Red flags & when to go in person for Migraine in Children

Audience: pediatric

Migraines in children can cause significant discomfort and affect daily activities. Telemedicine can help assess symptoms, provide advice, and guide treatment for many typical migraine cases. However, some warning signs require prompt in-person evaluation to rule out serious conditions. Knowing when to seek urgent care is important to ensure your child’s safety. This guide explains common red flags for migraines in children, what telemedicine can and cannot manage, and how to prepare for and follow up after a tele-visit. If your child experiences sudden severe headaches, neurological changes, or other concerning symptoms, do not delay in-person medical attention. Telemedicine offers a convenient way to get initial support but is not a replacement for emergency care or thorough physical exams when needed.

Red flags — go in person / ER

• Sudden, severe headache that is different from usual migraines — seek emergency care immediately.
• Neurological symptoms such as vision changes, weakness, difficulty speaking, or loss of balance — go to a healthcare facility promptly.
• Headache accompanied by fever, stiff neck, rash, or confusion — urgent in-person evaluation is needed.

What telemedicine can do

• Assessment of typical migraine symptoms and history.
• Advice on lifestyle changes and headache triggers.
• Medication management and prescription refills for stable cases.
• Follow-up visits to monitor symptom changes.

What telemedicine cannot do

• Evaluation of sudden, severe, or unusual headaches.
• Assessment of neurological deficits or acute changes in mental status.
• Headaches following trauma requiring imaging or emergency care.
• Management of headaches with signs of infection or systemic illness.

Understanding Migraines in Children

Migraines are a type of headache that can cause throbbing pain, often on one side of the head. Children may also feel nausea, sensitivity to light or sound, and may have difficulty concentrating. Migraines can last from a few hours to several days and may affect school and activities. Identifying typical migraine symptoms helps in managing them effectively.

When to Use Telemedicine for Pediatric Migraines

Telemedicine can be useful for discussing your child's headache patterns, triggers, and response to medications. It allows healthcare providers to offer advice on lifestyle changes, medication adjustments, and symptom management. Tele-visits are often suitable for follow-ups or when symptoms are stable and typical for your child.

Red Flags That Need In-Person Care

Certain symptoms require urgent in-person evaluation to rule out serious conditions:

If your child shows any of these signs, seek emergency care immediately.

Preparing for a Telemedicine Visit

Before the tele-visit, gather information such as:

Ensure a quiet, well-lit space for the visit and have a caregiver present to assist.

After the Telemedicine Visit

Follow the healthcare provider’s advice regarding medications, lifestyle changes, and symptom monitoring. Schedule follow-up visits if recommended. If symptoms worsen or new red flags appear, seek in-person care promptly. Keep a headache diary to track progress and share updates during future visits.

How to prepare for your tele-visit

• Note the timing, duration, and characteristics of your child's headaches.
• List any recent illnesses, injuries, or new medications.
• Prepare a list of current medications and dosages.
• Have a quiet, private space with good internet connection for the tele-visit.
• Ensure a caregiver is available to assist and provide history if needed.
• Write down any questions or concerns to discuss during the visit.

After your tele-visit

• Follow the provider's recommendations for medications and lifestyle adjustments.
• Monitor your child's symptoms and note any changes or new symptoms.
• Keep a headache diary to track frequency and triggers.
• Schedule follow-up telemedicine or in-person visits as advised.
• Seek immediate care if any red flag symptoms develop.
• Contact your healthcare provider if symptoms worsen or do not improve as expected.

FAQs

Can telemedicine diagnose my child's migraine?

Telemedicine can help healthcare providers understand your child's symptoms and history to suggest a likely diagnosis. However, some cases may require in-person exams or tests to confirm the diagnosis and rule out other causes.

When should I take my child to the emergency room for a headache?

If your child has a sudden, severe headache unlike any before, neurological symptoms (like weakness or vision changes), fever with stiff neck or rash, or headache after a head injury, seek emergency care immediately.

Can medications for adult migraines be used for children?

Some migraine medications are safe for children, but dosages and choices differ. Always consult a healthcare provider before giving any medication to your child.

How can I help prevent my child's migraines?

Encourage regular sleep, balanced meals, hydration, stress management, and avoiding known triggers such as certain foods or bright lights. Your healthcare provider can offer personalized advice.

Sources

1. Migraine in Children and Teens — MedlinePlus, U.S. National Library of Medicine.
2. Headache in Children — American Academy of Pediatrics.
3. Migraine — Centers for Disease Control and Prevention (CDC).
4. Migraine in Children and Adolescents — Mayo Clinic.

This telemedicine guidance is for educational purposes and is not a substitute for in-person medical evaluation and care. If your child has severe or worsening symptoms, seek immediate medical attention.