Migraines in Children: Signs, Triggers, Treatment

What is a pediatric migraine?

A pediatric migraine is migraine in a child or teen: a brain condition marked by repeated attacks of headache and other symptoms.⁠¹¹ NINDS describes migraine as a health condition that is more than having a bad headache.⁠¹²

Doctors diagnose it from the pattern of attacks, using the International Headache Society’s criteria. In children and teens these call for at least five attacks lasting 2 to 72 hours, each with at least two of four features (one-sided, pulsing, moderate or severe pain, or pain made worse by activity) and either nausea or vomiting, or sensitivity to both light and sound.⁠^1,2

It matters beyond the pain. Migraine can disrupt a child’s life at home, at school and with friends, and can lower quality of life.⁠¹¹

How common are migraines in children?

Common. A 2023 meta-analysis of 48 studies of 8- to 18-year-olds put migraine at 11%: 8% without aura and 3% with aura, though the studies varied widely.⁠⁴ The 2019 guideline of the American Academy of Neurology (AAN) and the American Headache Society (AHS) cites rates rising with age, from 1% to 3% at ages 3 to 7, to 4% to 11% at ages 7 to 11, and 8% to 23% by age 15.⁠³

Boys and girls are equally likely to have migraine in childhood and early adolescence; by late adolescence it is more common in girls, at a ratio similar to adults.⁠⁴

Can toddlers and babies get migraines?

Yes, though they cannot tell you. NINDS notes that very young children who cannot describe sensitivity to light and noise may refuse to watch television or use a device, or stop playing to lie down in a dark room.⁠¹²

Some migraine-related conditions start in infancy. Episodes in which a baby’s head tilts to one side and then straightens on its own can begin in the first year of life, and babies with colic are more likely to develop migraine later.⁠^13,14

What are the symptoms of migraine in children?

Head pain with nausea, vomiting, or sensitivity to light and sound is the core pattern, but children often show it differently from adults.⁠¹

• Pain on both sides

  More often on both sides of the head than in adults, usually at the front and sides.⁠¹

• Shorter attacks

  An attack can last 2 to 72 hours in children and teens, and time asleep counts toward it.⁠^1,2

• Nausea and vomiting

  Common enough to be a hallmark: the AAP puts vomiting or nausea at 80%.⁠¹⁰

• Light and sound sensitivity

  In young children it may show only in behavior, such as refusing screens or lying down in a dark room.⁠^1,12

• Lying down to sleep

  Most children want to lie down in a dark, quiet room, and many wake up with the migraine gone.⁠¹⁰

• Pallor and dark circles

  In abdominal migraine, pale skin often comes with dark shadows under the eyes.⁠⁶

Some children also have mood changes, food cravings or yawning hours before an attack, and feel exhausted or confused afterward.⁠¹²

How is migraine different in children than in adults?

Attacks can be shorter, the pain is more often on both sides, and the signs may be in behavior rather than words.⁠¹

What does a migraine aura look like in a child?

An aura is a set of temporary nervous system symptoms that build over minutes, usually before the headache. Visual aura is the most common, in over 90% of people with aura, often a zigzag shape that spreads; next come pins and needles, and less often trouble with speech.⁠¹⁵

About one-third of older children and teens with migraine have auras, usually 5 to 60 minutes before the headache.⁠² In children and teens, less typical visual symptoms on both sides may also be an aura.⁠¹⁵

What are the phases of a migraine attack?

NINDS describes four phases, though not everyone has all of them.⁠¹²

1. Prodrome

   A few hours to a few days before: food cravings, mood changes or uncontrollable yawning.⁠¹²

2. Aura

   In some people, about 10 minutes to an hour before the headache, usually lasting no more than an hour.⁠¹²

3. Headache

   The pain and the symptoms that come with it, lasting hours to days.⁠¹²

4. Postdrome

   Exhaustion or confusion afterward, for up to two days.⁠¹²

What are the types of migraine in children?

Migraine without aura is the most common type. The International Headache Society also groups several episodic syndromes, once called the childhood periodic syndromes, that occur in people who have migraine or are more likely to develop it.⁠^5,12

What is abdominal migraine?

Abdominal migraine is a childhood condition of repeated attacks of moderate to severe pain around the navel, with nausea, vomiting or pallor, lasting 2 to 72 hours with no headache and no symptoms in between.⁠⁶ A review puts the average age at diagnosis at 3 to 10 years, peaking at 7, and the prevalence at about 1% to 9%.⁠²⁰

A doctor first rules out stomach and kidney problems, and asks carefully about head pain, since in young children headache is often overlooked.⁠⁶ Most children grow out of the attacks, but most later develop migraine headaches.⁠^6,20

Treatment starts with explanation and reassurance, then avoiding triggers, behavior therapy and diet changes; medicine is considered only if those do not help.⁠²⁰

What is cyclic vomiting syndrome?

It is repeated attacks of intense nausea and vomiting, at least four times an hour, that last from an hour to 10 days, come at predictable intervals at least a week apart, and clear completely in between.⁠¹⁸ It is typically a self-limiting condition of childhood that research links to migraine.⁠¹⁸

What is benign paroxysmal vertigo of childhood?

