Neurological
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November 15, 2024

6 Lab Tests to Run on Teenagers With Persistent Migraines

Medically Reviewed by
Updated On
November 20, 2024

According to one systematic review and meta-analysis, migraine affects 11% of teenagers, significantly impacting their daily lives. Persistent migraines in adolescents can disrupt school performance, social life, and emotional well-being.

As teenagers face unique hormonal and lifestyle changes, migraines can become a chronic issue, with some studies suggesting that early-onset migraines increase the risk of recurring episodes in adulthood. Identifying underlying physiological factors through targeted lab tests assists in accurately assessing, managing, and alleviating migraine symptoms in adolescents.

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Understanding Migraines in Teenagers

Migraines are a type of severe headache that causes various neurological symptoms, including:

  • Throbbing one-sided head pain
  • Nausea and vomiting
  • Dizziness
  • Sensitivity to light, smell, and sound

Teenagers are affected by two main types of migraine:

  • Migraine without aura occurs in 60-85% of children and adolescents
  • Migraine with aura occurs in 15-30% of children 

Aura refers to distinctive sensory disturbances that occur before head pain begins and may include:

  • Visual Aura: changes in vision, such as flashing lights, blurred vision, blind spots
  • Sensorimotor Aura: sensory or motor disturbances, such as tingling, numbness, or weakness
  • Dysphasic Aura: changes to speech, like mumbling, slurring, or difficulty speaking

The prevalence of migraine increases with age. Statistics reveal that approximately 10% of children 5-15 years old get migraine, and that number jumps to 28% by age 18. (39)

Migraines are believed to be caused by a release of neurotransmitters in the brain that affect the nerves and blood vessels, causing inflammation and pain in the brain. Various factors can predispose and trigger this malfunction, including:

  • Genetics
  • Hormonal fluctuations
  • Stress
  • Irregular sleep
  • Diet
  • Alcohol
  • Smoking
  • Weather changes
  • Exercise
  • Odors and fragrances
  • Neck pain

Importance of Lab Testing in Persistent Migraines

Lab testing in adolescents with persistent migraines helps exclude other potential causes of headaches, identify triggers, and customize treatment strategies to prevent migraine attacks and reduce the interference they cause in teens' lives. 

6 Lab Tests for Teenagers With Persistent Migraines

The following lab tests open a window to explore and identify the possible underlying causes of migraine in teens. This information can then be used to recommend personalized management plans that increase treatment efficacy.

1. Basic Blood Work

Routine blood work can help rule out other conditions that can present with headaches and exacerbate migraine symptoms. The following tests may be considered:

  • Complete Blood Count (CBC): measures red and white blood cells, hemoglobin, hematocrit, and platelets
  • Comprehensive Metabolic Panel (CMP): measures blood sugar, electrolytes, proteins, liver enzymes, and kidney function
  • Thyroid Panel: measures thyroid hormones

Abnormalities that can be captured with these blood tests include: 

Examples of Basic Blood Tests

2. Micronutrient Test

Migraine headaches have been associated with the following nutrient deficiencies:

A micronutrient test is a specialty lab panel that combines direct and functional markers of vitamins, minerals, and other essential nutrients to assess nutritional status.

Identifying exact nutrients that are suboptimal allows doctors to prescribe supplements and recommend dietary modifications to replenish specific nutrients that the body requires.

Examples of Micronutrient Tests

3. Hormones

The prevalence of migraines in adolescent girls is significantly higher compared to boys. According to one study, the prevalence of migraine in adolescents is approximately 17.5% in females and 8.6% in males.

This increased prevalence in adolescent girls is relevant to the risk of recurring migraine episodes in adulthood. A long-term study found that childhood migraine persisted into adulthood in 65% of females compared to 21% of males.

The hormonal changes during puberty and throughout the menstrual cycle are thought to play a significant role in this gender difference, as they may influence the brain circuits involved in migraine pathophysiology. 

