Migraine in young children – recognizing, understanding, supporting
- Johanna
- Sep 5
- 7 min read
Headaches in children are not uncommon. However, when they occur repeatedly, the question quickly arises: Is it a migraine?
Migraines can start as early as preschool age. Studies show that up to 4 percent of preschool children are affected. Because young children often cannot clearly identify their symptoms, diagnosis is difficult and sometimes takes years.
In this article, you will learn how to recognize migraines in your child, what causes play a role, and how to manage everyday life despite migraines.
1. What is migraine?
Migraine is not just a common headache; it's a complex neurological disorder. During early childhood, headaches might not be the main symptom.
The brains of children with migraines can be seen as highly sensitive alarm systems. It reacts more intensely to stimuli that others barely notice, such as light, noises, specific smells, stress, or even changes in sleep patterns.
During an attack, various processes in the body become unbalanced:
Nerve cells become oversensitive and send more signals, which overloads the nervous system.
The trigeminal nerve releases neurotransmitters, including CGRP. This substance causes dilation of blood vessels and a minor inflammation of the meninges, the cause of the typical throbbing pain.
The serotonin system is also involved: a drop in serotonin levels makes the blood vessels even more sensitive and intensifies the symptoms.
In addition, the processing of sensory stimuli changes, which is why children often have difficulty tolerating light, noises, or smells during the attack.
An attack occurs in phases:
Precursor phase: Mood swings, fatigue, cravings, or concentration problems hours to days before the attack.
Aura: About 10 to 15 percent of children experience visual disturbances, tingling, or speech problems.
Headache phase: Severe, usually throbbing pain, often bilateral in children, lasting 1 to 4 hours. Sometimes accompanied by belly pain.
Recovery phase: exhaustion, lack of concentration, need for sleep.
2. Numbers and frequency
Migraine is one of the most common neurological diseases in childhood and adolescence.
Many children who develop migraines at an early age retain this tendency into adulthood, although for some the frequency decreases over time.
Early-onset migraine often has a less favorable course: in long-term observations, only 30 percent were completely free of headaches after 15 to 21 years if the disease began in preschool age (Marchese et al., 2020; Rustichelli et al., 2019).
3. Signs in young children under 6 years of age
Studies show that the official diagnostic criteria are difficult to apply to children under 6 years of age. In one study, over 70 percent of patients did not receive a clear diagnosis because attacks often lasted less than an hour and classic accompanying symptoms such as photosensitivity or nausea were absent (Torriero et al., 2017).
In toddlers and preschoolers, migraine symptoms often appear differently than in older children:
Often bilateral pain in the forehead area,
Duration usually only 1 to 2 hours, sometimes less than 1 hour
Nausea, vomiting, or abdominal pain, sometimes without headache, which can lead to confusion with gastrointestinal problems or appendicitis. This is known as an abdominal migraine.
Dizziness attacks.
Rare phenomena such as Alice in Wonderland syndrome: changes in the size of objects, distorted perception, altered sound and touch sensations, or hallucinations.
Urg to urinate.
Redness of the face or paleness.
Withdrawal, confusion, or loss of appetite can also be signs.
A positive family history is another indication: if one parent has migraines, the child's risk increases significantly.
The important thing is to take your child seriously. Migraines are not an illusion, but a real condition.
4. Do babies get migraines?
Whether babies can actually have migraines has not been conclusively scientifically established. They cannot yet verbalize their symptoms, and typical diagnostic criteria, such as pain quality, duration, or accompanying symptoms like photosensitivity, cannot be applied at this age.
Nevertheless, experts suspect that certain recurring symptoms in infancy and early childhood could be early precursors to later migraines. These include, in particular, bouts of vomiting, so-called infantile colic, or a pronounced tendency to dizziness and motion sickness in early childhood. These observations suggest that migraines may begin very early; however, conclusive scientific evidence is currently lacking, and further research is needed.
What is important is:
Not every baby with colic or frequent spitting up later develops migraines. Colic can just as easily be a part of normal development or the result of other causes.
What is crucial is loving, patient observation over long periods of time without panicking.
At the same time, studies show that children with such early abnormalities are more likely to develop migraines later in life. Therefore, it's worth paying close attention and seeking medical advice if symptoms persist or are particularly severe.
5. Diagnosis – How is migraine diagnosed?
The diagnosis is based on the criteria of the International Headache Society (IHS) and the current AWMF guideline (030-057, 2024).
