India, Oct. 10 -- My eight-year-old daughter complains of repeated headaches and sometimes even nausea. Her eye examination and basic investigations are normal. Could this be migraine? When should we consult a doctor? Recurring headaches may sometimes be due to migraine - a neurological condition that affects both children and adults. Migraine is usually diagnosed when a child has experienced at least five similar attacks lasting approximately 2 to 72 hours. The pain may be moderate to severe or throbbing, accompanied by nausea, vomiting or sensitivity to light and sound. Children often experience pain on both sides of the head, and their attacks may be shorter. Tension-type headache, inadequate sleep, dehydration, skipped meals, fever and viral illnesses can cause similar symptoms. A 2023 systematic review estimated that primary headaches affect approximately 62% of children and adolescents, while around 11% experience migraine [1]. A study of 100 children in North India found migraine to be the most frequent diagnosis, affecting 60%, followed by tension-type headache in 28% [2]. Inherited factors account for an estimated 35-60% of a person's susceptibility to migraine [3]. Before puberty, boys and girls are affected almost equally, whereas migraine becomes more common among girls after puberty. Urgent assessment is needed if a headache is sudden and extremely severe, follows a significant head injury or occurs with seizures, confusion or weakness. Headaches accompanied by repeated vomiting, fever with neck stiffness, or a progressive increase in frequency or severity also require evaluation. Common triggers include insufficient sleep, missed meals, dehydration, stress and prolonged screen exposure. A headache diary can help identify individual triggers. During an attack, allow the child to rest in a quiet, dark room. Regular sleep and meal timings, adequate hydration and sensible screen-time limits can reduce attacks. Paracetamol or ibuprofen may help when taken early, but the dose should be advised according to the child's age and weight. Frequent unsupervised use of these can cause medication-overuse headaches. But frequent or disabling migraine attacks may require preventive treatment under a paediatrician's or neurologist's supervision. Timely diagnosis, healthy routines and appropriate treatment can help children lead an active and unrestricted life. References: 1. Onofri A et al. Primary headache epidemiology in children and adolescents: a systematic review and meta-analysis. J Headache Pain. 2023;24:8. 2. Sinha R et al. Clinical Profile of Children with Primary Headache at a Tertiary Care Center in North India: A Retrospective Study. Ann Child Neurol. 2023;31(3):167-173. 3. Harder AVE et al. AMJM. Migraine genetics: Status and road forward. Cephalalgia. 2023;43(2). Dr Anupam Sibal is a leading Paediatric Gastroenterologist and Hepatologist with over three decades of experience and five books to his credit, including the national bestseller Is Your Child Ready to Face the World?...