Brief attacks of vertigo that come without warning and pass on their own, in an otherwise healthy child, often with unsteadiness, vomiting, pallor or fear.⁠¹⁹ Young children may not be able to describe the spinning, so parents may notice only spells of unsteadiness.⁠¹⁹

Read nextBenign paroxysmal vertigo of childhood

What is chronic migraine in children?

Headache on 15 or more days a month for more than 3 months, with migraine features on at least 8 of those days.⁠¹⁷ The most common cause of symptoms that suggest chronic migraine is medication overuse, so a headache diary of at least a month helps sort out the pattern.⁠¹⁷

What causes migraines in children?

Migraine without aura, the most common type, is a neurobiological disorder, the International Headache Society says.⁠^1,12 NINDS explains that migraine head pain happens when nerve signals, brain chemicals and blood vessels are not working properly in the brain.⁠¹²

Family history matters. A family history of migraine raises a child’s risk, and female sex is a risk factor that persists into adulthood.⁠³

Hormones play a part, especially in girls. NINDS calls hormone changes with the menstrual cycle one important trigger and notes that migraine episodes may begin with a first period, in line with migraine becoming more common in girls as they approach adolescence.⁠^4,12

On top of that tendency, attacks often follow triggers: every child in one clinic study could name at least one.⁠⁷

What triggers migraines in children?

Stress and lack of sleep top the list. In a study of 102 children and teens with migraine, every one reported at least one trigger, with an average of 7; the most common were stress (75.5%), lack of sleep (69.6%), warm weather (68.6%) and video games (64.7%).⁠⁷ In 86% of them, attacks typically began within 3 hours of the trigger.⁠⁷

• Too much or too little sleep

  Both are triggers, and poor sleep habits are linked to recurrent headache in teens.⁠^3,12

• Skipped meals

  Low blood sugar or skipped meals can set off an attack.⁠^10,12

• Stress

  The most common trigger children report.⁠⁷

• Bright or flashing light

  Along with loud or sudden noise and strong smells.⁠¹²

• Weather changes

  Sudden changes in the weather or surroundings.⁠¹²

• Hormonal changes

  Around periods and puberty, especially in girls.⁠¹²

Lifestyle matters in teens. Recurrent headache in adolescents is associated with being overweight, caffeine and alcohol use, lack of physical activity, poor sleep habits and tobacco exposure, and the AAN and AHS ask clinicians to counsel families that these factors may influence how often headaches come.⁠³

Do foods trigger migraines in children?

Less often than many families think. A 2020 review found the evidence for diet-related migraine very limited, and advised eating a balanced diet and not skipping meals rather than cutting out foods at random, unless an obvious trigger is found.⁠⁸

How do you find your child’s migraine triggers?

Keep a headache diary. The AAN and AHS suggest one to track how treatment is working, and NINDS lists what to write down after each headache.⁠^2,12

How is migraine diagnosed in children?

From the history and an examination. Recurrent headaches in children are diagnosed clinically rather than by any test.⁠²¹ The doctor asks about the headaches and does physical and neurological exams.⁠¹²

The AAN and AHS recommend diagnosing a specific headache type and asking about warning and aura symptoms, the pattern of the pain, the symptoms that come with it and how much it disrupts the child’s life.⁠² Their summary for families says children and teens with headache should have a diagnostic evaluation with a neurologist or headache medicine specialist.⁠¹¹

Does my child need an MRI or CT scan for migraines?

Usually not. An AAN practice parameter found routine neuroimaging is not indicated in children with recurrent headaches and a normal neurological exam, and NINDS notes that MRI and CT are not usually used to diagnose migraine.⁠^12,21 An EEG is not recommended in the routine evaluation either.⁠²¹

Imaging should be considered when the exam is abnormal or other findings suggest a brain problem. In that review, a headache present for less than a month, no family history of migraine, abnormal exam findings, problems with walking and seizures predicted a mass in the brain.⁠²¹

How do you treat a migraine attack in a child?

Early, while the pain is still mild. The AAN and AHS advise that acute treatments are more likely to work when used early in an attack, and the AAP agrees that the sooner a migraine is treated, the more likely treatment will work.⁠^2,10

1. Medicine at the start. Give the medicine your child’s doctor has recommended as soon as the migraine starts; the guideline names ibuprofen as an initial option.⁠^2,10
2. A dark, quiet room. Rest or a nap in a quiet, dark room; sleep is often the most helpful treatment.⁠^10,12
3. Cool cloth and fluids. A cool cloth or ice pack on the forehead, and plenty of fluids, especially after vomiting.⁠¹²
4. Write it down. Note the attack and what helped in the headache diary.⁠²

Evidence supports ibuprofen and acetaminophen in children and teens, and triptans mainly in teens.⁠²² No acute treatment has been shown to work for migraine nausea or vomiting, so the guideline suggests offering an anti-nausea medicine when vomiting is prominent.⁠^2,22

For attacks that peak fast or come with vomiting, a nasal spray or another non-oral form may work better, and families may need to try more than one medicine to find what works.⁠² Your child’s doctor chooses the medicine and the dose, and the guideline asks clinicians to agree treatment goals with each child and family.⁠²

Which migraine medicines are approved for children and teens?