Typical steps are :
Medical history: frequency, duration, accompanying symptoms.
Headache diary: essential for identifying patterns.
Physical examination and neurological testing. Referral to neurology/MRI may be necessary.
Exclusion of other causes, such as infections or tumors (very rare).
6. Causes and inheritance
Migraines are caused by an interaction of several factors.
Altered stimulus processing in the brain: sounds, light, or smells are perceived more intensely.
Neurotransmitters such as serotonin play a central role; their fluctuations affect blood vessels and pain perception.
Brain networks between the brainstem, thalamus, and cerebral cortex work differently in migraine, which explains accompanying symptoms.
Trigger factors such as stress, lack of sleep, certain foods, or changes in weather can trigger attacks.
Migraines are often hereditary. Children of affected parents have a two- to three-fold increased risk. The predisposition is particularly strong in migraines with aura. It's essential to recognize that heredity alone does not determine whether migraines will occur; environmental factors and triggers also play a significant role in the development of migraines.
7. Treatment during an attack according to the AWMF guideline
Non-drug treatment:
Rest in a darkened room,
Cooling of forehead or neck,
sufficient fluid,
Security and closeness,
Research on peppermint oil for migraine pain in children under 6 years of age is extremely limited. Existing studies primarily focus on older children and adults. Peppermint oil solutions (10% in ethanol) are approved for the treatment of tension headaches in children 6 years and older and demonstrate efficacy comparable to paracetamol (Göbel et al., 2016).
Medication after prior consultation with doctors :
Ibuprofen or paracetamol in age-appropriate dosage.
In case of severe nausea, an antiemetic may be helpful.
Triptans: only for adolescents aged 12 years and older and after medical consultation.
8. Prevent/reduce migraine attacks
The goal is to have as little discomfort as possible in everyday life. The following have proven effective:
Regular sleep patterns, regular meals, sufficient drinking, and exercise.
Relaxation techniques such as child-friendly yoga, breathing exercises, or progressive muscle relaxation.
Psychoeducation: Children should understand what migraine is; this reduces fears and provides security.
Drug prophylaxis: only in cases of severe and frequent attacks, under specialist medical supervision.
9. Shaping everyday life with migraines together
Migraines affect not only the child but the entire family. Each attack brings with it uncertainty, worry, and sometimes even a feeling of helplessness. At the same time, it means constantly reorganizing everyday life, whether at school, at home, or during leisure time.
But with understanding, good preparation, and loving structures, your child can learn to feel safe and supported despite migraines. It's also important for you as a parent to know: You are not alone, and with small, targeted steps, everyday family life can be less stressful, and confidence in your own strength can grow.
At school: An emergency plan with teachers is important. Retreat options, like a sick room, are helpful.
In the family: Rituals, clear structures, and fixed bedtimes provide security.
Emotional: Show understanding and empower your child to trust themselves.
Siblings: Include them so that there is no feeling of discrimination.
Accompanied by a team of specialists: pediatricians, neurologists, SPZ, etc.
10. Why early action is important
Untreated migraines can become chronic. Medication overuse headaches can also develop if painkillers are taken too frequently. Early and effective treatment protects children from having migraines that permanently limit their lives.
Conclusion – Strong together with knowledge and care
Migraines in young children are often difficult to diagnose, especially when abdominal pain or nonspecific symptoms predominate. The earlier migraines are diagnosed and treated, the better the symptoms can be alleviated and quality of life improved.
As parents, you can make a significant difference through understanding, clear structures, timely medical assessments, and loving support. This way, your child learns to live with migraines without letting the condition dominate their life.
Last Updated: 09/2025
Resources:
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Gelfand, A.A. (2015). Migraine in young children. Developmental Medicine & Child Neurology.
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Marchese, F., et al. (2020). Migraine in children under 6 years of age: A long-term follow-up study. European Journal of Pediatric Neurology.
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Raieli, V., et al. (2005). Recurrent and chronic headaches in children under six years of age. Journal of Headache and Pain.
Raieli, V., et al. (2015). Migraine in a pediatric population: a clinical study in children younger than 7 years of age. Developmental Medicine & Child Neurology.
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Rustichelli, C., et al. (2019). 33rd National Congress of the Italian Society for the Study of Headaches Naples (Italy), June 14 – 16, 2019. Neurological Sciences.
Torriero, R., et al. (2017). Diagnosis of primary headache in children younger than 6 years: A clinical challenge. Cephalalgia.
