Read this first: this page is informational only and Hermly itself is not designed for pediatric use (no parental controls, no pediatric-specific dosing or medication content, no appropriate cohort training data, and HealthKit integration assumes adult use). Pediatric migraine care belongs with a pediatrician or pediatric headache specialist.

With that framing: pediatric migraine is genuinely common — about 8 percent of children pre-puberty, rising to adult prevalence by late adolescence. It presents differently from adult migraine, often goes under-recognised, and benefits from specialist evaluation when frequent or severe.

Pediatric migraine looks different from adult migraine

The ICHD-3 criteria adapt for children:

  • Duration: 2–72 hours (vs 4–72 in adults). Pediatric attacks are often shorter — sometimes 1–2 hours and fully resolving.
  • Pain location: often bilateral and frontal (vs typically unilateral in adults). A young child describing “my whole head hurts” doesn’t rule out migraine.
  • Pain quality: less consistently pulsing than in adults. Can be described as “pounding” or just “hurts a lot”.
  • Associated symptoms that are more prominent in children:
    • Abdominal pain and vomiting — often as prominent or more than the headache itself.
    • Pallor — visible during attacks.
    • Behavioural withdrawal — retreating to a dark, quiet room (the pediatric equivalent of self-reporting photophobia / phonophobia).
    • Sleepiness or wanting to sleep through the attack.

Abdominal migraine — a pediatric variant

ICHD-3 1.6.1.2 (“Abdominal migraine”) is recognised primarily in children. Attacks involve recurrent moderate-to-severe abdominal pain lasting 2–72 hours, with associated symptoms (pallor, anorexia, nausea, vomiting) but often without prominent headache during the attack.

About 70 percent of children with abdominal migraine eventually develop typical migraine in adulthood. The pediatric pattern is a precursor.

This entity is sometimes missed because pediatricians not familiar with the headache classification may attribute recurrent abdominal pain to other causes. A pediatric neurologist or headache specialist will recognise it.

Cyclical vomiting syndrome

Another related entity (ICHD-3 1.6.1.1) — recurrent stereotyped attacks of intense nausea and vomiting lasting hours to days, with normal health between attacks. Also more common in children than adults, often a precursor to typical migraine.

These episodes can be disabling and benefit from same-class preventive treatments as migraine.

Pediatric migraine frequency norms

Among children with migraine, typical attack frequency:

  • Most: 1–4 attacks per month.
  • Higher frequency: increasing in late childhood and adolescence.
  • Daily or near-daily headache in children: needs comprehensive evaluation including imaging in some cases, since the differential is broader than in adults.

Treatment principles (informational only)

Pediatric migraine treatment differs from adult treatment in several ways — all of which need to be navigated by a pediatrician or pediatric headache specialist, not an app:

  • Acetaminophen and ibuprofen are first-line for acute treatment. Doses are weight-based.
  • Triptans: sumatriptan nasal spray, almotriptan, rizatriptan, and zolmitriptan are approved for pediatric use, but prescribing requires specialist judgment.
  • Behavioural therapy + biofeedback has strong evidence in pediatric migraine — sometimes more so than medication alone.
  • Preventive medication thresholds are similar to adults but the agent selection differs (some adult preventives are not used in children).
  • CGRP monoclonal antibodies are not yet approved for pediatric use.

The CHAMP trial (2017) compared placebo, amitriptyline, and topiramate for pediatric migraine prevention — all three were similarly effective, and the placebo response was substantial. This shaped current cautious prescribing in children.

When to seek pediatric evaluation

These features warrant pediatric medical evaluation:

  • More than 1–2 headaches per month consistently.
  • Headache with vomiting in a child.
  • Headache disrupting school attendance or activities.
  • Headache with vision changes, weakness, or confusion.
  • Headache after head trauma.
  • Headache awakening the child from sleep.
  • “Worst ever” headache.
  • New pattern in a child who previously didn’t have headaches.

The threshold for evaluation should be lower than for adults — a pediatrician’s office visit is the right starting point.

Hermly’s positioning

Hermly is designed and tested for adults. Specific reasons not to use it for a pediatric user:

  • The prediction model is trained on adult cohort data; pediatric prediction is a different problem.
  • HealthKit integration assumes the adult user’s account; sleep baselines, HRV norms, and cycle data all differ in children.
  • Acute medication logging assumes adult doses; pediatric dosing is weight-based and would require a different schema.
  • No parental controls or guardian access flows.
  • No COPPA-aware data handling for under-13 users.

If you’re a parent looking for a way to help track your child’s attacks, the simplest option is a paper calendar plus a pediatric headache diary that the pediatrician provides or recommends. Several free pediatric migraine apps exist — none that we’d specifically recommend over the others — and your pediatrician will know which align with their practice.

What this isn’t

Not a substitute for pediatric medical care. Not a guide to dosing — pediatric medication dosing is weight-based, age- specific, and not something an app should compute. Not a diagnosis tool.

What it is: a starting point for parents to understand that pediatric migraine is real, looks different from adult migraine, and benefits from specialist evaluation when frequent or severe.