At the time of the 2019 guideline, four triptans were approved by the FDA for young people: almotriptan from age 12, rizatriptan from 6 to 17, sumatriptan with naproxen from 12, and zolmitriptan nasal spray from 12.⁠² The strongest evidence in teens is for sumatriptan with naproxen tablets and zolmitriptan nasal spray, which made adolescents more likely to be pain-free at 2 hours.⁠^11,22

Who should not take triptans?

Children and teens with a history of ischemic vascular disease, such as stroke, or with a heart conduction pathway disorder such as Wolff-Parkinson-White syndrome, the guideline says.⁠² The FDA also lists hemiplegic migraine and migraine with brainstem aura as contraindications, and the guideline suggests referral to a headache specialist when other treatments fail in these children.⁠²

What is medication overuse headache?

It is headache on 15 or more days a month that develops from regular overuse of headache medicine, on 10 or more or 15 or more days a month depending on the medicine, for more than 3 months, in someone who already has a headache disorder.⁠²³ It usually, but not always, resolves once the overuse stops, and most people improve after the overused medicine is stopped.⁠²³

To prevent it, the AAN and AHS advise counseling families to use ibuprofen or acetaminophen on no more than 14 days a month and triptans on no more than 9 days a month.⁠² They note that overuse has been linked to this headache in adults but has not been well studied in children.⁠²

How can you prevent migraines in children?

Start with habits. Most children do well with treatment of attacks plus behavioral and lifestyle changes, and do not need a preventive medicine or therapy, according to the 2019 AAN and AHS prevention guideline.⁠³

• Enough sleep

  Enough sleep every night; poor sleep habits are linked to recurrent headache in teens.⁠^3,10

• Meals and fluids

  No skipped meals, and plenty to drink.⁠^8,10

• Activity and weight

  Physical activity, and weight loss for children who are overweight, can reduce headaches.⁠³

• Limit caffeine

  Caffeine use is associated with recurrent headache in teens.⁠³

Preventive treatment is worth discussing when headaches are frequent, disrupt daily life, or come with medication overuse.⁠³

Do migraine prevention medicines work for children?

The evidence is weak. The guideline found that most randomized trials of preventive medicines for children did not show them working better than placebo, and that 30% to 61% of children given placebo had their headaches cut by half or more.⁠³

Topiramate is probably, and propranolol possibly, more effective than placebo; the evidence for amitriptyline on its own is insufficient.⁠³ The guideline asks clinicians to share the decision with families and to try a preventive for at least 2 months.⁠³

What did the CHAMP trial find?

The CHAMP trial gave 361 children and teens aged 8 to 17 amitriptyline, topiramate or placebo for 24 weeks, and was stopped early for futility.⁠⁹ Half or more improved in every group: headache days fell by at least half in 52% on amitriptyline, 55% on topiramate and 61% on placebo, with no significant differences.⁠⁹

The two medicines caused more side effects, including tiredness and dry mouth with amitriptyline and tingling and weight loss with topiramate. Three children on amitriptyline had serious mood changes, and one on topiramate attempted suicide.⁠⁹

The lesson is not that nothing helps. Most children improved, and the trial found these two medicines added side effects without adding benefit.⁠^3,9

Does cognitive behavioral therapy help migraines in children?

Yes, in a randomized trial. Among 135 young people aged 10 to 17 with chronic migraine, all taking amitriptyline, those who had cognitive behavioral therapy (CBT) had 11.5 fewer headache days at 20 weeks, against 6.8 fewer with headache education.⁠²⁴

Two-thirds (66%) of the CBT group cut their headache days by half or more, against 36%, and at 12 months the figures were 86% and 69%.⁠²⁴ The guideline adds that CBT alone may be effective.⁠³

RelatedCBT: what parents should know

What safety warnings come with migraine prevention medicines?

Amitriptyline carries an FDA boxed warning about suicidal thoughts and behavior, especially in children, teens and young adults, and the guideline asks clinicians to tell families about this risk.⁠³ Topiramate carries a risk of birth defects and can make combined birth control pills less effective, which the guideline asks clinicians to discuss.⁠¹¹

Are anxiety and depression linked to migraine in children?

Yes. People with migraine more often have depression and anxiety, and the AAN and AHS recommend screening children and teens with migraine for mood and anxiety disorders, because these raise the risk that headaches persist.⁠^3,12 In teens, depression is associated with more headache disability.⁠³

RelatedGeneralized anxiety disorder in childrenManaging anxiety in children

Is it a migraine or sensory overload?

Sometimes it is hard to tell, because sensitivity to light, noise and smells is part of migraine, and bright or flashing lights, loud noises and strong smells are also among the triggers NINDS lists.⁠¹² Our separate guide compares the two and what helps each.

