1. Medical conditions awareness session: Migraine in children and young people. Information for supervising adults.

2. Migraine in children and young people – the facts Migraine has many symptoms – it is not ‘just a headache’. Migraine is recognised by the World Health Organisation as amongst the top 20 most disabling lifetime conditions. Migraine can affect children of all ages: Peaks have been noted at aged five and at age 10-12 years. 10% of schoolchildren are affected by migraine. Migraine occurs equally in both sexes up until 12 years, after which it becomes more common in girls (who often experience their first attack around puberty). An estimated 2.75 million school days are missed each year due to migraine – it can have a huge impact on a child’s schooling if not managed effectively.

3. Migraine in children and young people – the facts (cont.) Unlike a broken bone, understanding for someone with migraine can be much less – adding to the distress caused. In addition to the physical symptoms, the psychological impact of migraine on children and young people can be immense. There is no ‘test’ for migraine – diagnosis depends on the history and pattern of attacks. There is no cure for migraine but with understanding, consideration and support, the chance of a young migraineur experiencing an attack can be reduced. Although some children do ‘grow out’ out of it, many children with migraine will have attacks in adulthood – therefore early management of the condition is important.

4. What is migraine? Migraine can affect the whole body and can result in many symptoms. As a result, migraine can easily be overlooked or mistaken for other conditions. Although headache is common in adults with migraine, it is less of a feature for children – other symptoms may be more prevalent: » Abdominal pain » Nausea and / or vomiting » An increased sensitivity to light, noise, and / or smells » ‘Aura’ – neurological symptoms such as visual disturbances, confusion, numbness, slurred speech, or pins and needs » Flushing or pallor (looking pale)

5. What is migraine? (cont.) Attacks may last for as little as an hour, but can be as long as three days – the average is between two and four hours. Many people can be surprised how quickly a child can be back to normal after an attack. The frequency of attacks varies: the average is one a month, some children may experience an attack twice a week, others may experience an attack twice a year. Symptoms resolve completely between attacks. Common migraine misunderstandings: The child has lots of stomach bugs, the child is exaggerating symptoms of a common headache, they are trying to avoid school or other activity, they are being ‘difficult’ or have behavioural issues… With headaches or abdominal pain which may be associated with other symptoms and: occur in defined episodes; do not come and go during the attack; disrupt normal activities; and if the child is completely normal between attacks….. it is likely to be migraine and it is preferable for the child to see their GP.

6. How will a child with migraine behave? Migraine is a very individual condition. During an attack children will be unable to continue normal activities Commonly during an attack children may: Become withdrawn / unable to concentrate Want to be left alone Feel nauseous / need to vomit Lose their appetite Complain of an intolerance to light, sound or smells Need to go to the toilet Want to lie down / sleep / sit in the dark

7. What causes migraine? There is a genetic predisposition to migraine, so parents or grandparents may be migraineurs – but not always. Migraine is a very individual condition. What may trigger an attack in one child may not affect another. For many there is not just one trigger but a combination of factors which individually can be tolerated, but when several occur together a threshold is passed and an attack occurs: Example: Banana and a can of coke for lunch = no migraine Skipping breakfast after a late night, banana and a can of coke for lunch = migraine

8. What causes migraine? Some common migraine ‘triggers’ include: Dehydration Heightened emotions such as excitement, stress and anxiety Changes in sleep patterns Not eating regularly or having an unbalanced diet Particular foods (individual for each child) Long periods watching TV or on the computer Long periods in a stuffy atmosphere Staring at white walls or boards Light, dental or eyesight problems Puberty Muscle tension However the triggers, or combination of triggers which lead to an attack for a particular child may be quite unique.

9. Treatments Many children do not require medication to treat their migraine. During an attack many will recover well with rest / sleep. Vomiting is common and often eases the attack. Many children benefit from over the counter analgesics, such as paracetamol and ibuprofen. During a migraine a process called gastric stasis can happen – which can delay the absorption of medications in to the blood stream. It is important that medications are taken quickly - and at an adequate dose for that child. If painkillers are taken quickly, a full blown attack may be prevented. Discuss with parents / carers what medication should be given to a child when an attack strikes, and discuss the procedure for doing so with them (and the child’s teachers) to ensure this can be done quickly.

10. Treatments continued For some children over the counter treatments do not bring sufficient relief. Some children are prescribed medication to take when they have an attack. There is a group of drugs developed to treat migraines in adults called ‘triptans’. One triptan is licensed for children – sumatriptan. Children may also be prescribed other medications to help with the symptoms of an attack, including anti-nausea treatments. Some children with frequent and / or severe migraines may be prescribed preventative medications. Many children also find that complementary therapies and relaxation techniques help.

11. Helping a child with migraine If you suspect a child has migraine, try to discuss this with the parent / carer and encourage them to have a diagnosis confirmed by a GP if they have not already done so. Discuss possible triggers with the parent / carer (especially if attacks often occur at school / in a particular setting) so that steps can be taken to address these. Agree a care plan with other staff at school and the child’s parents / carer. By encouraging and allowing children to make some - often simple - lifestyle changes, such as drinking water, the chances of a migraine attack can be reduced. Showing understanding is key. During an attack, allowing a child to take action early (to get some water, to have something to eat, to take a break from what they are doing, to go somewhere quiet, to take their medication etc.) may enable them to return to activities quickly. Work with the child’s GP and parents / carer on dispensing medications early in attacks if necessary – does the school’s / group’s medications policy support young migraineurs?

12. In summary Migraine can often be effectively managed so that it doesn’t cause the immense stress and disruption to a child and their schooling which sometimes occurs. A child who feels able to ask for help and take action for their migraine early is likely to have a less severe / shorter attack than a child who tries to ‘battle on’. With a little understanding YOU could make a huge difference to a child with migraine. Migraine Action has a wide range of free resources to support children with migraine, parents, teachers and school nurses – visit www.migraine.org.uk/youngmigraineurswww.migraine.org.uk/youngmigraineurs www.migraineadventure.org.uk 8 -10 yr olds www.migraineexplorers.org.uk 11 -13 yr olds www.migrainenetwork.org.uk 14 – 17 yr olds Version 2 Amended September 2011 Next Review Date September 2013