The Stages of a Migraine and How to Minimize Their Impact

Nothing is more heartbreaking for parents than having a child in pain. When a migraine is the cause, children often face a long ordeal of severe head pain, nausea, and vomiting — and that’s only the headache phase.

Migraines can pass through four stages with distinct, varying symptoms. Even though every child doesn’t experience all four stages, you’ll be better equipped to help if you understand the signs of each stage and have a plan for minimizing their impact.

Migraines are neurological conditions, which means the caring THINK Neurology for Kids team — Shaun S. Varghese, MD, Cristina R. Marchesano, MD, Lorena Herbert, MD, Barbara Kiersz-Mueller, DO, Lauren Weaver, MD, Alicia Walls, MD, Sundeep Mandava, MD, Jennifer E. Martin, CPNP-PC, Tammy DeLaGarza, FNP-C, Una Childers, PA-C, MPAS, Heather King, CPNP-PC, and Robby Korah, FNP-C — is your best source of expert care and information for managing your child’s migraines.

Here's what parents need to know about children’s migraines:

Migraine stages

Migraines may progress through the following four stages, but your child may not experience all of them. 

Stage 1: Prodrome

Nearly 7 out of 10 children experience prodrome, a warning stage with signs occurring the day before their migraine.

The signs are often subtle. Your child may be tired, moody, or feel slightly unwell and out of sorts. Many children become irritable. Or they may crave food or feel thirsty. Some complain of minor physical symptoms like a stiff neck or frequent yawning.

Stage 2: Aura

Aura is a neurological warning sign that’s distinct and noticeable and occurs 30-60 minutes before a migraine. An estimated 15-30% of children experience aura and its unique sensations, such as:

• Visual changes: seeing spots, squiggly lines, flashing or moving lights, or bright colors (like a kaleidoscope)
• Sensorimotor changes: numbness, tingling, and weakness
• Dysphasic aura: temporary speech and language changes like slurred speech and mumbling

Vision changes, the most common type, may appear alone or with sensorimotor symptoms. Though rare, some children may have an unpleasant or metallic taste in their mouth or smell odors that aren’t present.

Stage 3: Migraine attack

This stage begins with their headache pain. Children’s migraines may only last an hour or two. (By comparison, adult migraines typically last four hours.) However, migraines can persist for up to three days without medication to shorten the headache.

Migraines cause several symptoms. As long as the migraine lasts, your child may experience:

• Throbbing head pain (on one or both sides and often in the temples or above their eyes)
• Nausea and vomiting
• Stomach (abdominal) pain
• Sensitivity to lights, sounds, and smells
• Dizziness and vertigo (the sensation of spinning)

For some children, being able to fall asleep ends their migraine, and they finally get relief from the pain.

Stage 4: Postdrome

Stage 4 is a recovery phase. After the head pain ends, many children need additional time to recuperate and return to their usually healthy, energetic selves.

Some children may rebound and regain their energy in a few hours; for others, it may take days. During recovery, your child may be tired, weak, moody, or confused. Some may remain overly sensitive to light and sound until they fully recover.

Minimizing migraines

You can take several steps to minimize the pain and duration of your child’s migraines. Even better, you may be able to prevent their migraine from developing.

Here are three guidelines for improving migraines:

Schedule a headache evaluation

The first essential step is a neurological exam to confirm that your child's symptoms are migraines and rule out any other possible causes of pain. Then, we work with you to develop a comprehensive care plan that meets your child's unique needs.

Most importantly, your child may need prescription medications they can take at the first signs of a pending migraine. These drugs can reduce or stop the pain and shorten the migraine's duration. We may also recommend medications to help prevent or reduce future migraines.

Make lifestyle modifications

Migraines in children are often minimized by ensuring they stay well hydrated, get enough sleep, and don’t skip meals. Getting plenty of exercise goes a long way toward reducing migraine intensity and duration.

Identify and eliminate triggers

Migraines begin due to triggers, such as certain foods, changes in weather, stress, lack of sleep, hormonal fluctuations, and skipping meals. Identifying your child's triggers and then avoiding them may stop their migraines. 

The THINK Neurology for Kids team can help your child overcome migraine pain. Call the office in The Woodlands, Katy, Sugar Land, Lakeway, or Lake Jackson, Texas, or book online today.