Read nextMigraine or sensory overload? How to tell the differenceSensory over-responsivity

When is a child’s headache an emergency?

When it comes with signs of a problem in the brain or a serious illness. The AAP’s guidance sorts the signs by how fast to act.⁠¹⁰

• Call 911 now

  Your child is hard to wake or passes out, acts or talks confused, or has weakness of an arm or leg on one side.⁠¹⁰

• Go to the ER now

  Walking is unsteady, the neck is stiff, the pain is severe and constant, or a severe migraine continues after migraine medicine and sleep.⁠¹⁰

• Call the doctor now

  Vomiting, blurred or double vision, or your child looks or acts very sick.⁠¹⁰

• Call within 24 hours

  Fever, sinus pain over the forehead, or swelling around the eye with pain.⁠¹⁰

Doctors also look harder for another cause when there is a sudden change in headaches, swelling of the optic nerve (papilledema), focal neurological signs, or seizures.⁠²

A headache after a head injury follows different advice: severe, deeper or whole-head pain after an injury needs to be seen.⁠¹⁰

RelatedConcussion in childrenSeizures in children

When should you call your child’s doctor about headaches?

During office hours, call if you suspect migraine that has never been diagnosed, headaches are a frequent problem, a headache without other symptoms lasts more than 24 hours, or any headache lasts more than 3 days.⁠¹⁰

Related on DrSensory

• Migraine or sensory overload?

  The signs that separate the two, and when head pain needs care today.

• Benign paroxysmal vertigo of childhood

  Sudden dizzy episodes in young children, and what must be ruled out.

• Concussion in children

  What to do after a head injury, and how recovery works.

• Seizures in children

  What to do during a seizure, and when it is an emergency.

• Vestibular disorders

  How the causes of dizziness are told apart, and when it is urgent.

• Sensory over-responsivity

  Signs sense by sense, and what helps.

• Generalized anxiety disorder

  Signs by age, causes, screening and treatment in children.

• Managing anxiety in children

  How to help an anxious child at home, and when to seek treatment.

• Medical and physical conditions

  The hub for neurological and physical conditions in children.

