A Teen’s Guide to Migraine: More Than Just a Headache

Understanding Migraine: It’s a Brain Thing!

It can be frustrating when people dismiss your experience as “just a headache.” A migraine attack is a complex neurological event, meaning it originates in your brain and involves your nervous system. It’s not a sign of weakness; it’s a biological condition. Researchers believe that during a migraine attack, waves of activity spread across the brain, causing the release of inflammatory substances around nerves and blood vessels. One key molecule involved is CGRP (Calcitonin Gene-Related Peptide), a protein that plays a central role in transmitting pain signals ².

What’s Happening During a Migraine?

A migraine attack often unfolds in distinct stages, although not everyone experiences all of them. Your experience is unique to you.

The Heads-Up (Prodrome Phase): A day or two before the main attack, you might notice subtle warnings. These can include mood swings, food cravings, fatigue, frequent yawning, or neck stiffness.

The Aura (If You Get One): Affecting about one-third of people with migraine, an aura is a series of sensory disturbances that usually precede or accompany the headache. Most auras are visual (seeing flashing lights, zigzags, or blind spots), but they can also involve tingling in the hands or face, or difficulty speaking.

The Main Event (Attack Phase): This is the headache phase, characterized by a moderate to severe throbbing or pulsing pain, often on one side of the head. In children and teens, the pain can sometimes be on both sides or at the front of the head. This phase is frequently accompanied by nausea, vomiting, and extreme sensitivity to light (photophobia) and sound (phonophobia) ³.

The Hangover (Postdrome Phase): After the headache subsides, you can feel exhausted, drained, and mentally foggy for up to a day. It’s often described as a “migraine hangover.”

Terms:

• Neurological: Related to the brain and nerves.
• Prodrome: Early warning signs.
• Aura: Sensory changes before a headache.

Types of Migraines Teens Get

Migraine isn’t a one-size-fits-all condition. Here are some types commonly seen in young people.

Migraine without aura: This is the most common form, featuring the headache and other symptoms without any preceding sensory disturbances ³.

Migraine with aura: This type includes the characteristic aura phase before or during the headache ³.

Abdominal Migraine: More common in children than adults, this involves episodes of moderate to severe stomach pain, typically around the belly button (periumbilical pain), often with nausea or vomiting. It usually occurs without a significant headache. Many children with abdominal migraine go on to develop typical migraine with headache as they get older ⁴.

Vestibular Migraine: This type primarily affects your sense of balance, causing dizziness or vertigo (a spinning sensation), which may or may not be accompanied by a headache.

Hemiplegic Migraine: This is a rare and serious type of migraine with aura where a person experiences temporary weakness on one side of their body. Any symptoms like this require immediate medical attention to rule out other serious conditions like a stroke.

Spotting Your Migraine

Distinguishing a migraine attack from a tension-type headache is the first crucial step towards effective management. The official diagnostic criteria, known as the International Classification of Headache Disorders (ICHD-3), have been adapted for children and adolescents. For kids, the headache phase might be shorter (lasting 2 to 72 hours, compared to 4–72 hours in adults) and the pain is more often on both sides of the head ³.

Telltale Signs of a Migraine

• Head pain that is moderate to severe and often has a throbbing or pulsing quality.
• Pain that worsens with routine physical activity (like walking or climbing stairs).
• Nausea, vomiting, or both.
• Extreme sensitivity to both light and sound.
• A desire to rest in a dark, quiet room.

For younger children who can’t describe their symptoms, parents might notice them stopping their play, looking pale, and becoming quiet or irritable.

When to Call in the Experts (aka See a Doctor)

While most migraine attacks are not dangerous, it’s essential to seek medical advice to get an accurate diagnosis and rule out other causes. See a doctor if:

• This is the first time you’ve experienced a severe headache.
• Your headache pattern changes suddenly.
• The headache is described as “the worst headache of your life.”
• The headache is accompanied by fever, stiff neck, confusion, seizures, double vision, weakness, or trouble speaking.
• The headache occurs after a head injury.
• Your migraine attacks are becoming more frequent or severe.

