication of migraine, preferably within 30 minutes of onset. In addition to taking medication, resting or sleeping in a dark, quiet room may be beneficial. Medication is most effective when used in combination with lifestyle modifications and proper patient education.

Preventive Therapy

For frequent headaches (more than four attacks per month), especially chronic daily headaches (more than 15 headache days per month), preventive therapies could be an option. The goal of preventive therapies is to reduce headache frequency and/or severity and to reduce headache-related functional disability. Preventive treatments are most effective alongside lifestyle modification, co-morbidity management and cognitive behavioral therapy.

Historically, the preventive medications recommended for teens were those known to be effective in reducing headache frequency in adults. Our guide includes the specific medications commonly used to help with reducing the headache burden in children and adolescents, but much of their use has been extrapolated from studies in adults.

Lifestyle Changes

Identifying specific triggers, exacerbating and relieving factors unique to each individual, is a key aspect of controlling migraine pain. The SMART (Sleep, Meals, Activity, Relaxation, Triggers) daily tips may be beneficial in preventing and/or reducing the frequency of migraine episodes.

Sleep

  • Regular bedtime routine with consistent sleep times (even on weekends)
  • Limit naps
  • No screen time one to two hours before bedtime
  • Aim for nine to 11 hours of sleep each night
  • If having difficulty falling asleep, can use melatonin 5-10 mg to help with sleep onset (Note: should be taken 30-60 minutes before the desired bedtime)

Meals (Nutrition and Hydration)

  • Consistent meals daily, no skipping meals (especially breakfast)
  • Snacks as needed
  • Aim to drink body weight equivalent in water per day (each kilogram of body weight equals one ounce of water)
  • Bring a water bottle to school to ensure consistent hydration throughout the day
  • If consuming high sugar electrolyte drink, dilute with half water

Activity

  • At least 30 minutes of physical activity three to five days per week, heart rate should be raised. May increase duration and intensity of exercise as tolerated
  • Limit screen time to two hours or less per day

Relaxation

  • Relaxation training and biofeedback programs reduce stress and/or anxiety (mindfulness apps, deep breathing techniques, yoga, etc.)
  • Counter-stimulation using a strong (more tolerable) stimulus during a migraine to distract from pain and break the pain cycle (ex: ice pack to forehead or back of the neck, strong mint or sour candy on tongue)

Triggers

  • Recognize and eliminate triggers including dietary, environmental, medication, physical, hormonal, behavioral (ex: specific foods, irregular meals, odors, weather changes, stress, poor sleep habits, menstrual cycle, etc.)
  • Keep a headache log to identify triggers and track response to the above measures

Download specific information on the medication, mechanism of action, dosing and frequency, side effects, contraindications and warnings of adolescent migraine treatment.

Primary care practitioners are essential to identifying and treating headache disorders. The American Headache Society’s First Contact – Headache in Primary Care program provides educational resources to empower healthcare professionals and improve headache and migraine care. Learn more about the program here.

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