Sources

1. International Headache Society. 1.1 Migraine without aura. The International Classification of Headache Disorders, 3rd edition (ICHD-3), 2018. Checked October 23, 2026.
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   “At least five attacks”; “Headache has at least two of the following four characteristics”: “unilateral location”, “pulsating quality”, “moderate or severe pain intensity”, “aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs)”; during headache “nausea and/or vomiting” or “photophobia and phonophobia”; “In children and adolescents (aged under 18 years), attacks may last 2-72 hours (the evidence for untreated durations of less than two hours in children has not been substantiated)”; “Migraine headache in children and adolescents (aged under 18 years) is more often bilateral than is the case in adults; unilateral pain usually emerges in late adolescence or early adult life”; “Migraine headache is usually frontotemporal. Occipital headache in children is rare and calls for diagnostic caution”; “In young children, photophobia and phonophobia may be inferred from their behaviour”; “It is now clear that migraine without aura is a neurobiological disorder”.
2. American Academy of Neurology. AAN Practice Guideline Summary for Clinicians: Acute Treatment of Migraine in Children and Adolescents. 2019. Checked October 23, 2026.
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   The AAN and American Headache Society guideline update of 2019: “Diagnostic criteria for pediatric migraine include at least 5 headaches over the past year that last 2–72 hours when untreated”; “The time a child sleeps can be considered part of the headache duration”; “Auras typically occur in about one-third of older children and adolescents and precede the headache by 5–60 minutes”; “Patients with signs and symptoms of secondary headache, such as sudden change in headache, papilledema, focal deficits, and the additional presence of seizures, require further evaluation beyond a thorough history and physical examination”; “clinicians should diagnose a specific headache type (primary, secondary, or other headache syndrome)”; “Clinicians should counsel that acute migraine treatments are more likely to be effective when used earlier in the migraine attack, when pain is still mild”; clinicians should prescribe ibuprofen “as an initial treatment option to reduce pain in children and adolescents with migraine”; ; the triptans “approved by the Food and Drug Administration (FDA) for use in children” were almotriptan (12 years and older), rizatriptan (6 to 17 years), sumatriptan/naproxen (12 years and older) and zolmitriptan nasal spray (12 years and older); “Clinicians should counsel patients and families that a series of medications may need to be used to find treatments that most benefit the patient”; “Clinicians may prescribe a nonoral route when headache peaks in severity quickly, is accompanied by nausea and/or vomiting, or oral formulations fail to provide pain relief”; “For children and adolescents with migraine who experience prominent nausea and/or vomiting, clinicians should offer additional antiemetic treatments”; “Clinicians should make collaborative agreements with children and adolescents with migraine and their families on treatment goals that are individualized to the patient”; “Clinicians may counsel children and adolescents with migraine and their families to maintain a headache diary to monitor their response to treatments”; “Clinicians should counsel patients and families to use no more than 14 days of ibuprofen or acetaminophen per month, no more than 9 days of triptans per month”; “Overuse of medication to treat acute attacks has been associated with medication overuse headache in adults” but “has not been well studied in children”; “Clinicians must not prescribe triptans to those with a history of ischemic vascular disease or accessory conduction pathway disorders”; including “Wolff-Parkinson-White syndrome”; “According to the FDA, triptans are contraindicated in those with a history of hemiplegic aura or migraine with brainstem aura”; “Clinicians may consider referral of children and adolescents with hemiplegic migraine or migraine with brainstem aura who do not respond to other treatments to a headache specialist”.
3. Oskoui M, Pringsheim T, Billinghurst L, et al. Practice guideline update summary: pharmacologic treatment for pediatric migraine prevention. Neurology. 2019;93(11):500–509. doi:10.1212/WNL.0000000000008105 (PMID 31413170; PMC6746206). Checked October 23, 2026.
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   A guideline of the American Academy of Neurology and the American Headache Society. “Migraine is common in children and adolescents, with a prevalence of 1%–3% in 3- to 7-year-olds, 4%–11% in 7- to 11-year-olds, and 8%–23% by age 15 years”; “Most children benefit from acute migraine treatments along with behavioral and lifestyle changes for headache prevention and do not require additional pharmacologic or biobehavioral preventive treatment”; “Individuals with a family history of migraine are at higher risk of developing migraine, and female sex is a risk factor of migraine that persists into adulthood”; “Recurrent headache in adolescents is associated with being overweight, caffeine and alcohol use, lack of physical activity, poor sleep habits, and tobacco exposure”; “Depression is associated with higher headache disability in adolescents”; “Weight loss can contribute to headache reduction in children who are overweight”; “Clinicians should counsel patients and families that lifestyle and behavioral factors may influence headache frequency (Level B)”; “Clinicians should discuss the potential role of preventive treatments in children and adolescents with frequent headache or migraine-related disability or both (Level B)”; “Clinicians should discuss the potential role of preventive treatments in children and adolescents with medication overuse (Level B)”; “The majority of randomized controlled trials studying the efficacy of preventive medications for pediatric migraine fail to demonstrate superiority to placebo”; “with 30%–61% of children who received placebo having had a 50% or greater reduction in headache frequency”; “Children with migraine receiving propranolol are possibly more likely than those receiving placebo to have an at least 50% reduction in headache frequency”; “Children and adolescents receiving topiramate and cinnarizine are probably more likely than those receiving placebo to have a decrease in headache frequency”; “There is insufficient evidence to judge the independent effectiveness of amitriptyline on migraine prevention in children and adolescents”; “clinicians should engage in shared decision-making regarding the use of short-term treatment trials (a minimum of 2 months) for those who could benefit from preventive treatment (Level B)”; “A Food and Drug Administration (FDA) black box warning regarding risk of suicidal thoughts and behavior with amitriptyline use especially in children, adolescents, and young adults is in effect at the time of this guideline”; “inform patients of the potential side effects of amitriptyline including risk of suicide”; “It is possible that CBT alone is effective in migraine prevention”; “Children and adolescents with migraine should be screened for mood and anxiety disorders because of the increased risk of headache persistence (Level B)”.