One of the most powerful tools you can use is a headache diary. This helps you and your doctor identify patterns, triggers, and what treatments work best. An app like Migraine Buddy or others linked here can make this easy. Track when the attack happened, your symptoms, what you ate, your sleep patterns, stress levels, and any medication you took.

What Kicks Off a Migraine? Triggers for Aussie Teens

Identifying personal triggers is a key part of managing migraine. It’s not about blaming yourself; it’s about gathering information to gain control. Common triggers for teenagers include:

School and Study Stress: The pressure of exams, assignments, and social dynamics is a significant trigger for many.

Sleep Ups and Downs: Irregular sleep is a major culprit. The teenage body clock naturally shifts towards later nights, but early school starts disrupt this. Both too little sleep (most teens need 8-10 hours) and sleeping in on weekends can trigger an attack ⁵.

Food, Drinks, and Not Enough Water:

• Skipping meals: This can cause blood sugar levels to drop, a common trigger.
• Dehydration: Not drinking enough water, especially in the Australian heat or during sport, is a frequent cause.
• Caffeine: Too much caffeine from coffee or energy drinks, or suddenly stopping caffeine, can trigger attacks.
• Specific foods: While food triggers are highly individual, some people report triggers like aged cheeses, processed meats, and citrus fruits. A diary is the best way to investigate this.

Screen Overload: Prolonged use of phones, laptops, and gaming consoles can lead to eye strain and trigger headaches, partly due to bright screens and blue light exposure.

Hormonal Rollercoasters: For many girls, migraine attacks are linked to the hormonal fluctuations of the menstrual cycle. Migraine often becomes more common and severe for girls after puberty.

Your Environment:

• Lights: Bright sunlight, glare, and flickering fluorescent lights in classrooms or shopping centres.
• Noises: Loud, sudden, or continuous noise.
• Smells: Strong perfumes, chemical smells, and smoke.
• Weather: For some, changes in weather, like a drop in barometric pressure before a storm, or a sudden heatwave, can be a trigger.

Exercise (The Too-Much-Too-Soon Kind): While regular, moderate exercise is protective, very intense or sudden exertion can sometimes trigger a migraine attack, especially in the heat.

Tackling Migraines Day-to-Day: Your Action Plan

Living with migraine requires developing strategies to navigate school, social life, and everything in between.

At School

• Communicate: Let your teachers, year advisor, and the school nurse know about your migraine. This helps them understand if you need to miss class or require accommodations.
• Find a Safe Haven: Identify a quiet, dim space, like the nurse’s office, where you can go if an attack starts at school.
• Have a Plan for Exams: If migraine impacts your studies, especially during exam periods, you may be eligible for special provisions (like rest breaks or extra time). Discuss this with your school well in advance.
• Stay Hydrated: Always have a water bottle with you.

Hanging Out with Friends

• Be Open: True friends will be understanding if you need to cancel plans or leave an event early. Explaining what migraine is like for you can build empathy.
• Plan Ahead: For big events, be extra diligent about managing your key triggers like sleep and hydration in the days leading up to it.
• Have an Escape Plan: If you’re out and feel an attack starting, know how you’ll get home safely.

Your Migraine Go-Kit

Keep a small kit in your school bag with essentials:

• Your acute medication (as prescribed by your doctor).
• A water bottle and a healthy snack.
• Sunglasses for light sensitivity.
• Earplugs or noise-cancelling earbuds.
• A small instant cool pack.

Definitions:

• Periumbilical: Around the belly button.
• Photophobia: Extreme sensitivity to light.
• Phonophobia: Extreme sensitivity to sound.

Lifestyle Tweaks for Fewer Migraines

Consistency is key. Small, regular habits can make a big difference in reducing the frequency and severity of attacks. This approach is often called SEEDS:

• Sleep: Aim for a consistent sleep schedule, even on weekends.
• Eat: Eat regular meals and don’t skip breakfast.
• Exercise: Engage in regular, moderate activity like walking, swimming or cycling.
• Drink: Drink water consistently throughout the day.
• Stress Management: Find healthy ways to unwind, whether it’s through mindfulness, music, art, or spending time in nature.

