So what are the early symptoms of migraine in children and are triggers different in children?

So Simone's daughter has a headache that interrupts her daily activity.

She told us that she needs to go to bed and therefore there is a significant chance that she has migraine.

When we ask her whether or not she also has sensitivity to light, sound or smell, or has nausea or has both, if she does, then we can be even more certain that this is migraine.

Whilst many children are going to present with typical migraine at the time of puberty, with or without aura, symptoms are typically shorter than in adults.

Small changes in routine are highly likely to precipitate attacks and hence addressing lifestyle may be the only intervention that's needed.

Looking back, In the lives of children with migraine, you may identify a history of infantile colic or motion sickness.

So what diagnostic tools exist and what are the red flags that indicate the child needs further investigation of their symptoms?

Can you explain what's meant by menstrual migraine and whether Simone's symptoms would be diagnosed as menstrual migraine? And are there diagnostic tools and is it worth doing any specific investigation?

True menstrual migraine is a term used when migraine occurs only at the time of the menstrual cycle.

It will usually start at any time between two days before up to three days after the onset of menstruation.

For a diagnosis, this needs to happen on two out of three periods.

Most ladies will also have migraine at other times too and then we call this menstrual related migraine.

Simone has severe migraine with menstruation but also another attack during the month and therefore she has menstrual related migraine.

The best way to make the diagnosis is to look at diaries.

Is there a link between premenstrual syndrome and migraine? And if so, is it worth targeting the PMS to reduce the symptoms of migraine? Whilst there's no proven link

If a diagnosis of migraine is established, what are the options for pharmacological management of an acute episode?

So once we've addressed lifestyle, then every single migraine sufferer should be offered acute treatment.

So first we start with simple analgesia.

In an adult, that's going to be a non-steroidal anti-inflammatory drug such as ibuprofen or aspirin.

Best to use quite high doses.

So often the dose of ibuprofen that we would recommend would be 600 milligrams rather than the standard 400.

And if you're using aspirin to use soluble aspirin and 900 milligrams, When this is taken, you want to consider whether they need a PPI if they've got a risk of gastritis.

So Simone doesn't have immediate plans to have children but does the fact that she is of childbearing age influence her management and are there any treatments that are not an option for her?