4. Onofri A, Pensato U, Rosignoli C, et al. Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis. Journal of Headache and Pain. 2023;24(1):8. doi:10.1186/s10194-023-01541-0 (PMID 36782182; PMC9926688). Checked October 23, 2026.
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   In 8- to 18-year-olds, “we identified 48 studies that fulfilled our inclusion criteria”; “The pooled prevalence of primary headaches was 11% for migraine overall”; “8% for migraine without aura (MwoA)”, “3% for migraine with aura (MwA)”; “In childhood and early adolescence, boys and girls are equally likely to be affected by migraine, but in late adolescence the prevalence of migraine is higher in girls, with a ratio similar to that seen in adults”; “even if flawed by a high degree of heterogeneity”.
5. International Headache Society. 1.6 Episodic syndromes that may be associated with migraine. The International Classification of Headache Disorders, 3rd edition (ICHD-3), 2018. Checked October 23, 2026.
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   Previously “Childhood periodic syndromes”; “This group of disorders occurs in patients who also have 1.1 Migraine without aura or 1.2 Migraine with aura , or who have an increased likelihood to develop either of these disorders”; “Although historically noted to occur in childhood, they may also occur in adults”.
6. International Headache Society. 1.6.1.2 Abdominal migraine. The International Classification of Headache Disorders, 3rd edition (ICHD-3), 2018. Checked October 23, 2026.
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   “An idiopathic disorder seen mainly in children as recurrent attacks of moderate to severe midline abdominal pain, associated with vasomotor symptoms, nausea and vomiting, lasting 2-72 hours and with normality between episodes. Headache does not occur during these episodes”; “At least five attacks of abdominal pain”; “midline location, periumbilical or poorly localized”; “anorexia”, “nausea”, “vomiting”, “pallor”; “Complete freedom from symptoms between attacks”; “In young children the presence of headache is often overlooked”; “Pallor is often accompanied by dark shadows under the eyes”; “Most children with abdominal migraine will develop migraine headache later in life”.
7. Neut D, Fily A, Cuvellier JC, Vallée L. The prevalence of triggers in paediatric migraine: a questionnaire study in 102 children and adolescents. Journal of Headache and Pain. 2012;13(1):61–65. doi:10.1007/s10194-011-0397-2 (PMID 22042255; PMC3253155). Checked October 23, 2026.
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   “at least one migraine trigger was reported by the patient and/or was the parents’ interpretation in 100% of patients”; “The mean number of migraine triggers reported per subject was 7”; “Mean time elapsed between exposure to a trigger factor and attack onset was comprised between 0 and 3 h in 88 patients (86%)”; “The most common individual trigger was stress (75.5% of patients), followed by lack of sleep (69.6%), warm climate (68.6%) and video games (64.7%)”.
8. Yamanaka G, Morichi S, Suzuki S, et al. A review on the triggers of pediatric migraine with the aim of improving headache education. Journal of Clinical Medicine. 2020;9(11):3717. doi:10.3390/jcm9113717 (PMID 33228144; PMC7699367). Checked October 23, 2026.
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   “While there is a gradual uptick in research supporting the association between migraine, stress, and sleep, the evidence for diet-related migraines is very limited”; “Unless obvious dietary triggers are defined, clinicians should counsel patients to eat a balanced diet and avoid skipping meals rather than randomly limiting certain foods”.
9. Powers SW, Coffey CS, Chamberlin LA, et al. Trial of amitriptyline, topiramate, and placebo for pediatric migraine. New England Journal of Medicine. 2017;376(2):115–124. doi:10.1056/NEJMoa1610384 (PMID 27788026; PMC5226887). Checked October 23, 2026.
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   The CHAMP trial, in “children and adolescents 8 to 17 years of age with migraine”; “A total of 361 patients underwent randomization”; “The trial was concluded early for futility after a planned interim analysis”; “There were no significant between-group differences in the primary outcome, which occurred in 52% of the patients in the amitriptyline group, 55% of those in the topiramate group, and 61% of those in the placebo group”; “a relative reduction of 50% or more in the number of headache days” over “a 24-week trial”; “Patients who received amitriptyline or topiramate had higher rates of several adverse events than those receiving placebo, including fatigue (30% vs. 14%) and dry mouth (25% vs. 12%) in the amitriptyline group and paresthesia (31% vs. 8%) and weight loss (8% vs. 0%) in the topiramate group”; “Three patients in the amitriptyline group had serious adverse events of altered mood, and one patient in the topiramate group had a suicide attempt”; and, in the introduction of the PMC author manuscript, “The majority continue to have headaches into adulthood”.
10. American Academy of Pediatrics, HealthyChildren.org. Headache (symptom checker, Barton Schmitt, MD, FAAP). Checked October 23, 2026.