When a Migraine Hits: What to Do

• Act Fast: Take your prescribed acute medication at the first sign of an attack. Early treatment is much more effective than when it is delayed.
• Rest: Find a dark, quiet room to lie down.
• Cool Down: Apply a cold pack to your forehead or the back of your neck.
• Sleep: Often, sleep is the most effective way to end an attack.

Treatment Options for Australian Teens (as of August 2025)

Treatment for migraine is divided into two main categories: acute treatments to stop an attack that has already started, and preventive treatments to reduce the frequency and severity of future attacks. All treatment decisions must be made with your doctor.

Stopping a Migraine in Its Tracks (Acute Treatments)

Simple Pain Relievers: For mild to moderate attacks, over-the-counter options like ibuprofen can be effective. It is crucial not to use these medications too frequently (no more than 10-15 days per month), as this can lead to Medication Overuse Headache, a condition where the pain relief medication itself starts causing more frequent headaches ⁶.

Prescription Triptans: These are migraine-specific medications that are often very effective for moderate to severe attacks. They work by targeting serotonin receptors to reduce inflammation and constrict blood vessels in the brain. For adolescents in Australia, triptans like sumatriptan and rizatriptan (which comes as a wafer that dissolves on the tongue) can be prescribed by a GP. A landmark study confirmed that these are more effective than a placebo (a dummy pill) for pain relief in teens ⁷.

Gepants (CGRP Receptor Antagonists): This is a newer class of acute treatment that works by blocking the CGRP protein from docking onto its receptor. In Australia, Rimegepant is approved by the Therapeutic Goods Administration (TGA) for acute treatment. However, as of August 2025, it is not yet subsidised on the Pharmaceutical Benefits Scheme (PBS), meaning patients have to pay the full private cost.

Anti-Nausea Medications: If nausea and vomiting are major symptoms, your doctor can prescribe medications like metoclopramide to help.

Reducing How Often Migraines Happen (Preventive Treatments)

If your migraine attacks are frequent (e.g., more than 3-4 per month) and significantly impacting your life, your doctor may discuss preventive therapy. The goal is to reduce attack frequency by at least 50%.

Supplements (Nutraceuticals): There is some evidence for certain vitamins and minerals, though they should only be used under medical supervision. These include Magnesium, Riboflavin (Vitamin B2), and Coenzyme Q10.

Traditional Oral Medications: Several medications originally developed for other conditions have been found to help prevent migraine. These are often prescribed “off-label” for teens.

• Topiramate: An anti-epilepsy medication that is TGA-approved for migraine prevention in adolescents aged 12 and older.
• Amitriptyline: An older antidepressant used in low doses that can help, particularly if there are also sleep problems.
• Propranolol: A beta-blocker (a type of blood pressure medication).

A landmark study in pediatric migraine, the CHAMP study, surprisingly found that both amitriptyline and topiramate were no more effective than a placebo (a dummy pill) for reducing headache days. However, all groups, including the placebo group, saw a significant reduction in headache frequency (around 60%), highlighting the powerful effect of regular medical attention and lifestyle advice in pediatric migraine care ⁸. This finding has shifted focus towards non-drug therapies as a first-line approach.

CGRP Monoclonal Antibodies (mAbs): These are newer, highly specific preventive treatments given as a monthly or quarterly injection. In Australia, drugs like Erenumab (Aimovig), Galcanezumab (Emgality), and Fremanezumab (Ajovy) are available on the PBS for adults with chronic migraine who have not responded to three other older preventive medications. While not specifically PBS-listed for adolescents, a neurologist can prescribe them privately, or in some cases, through special access schemes. For more information, you can read our article on Chronic Migraine.

Botulinum Toxin (Botox): For adults with chronic migraine, injections of Botox into specific head and neck muscles every 12 weeks is an effective PBS-funded treatment. Its use in adolescents is less common and typically managed only by specialist neurologists.

Non-Medication Approaches

Given the high placebo effect and potential side effects of medication, non-drug approaches are increasingly recommended as the first line of treatment for young people.

Cognitive Behavioural Therapy (CBT): This is a type of talk therapy that has proven highly effective. It teaches you to identify and change unhelpful thought patterns and behaviours related to pain. A major clinical trial found that adding CBT to amitriptyline treatment resulted in significantly better outcomes and less disability than medication alone, with benefits lasting for at least a year ⁹.

