Children can get migraines

Of all the memories that linger from my childhood, the most vivid are those that correlate with a migraine headache. Vomiting in the school bathroom. Lectured by a well-intentioned but ignorant principal to suck it up and play through the pain. Resting my aching head on the cold tile floor of my second-grade classroom as I wait for my mother to pick me up from school. Leaving a friend's slumber party early, in tears.

You'd think that after 40 years of migraines I'd be an expert in diagnosing the illness in others. But when my own son began complaining of headaches a couple of years ago at age 5, I didn't know how to address it. All he could tell me was that his head hurt. He wasn't sobbing or vomiting, as I did as a child, so I wasn't sure of the best plan of action. Was he in the throes of a migraine attack?

According to the American Academy of Pediatrics, "Any child can get a migraine. About 10 % of children age 5 to 15 and up to 28% of teens get them."

The odds increase if there is a family history of the affliction. The American Migraine Foundation says that if one or both parents suffer from migraine, there is a 50% to 75% chance that the child will inherit it.

But what makes migraine so challenging, particularly in children, is that migraineurs can experience symptoms differently. One child might have visual disturbances before a headache, while another might feel only pain in the stomach, with no head pain at all. These variations make it all the harder for parents to know the severity of the situation.

Even with my own history - first migraine at age 4, first medication prescribed by a neurologist at 12 and a family history of migraine on my mother's side - I can't say definitively that my son is suffering from migraine during one of his headaches.

When a child can't adequately describe what they're feeling, it's difficult for parents to know if the headache is indicative of a more serious condition. When is stomach pain really a sign of migraine? At what point should the child's pediatrician be consulted? Should the child see a neurologist?

John Gaitanis, chief of pediatric neurology at Floating Hospital for Children at Tufts Medical Center, says that typically, migraine in children starts small and can be preceded by an aura - a sensory disturbance that can include flashing lights, black spots or colors - and nausea. Then a headache builds in intensity until it plateaus out and lingers for anywhere from 90 minutes to four hours, with two hours being the average.

"If you have all those features, then it's overwhelmingly likely it's migraine," Gaitanis says. "But when you start to take away some of those features, then your probability changes a little bit, so you have to explore all different headache options."

To further complicate the issue, younger children between the ages of 5 and 9 can exhibit subtypes of migraine. One, called abdominal migraine, affects the stomach but not the head, and according to the American Migraine Foundation "consists of episodes of abdominal pain that may be accompanied by nausea, vomiting, loss of appetite or loss of facial color." The pain is typically in the middle of the abdomen around the bellybutton and can last from two hours to three days.

The other, cyclic vomiting syndrome, is defined by the Mayo Clinic as episodes of severe vomiting, with no apparent cause, that can last for days. Often, children who suffer from either condition begin to get the more familiar migraine head pain once they enter their teens.

With such a wide array of symptoms, parents might not know when to seek medical help. Elizabeth Leleszi, medical director of the Beaumont Children's Headache Center, says they should pay attention to their instincts.

"The first rule of pediatrics, I learned long ago, is that the parents are 99.99% right," Leleszi says. "So, if something is just not right, bringing that to the attention of the pediatrician, family practitioner or their primary care provider is very important."