Signs of Migraine in a Young Child, Including No Headache

They have gone quiet on the sofa in the middle of a Saturday. No fuss, no crying, no obvious illness — a five-year-old who was building something on the floor twenty minutes ago and is now lying face down not doing anything. An hour later they are up and eating toast as though nothing happened, and by Monday you have stopped thinking about it.

Migraine in young children looks different enough from the adult version that a lot of parents do not recognise it, and children too young to describe symptoms cannot help you. What follows is about what to notice and record, not about deciding anything — the deciding is a GP’s job, and it goes much better with a page of dates.

Three ways the picture differs

Attacks are shorter. The adult definition runs four to seventy-two hours untreated. In children the same event can be over in an hour or two, which is one reason it gets read as a passing off-colour spell rather than a pattern.

The pain is often on both sides. The one-sidedness people associate with migraine is much less reliable in children, so “it’s both sides, so it isn’t migraine” is not a safe inference at this age.

There may be no headache at all. This is the one worth knowing about, because it changes what you would even be looking for.

When it presents as tummy ache

Abdominal migraine is a recognised entry in the international headache classification, under episodic syndromes that may be associated with migraine. It is described as recurrent attacks of moderate or severe midline abdominal pain, with nausea and vomiting, lasting 2 to 72 hours, with complete normality between episodes — and no headache during them.

Two details in that description do the most work for a parent.

Midline matters. The pain is around the navel rather than localised off to one side, and children asked to point at it tend to indicate the middle or say the whole tummy.

Complete normality between episodes matters more. A child who is entirely well in between, repeatedly, is describing a different shape from a child with a persistent low-grade stomach problem. That in-between normality is the thing you are best placed to observe and nobody else will see.

Children who have this often go on to have migraine headaches as adults, which is part of why it is worth writing down rather than waiting to see.

None of that makes recurrent tummy ache in a child a migraine. It has many causes, most of them nothing to do with this, and some that need looking at properly. It means the pattern is worth recording and taking to a GP rather than assumed to be either.

Watch, do not interview

A five-year-old asked whether their head throbs will say yes, or no, or that their sock feels funny. Questions with adult vocabulary in them produce answers about the question rather than the symptom.

What they do is more reliable than what they say.

• Going still. Stopping play voluntarily is the single most useful sign at this age, because children do not do it for minor discomfort.
• Seeking dark and quiet. Turning the television off themselves, going to their room mid-afternoon, pulling a blanket over their head.
• Looking pale, sometimes with dark rings under the eyes, often noticed by someone else before you notice it.
• Being sick, or refusing food while not otherwise unwell.
• Not tolerating movement — lying very still rather than the usual fidgeting.
• The recovery. Coming back to themselves fairly abruptly, and often being flat or unusually tired for a while afterwards.

The questions that do work are concrete and offer a choice: does it hurt more when you jump, or when you keep still? Is it more like a bump or more like a squeeze? Where would you put a sticker if it showed where it hurts?

What to record

Times, mostly. Descriptions at this age are unreliable and durations are not.

• Date and the time it started — the time they went quiet counts, not the time they told you
• How long until they were themselves again
• What they did: lay down, dark room, sick, off food, stopped playing
• Where the pain was, if they can indicate it: head, tummy, middle or side
• The few hours before: what they had eaten, how they slept, whether anything was going on
• The rest of the day after

Six lines, filled in the same evening. Three months of that is a genuinely useful document, and it is not something you can produce from memory in a ten-minute appointment where your child is also present and being asked to explain themselves.

The free printable diary has a row per day, which is the right shape for this — most days will be a tick. Migraine Journal stamps the time when you log, which for short attacks is the field that decays fastest.

Do not turn it into a project the child can feel. A parent visibly maintaining a health file about a small person changes how that person reports things, and children who sense their symptoms are being audited start editing them. Keep it brief and keep it yours.

When to go, and what to take

Take it to a GP when you have a handful of episodes rather than one, and lead with the pattern: how many, how long, how far apart, and what they were like in between.

Some things do not wait for a pattern. A headache that wakes a child from sleep, one that is worse in the morning or with coughing, anything with vomiting that persists, any new clumsiness, weakness, changed vision, or a change in personality or behaviour — those are reasons to seek advice promptly rather than to add another row. The same goes for a headache that is different in kind from the previous ones, or a child who seems generally unwell between episodes. This page is about a repeated pattern in an otherwise well child, and it does not cover anything outside that.

If it turns out to be migraine and school becomes part of the problem, how to talk to your child’s school about migraines covers getting a written plan rather than informal kindness — there’s a free school letter and plan template if you’d rather start from something already laid out — and how to help a teenager with migraines covers the version where the child is old enough to start managing it themselves.

Nothing here is medical advice, and none of it is a diagnosis. What a parent can contribute is the part no clinician can see: the same child, at home, over months. The rest of the caregiving guides are written for the same job.