Biofeedback: This technique uses sensors to help you learn to control bodily functions like muscle tension, which can help reduce migraine.

Relaxation Techniques and Mindfulness: Learning deep breathing, meditation, and other relaxation strategies can help manage stress, a common migraine trigger.

What’s New and Coming Soon?

Migraine research is a rapidly advancing field. Scientists are exploring new targets beyond CGRP, such as a molecule called PACAP, with new treatments currently in clinical trials. The development of more effective, better-tolerated treatments offers hope for the future.

Definitions:

• Placebo: A dummy treatment with no active drug.
• Chronic Migraine: Headaches on 15+ days per month.
• CBT: Therapy to change thoughts and behaviours.

A Few Key Things About Treatment

• Your Plan is Unique: What works for your friend might not work for you. Finding the right combination of lifestyle, non-drug, and medication strategies is a journey you’ll take with your doctor.
• Beware Medication Overuse Headache (MOH): Using acute pain medication too often can make your headaches worse. Always follow your doctor’s advice.
• Patience is Key: Preventive treatments can take 2-3 months to show their full effect.

The Emotional Side of Migraine

Living with an unpredictable and often invisible condition like migraine can be emotionally challenging. Studies have shown that young people with frequent headaches report a lower quality of life and are more likely to experience anxiety and depression than their peers ¹⁰.

Common Feelings

• Frustration and Isolation: Missing out on school, sport, or social events can make you feel frustrated and disconnected from your friends.
• Anxiety: The constant worry about when the next attack might strike can be very stressful.
• Feeling Misunderstood: It’s hard when people don’t grasp the severity of your pain because they can’t “see” it.

Ways to Cope and Look After Your Mental Health

• Acknowledge Your Feelings: It’s okay to feel down or frustrated. Talking about it with a trusted parent, friend, or professional can help.
• Be Kind to Yourself: On a bad migraine day, practice self-compassion. You did not ask for this.
• Seek Professional Help: If you are struggling with your mental health, speak to your GP. They can refer you to a psychologist or counsellor. Migraine & Headache Australia supports research and provides resources to help people understand the full impact of headache disorders.

Getting Help: The Aussie Healthcare System

Your GP: The Starting Point

Your General Practitioner (GP) is your first port of call. They can provide a diagnosis, offer advice on lifestyle and triggers, prescribe initial medications, and create a GP Management Plan if your condition is chronic, which can give you Medicare rebates for a limited number of visits to allied health professionals (like a psychologist or physiotherapist).

Specialists

If your migraine is severe or difficult to manage, your GP may refer you to a neurologist (a specialist in brain conditions) or a paediatric neurologist (a specialist for children and teens). Some hospitals also have dedicated headache clinics.

Medicare and Costs

• GP and Specialist Visits: Medicare provides a rebate for a portion of the fee for seeing a doctor. There is often an out-of-pocket cost.
• Medications: Many migraine medications are subsidised through the Pharmaceutical Benefits Scheme (PBS). Newer medications may not be on the PBS or may have strict eligibility criteria. Your doctor or pharmacist can explain the costs.

School Support

Your school has a duty of care to support you. This can include developing an Individual Health Care Plan and making special arrangements for exams.

Looking Ahead: Migraines and Your Future

Migraine does not have to define your life or limit your ambitions.

Big Life Events

• Exams and University: With good planning, support from your doctors, and accommodations from your educational institution, you can succeed.
• Driving: It’s important to discuss with your doctor whether your migraine, especially if you have aura, could affect your ability to drive safely. Never drive if you feel an attack beginning or if your medication causes drowsiness.

The Long Haul

Migraine patterns can change over a lifetime; for many, they improve with age. You will become the expert on your own body. With growing awareness and exciting new treatments on the horizon, the future for people with migraine is brighter than ever.

You’ve Got This!

Dealing with migraine as a teenager is tough, but you are resilient. By understanding your condition, working with your healthcare team, and advocating for yourself, you can take back control. You are not on this journey alone.

How Migraine & Headache Australia can help: explore the Migraine overview, Treatment options, Headache & Migraine Diaries, Doctor Directory, and consider joining the Headache Register for updates on research and treatments.

References

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