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    Call 911 now: “Hard to wake up or passed out”, “Acts or talks confused”, “Weakness of arm or leg on one side of the body”; go to the ER now: “Walking is not steady”, “Stiff neck (can't move neck normally)”, “Severe constant pain (child not able to move or do anything)”, “Severe migraine that persists after migraine medicines and going to sleep”; call the doctor now: “Vomiting”, “Blurred vision or seeing double”, “Your child looks or acts very sick”; within 24 hours: “Fever”, “Sinus pain (not just congestion) of forehead”, “Swelling around the eye with pain”; during office hours: “Headache without other symptoms lasts more than 24 hours”, “Migraine headache suspected, but never diagnosed”, “Any headache lasts more than 3 days”, “Headaches are a frequent problem”; “Vomiting or nausea is present in 80%”; “Most children want to lie down in a dark, quiet room”; “Migraines most often run in the family (genetic)”; “Muscle tension headaches give a feeling of tightness around the head”; “The neck muscles also become sore and tight”; “They are throbbing and often occur just on one side”; “Lights and sound make them worse”; “Caffeine is present in some pain meds and may play a role”; head injury: “Severe, deeper or entire-head pain needs to be seen”; “skipping a meal can cause a headache in many children”; “The sooner a migraine headache is treated, the more likely the treatment will work”; “Often the most helpful treatment is going to sleep”; “People with a migraine often wake up from sleep with their migraine gone”; ibuprofen “is the best over-the-counter drug for migraines”; “With treatment, migraine headaches usually go away in 2 to 6 hours”; “Children with a true migraine headache are not able to stay in school”; for tension headaches “they should take a pain medicine and go to school”.
11. American Academy of Neurology. Practice Guideline Update: Acute and Preventive Treatment of Migraine in Children and Adolescents. Summary for Patients and Their Families. 2019. Checked October 23, 2026.
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    “Children and adolescents with headache should have a diagnostic evaluation with a neurologist or headache medicine specialist”; “Migraine is a brain disease that is marked by episodes of attacks of headaches and other symptoms”; “It can disrupt life activities, such as participation in home, school, and social functions, and can have a negative effect on quality of life”; “There is strong evidence that combination sumatriptan/naproxen oral tablets and zolmitriptan nasal spray are effective at stopping headache pain in adolescents within two hours”; “Counseling patients about the risk of birth defects associated with the use of topiramate and the potential for this drug to decrease the effectiveness of oral combined hormonal contraceptives”; “This guideline was endorsed by the Child Neurology Society and the American Academy of Pediatrics”.
12. National Institute of Neurological Disorders and Stroke. Migraine. Checked October 23, 2026.
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    “Migraine is a health condition that is more than having a bad headache”; “Current research shows that migraine-associated head pain happens when nerve signals, brain chemicals, and blood vessels aren’t working properly in the brain”; “Very young children who aren’t able to describe their symptoms, like sensitivity to light and noise, might refuse to watch television or use an electronic device”, “or they may stop playing to lie down in a dark room”; the prodrome “can happen a few hours to a few days before an episode starts”, with “food cravings, unexplained mood changes such as feeling unexpectedly sad or very happy, uncontrollable yawning”; “Auras appear about 10 minutes to an hour before the actual episode, and usually last no more than an hour”; “The headache phase can last from hours to days”; “People are usually exhausted or confused after a migraine episode”; “The postdrome phase may last up to two days before people feel healthy again”; “The most common type of migraine is migraine without aura”; “Hemiplegic migraine is a rare and severe form of migraine”; “Menstrual migraine happens on the first day of a person’s menstrual cycle for at least two out of three cycles”; triggers include “Sudden changes in the weather or a person’s environment”, “Too much or not enough sleep”, “Strong smells”, “Loud or sudden noises”, “Low blood sugar or skipped meals”, “Hormonal changes” and “Bright or flashing lights”; “Hormone changes that happen with the menstrual cycle or pregnancy seem to be one important trigger for migraine”; “Migraine episodes may begin during a person’s first menstrual period”; “People living with migraine more commonly experience mental health conditions (such as depression and anxiety)”; “Imaging tests, such as an MRI or CT scan, aren’t usually used to diagnose migraine”; a doctor “may also ask specific questions about headaches”; the headache journal records “The time of day when it happened”, “How intense it was and how long it lasted”, “Any medicines taken, including both prescription and over-the-counter”, “The quality and length of the previous night’s sleep” and “Food and drinks consumed in the previous 24 hours”; quick steps: “Napping or resting in a quiet, dark room”, “Putting a cool cloth or ice pack on the forehead”, “Drinking lots of fluid, especially if a migraine episode includes vomiting”; “Small amounts of caffeine may help relieve symptoms during a migraine episode's early stages”.
13. International Headache Society. 1.6.3 Benign paroxysmal torticollis. The International Classification of Headache Disorders, 3rd edition (ICHD-3), 2018. Checked October 23, 2026.
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    “Recurrent episodes of head tilt to one side, perhaps with slight rotation, which remit spontaneously. The condition occurs in infants and small children, with onset in the first year”; “may evolve into 1.6.2 Benign paroxysmal vertigo or 1.2 Migraine with aura”.
14. International Headache Society. A1.6.4 Infantile colic (appendix). The International Classification of Headache Disorders, 3rd edition (ICHD-3), 2018. “Excessive, frequent crying in a baby who appears to be otherwise healthy and well fed”; “Infants with colic have a higher likelihood of developing 1.1 Migraine without aura or 1.2 Migraine with aura later in life”. Checked October 23, 2026.
15. International Headache Society. 1.2 Migraine with aura. The International Classification of Headache Disorders, 3rd edition (ICHD-3), 2018. Checked October 23, 2026.
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    “Recurrent attacks, lasting minutes, of unilateral fully-reversible visual, sensory or other central nervous system symptoms that usually develop gradually and are usually followed by headache and associated migraine symptoms”; “Visual aura is the most common type of aura, occurring in over 90% of patients with 1.2 Migraine with aura , at least in some attacks”; “It often presents as a fortification spectrum: a zigzag figure near the point of fixation that may gradually spread right or left”; “In children and adolescents, less typical bilateral visual symptoms occur that may represent an aura”; “Next in frequency are sensory disturbances, in the form of pins and needles”; “Less frequent are speech disturbances”.
16. International Headache Society. 1.2.3 Hemiplegic migraine. The International Classification of Headache Disorders, 3rd edition (ICHD-3), 2018. “Migraine with aura including motor weakness”; “fully reversible motor weakness”. Checked October 23, 2026.
17. International Headache Society. 1.3 Chronic migraine. The International Classification of Headache Disorders, 3rd edition (ICHD-3), 2018. Checked October 23, 2026.
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    “Headache occurring on 15 or more days/month for more than 3 months, which, on at least 8 days/month, has the features of migraine headache”; “The most common cause of symptoms suggestive of chronic migraine is medication overuse”; “Characterization of frequently recurring headache generally requires a headache diary to record information on pain and associated symptoms day-by-day for at least one month”.
18. International Headache Society. 1.6.1.1 Cyclical vomiting syndrome. The International Classification of Headache Disorders, 3rd edition (ICHD-3), 2018. Checked October 23, 2026.
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    “Recurrent episodic attacks of intense nausea and vomiting, usually stereotypical in the individual and with predictable timing of episodes. Attacks may be associated with pallor and lethargy. There is complete resolution of symptoms between attacks”; “nausea and vomiting occur at least four times per hour”; “attacks last for ≥1 hour, up to 10 days”; “attacks occur ≥1 week apart”; “is typically a self-limiting episodic condition occurring in childhood”.
19. International Headache Society. 1.6.2 Benign paroxysmal vertigo. The International Classification of Headache Disorders, 3rd edition (ICHD-3), 2018. Checked October 23, 2026.
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    “A disorder characterized by recurrent brief attacks of vertigo, occurring without warning and resolving spontaneously, in otherwise healthy children”; “Young children with vertigo may not be able to describe vertiginous symptoms”; associated signs include “nystagmus”, “ataxia”, “vomiting”, “pallor” and “fearfulness”.
20. Mani J, Madani S. Pediatric abdominal migraine: current perspectives on a lesser known entity. Pediatric Health, Medicine and Therapeutics. 2018;9:47–58. doi:10.2147/PHMT.S127210 (PMID 29733088; PMC5923275). Checked October 23, 2026.
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    “The average age of diagnosis is 3–10 years with peak incidence at 7 years”; “The overall prevalence of AM is ~1%–9%”; “It resolves completely in most of the patients. However, these patients have a strong propensity to develop migraine later in life”; “Explanation and reassurance should be the first step once the diagnosis is made”; “Nonpharmacologic treatment options including avoidance of triggers, behavior therapy, and dietary modifications should be the initial line of management. Drug therapy should be considered only if symptoms are refractory to these primary interventions”.
21. Lewis DW, Ashwal S, Dahl G, et al. Practice parameter: evaluation of children and adolescents with recurrent headaches. Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;59(4):490–498. doi:10.1212/wnl.59.4.490 (PMID 12196640). Checked October 23, 2026.
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    From the abstract: “Recurrent headaches occur commonly in children and are diagnosed on a clinical basis rather than by any testing”; “Obtaining a neuroimaging study on a routine basis is not indicated in children with recurrent headaches and a normal neurologic examination”; “Neuroimaging should be considered in children with an abnormal neurologic examination or other physical findings that suggest CNS disease”; “Variables that predicted the presence of a space-occupying lesion included 1) headache of less than 1-month duration; 2) absence of family history of migraine; 3) abnormal neurologic findings on examination; 4) gait abnormalities; and 5) occurrence of seizures”; “EEG is not recommended in the routine evaluation”.
22. Oskoui M, Pringsheim T, Holler-Managan Y, et al. Practice guideline update summary: acute treatment of migraine in children and adolescents. Neurology. 2019;93(11):487–499. doi:10.1212/WNL.0000000000008095 (PMID 31413171). Checked October 23, 2026.
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    From the abstract: “There is evidence to support the efficacy of the use of ibuprofen, acetaminophen (in children and adolescents), and triptans (mainly in adolescents) for the relief of migraine pain, although confidence in the evidence varies between agents”; “There is high confidence that adolescents receiving oral sumatriptan/naproxen and zolmitriptan nasal spray are more likely to be headache-free at 2 hours than those receiving placebo”; “No acute treatments were effective for migraine-related nausea or vomiting; some triptans were effective for migraine-related phonophobia and photophobia”.
23. International Headache Society. 8.2 Medication-overuse headache (MOH). The International Classification of Headache Disorders, 3rd edition (ICHD-3), 2018. Checked October 23, 2026.
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    “Headache occurring on 15 or more days/month in a patient with a pre-existing primary headache and developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more or 15 or more days/month, depending on the medication) for more than 3 months. It usually, but not invariably, resolves after the overuse is stopped”; “Clinical evidence shows that the majority of patients with this disorder improve after discontinuation of the overused medication”.
24. Powers SW, Kashikar-Zuck SM, Allen JR, et al. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA. 2013;310(24):2622–2630. doi:10.1001/jama.2013.282533 (PMID 24368463; PMC4865682). Checked October 23, 2026.
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    From the abstract, as the PMC author manuscript gives it: “A randomized clinical trial of 135 youth (79% female) aged 10 to 17 years diagnosed with chronic migraine”; “At the 20-week end point, days with headache were reduced by 11.5 for the CBT plus amitriptyline group vs 6.8 for the headache education plus amitriptyline group”; “In the CBT group, 66% had a 50% or greater reduction in headache days vs 36% in the headache education group”; “At 12-month follow-up, 86% of the CBT group had a 50% or greater reduction in headache days vs 69% of the headache education group”.
25. National Institute of Mental Health. Suicide Prevention. “If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org”; “In life-threatening situations, call 911”. Checked October 23, 2026.

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child. If you are worried about immediate safety, call or text 988 (US). Never start, stop, or change a dose without medical guidance.