Testing female hormone (estrogen and progesterone) levels can help determine if hormonal shifts contribute to migraine frequency. Some studies suggest that stabilization of hormone levels can significantly alleviate migraines in females.

Stress and sleep disturbances are common migraine triggers, associated with 80% and 50% of cases, respectively (44). Cortisol and melatonin are two primary hormones that coordinate our sleep-wake cycle and stress response. Measurements of these hormones allow us to identify circadian disruptions that can cause poor sleep and maladaptive stress responses. 

Examples of Hormone Panels

4. Gut Microbiome

The gut-brain axis refers to the bidirectional communication between the gastrointestinal (GI) and central nervous systems (CNS). This interaction is influenced by various factors, including the gut microbiota, which can modulate brain function and behavior through mechanisms such as synthesizing neurotransmitters, modulating the immune system, and regulating tryptophan metabolism.

Studies have shown that individuals with migraines often exhibit alterations in their gut microbiota. For example, children with migraines tend to have distinct differences in bacterial genera that regulate tryptophan metabolism. Other studies have found an increased prevalence of Helicobacter pylori infection, decreased diversity, and dominance of pro-inflammatory bacterial species in patients who suffer from migraines (4, 6).

Examples of Gut Microbiome Tests

5. Food Sensitivities

Foods are also a well-documented trigger of migraine attacks. In addition to certain dietary compounds, such as nitrates and tyramine, that can modulate neurotransmitter signaling and provoke blood vessel changes, evidence also suggests that immune-mediated food sensitivities play a role in neuroinflammation and migraine development. 

Food sensitivities refer to delayed reactions to foods mediated by immune proteins called IgA and IgG that evoke symptoms hours to days after ingestion. Research supports the use of IgG food sensitivity testing to identify dietary triggers and customize elimination diets as an effective non-pharmaceutical means of treating migraines.

Examples of Food Sensitivity Tests

6. Environmental Toxins

Multiple chemical sensitivity (MCS) is characterized by heightened sensitivity to low-dose chemical exposures and shares common features with central sensitivity syndromes (CSS), characterized by CNS hyperresponsiveness to stimuli. It has been estimated that 20% of migraine patients also have MCS. 

Even low-level exposure to toxicants, including air pollutants, pesticides, and organic solvents, has been linked to migraines and other types of recurrent headaches (18, 28).

Examples of Environmental Toxin Tests

Additional Diagnostic Tests

Migraines can be diagnosed clinically using the ICDH-3 Diagnostic Criteria for Migraine.

In some instances, neuroimaging may be recommended. Magnetic resonance imaging (MRI) is the preferred imaging method of choice. Indications that warrant imaging include:

  • Abnormal neurologic exam
  • Coexisting seizures
  • Recent onset of severe headache
  • Change in type of headache
  • Associated features that suggest neurologic dysfunction

Managing Migraines Based on Lab Results

The primary goals of migraine treatment include managing acute attacks and preventing future headaches. 

Acute Management

Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and acetaminophen, are the preferred agents for mild-to-moderate migraine. Prescription triptan medications can be considered for moderate-to-severe migraines that are unresponsive to OTC medications. (29)

Migraine Prevention

Migraine prophylaxis treatment options will vary depending on what is uncovered through diagnostic testing. Options may include: 

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Key Takeaways

  • A strategic selection of lab tests offers a holistic view of potential contributors to persistent migraines in teenagers. 
  • Basic blood work, including a CBC, CMP, and thyroid panel, can identify underlying medical issues that may be misdiagnosed as migraine. 
  • Micronutrient tests measure multiple essential nutrients to screen for deficiencies linked to migraine frequency and severity.
  • Hormonal fluctuations, especially in females, are strongly associated with migraine. Hormone panels can identify estrogen, progesterone, cortisol, and melatonin imbalances that can exacerbate headaches. 
  • The gut-brain axis refers to the bidirectional relationship between the GI tract and the CNS. Gut health tests, including microbiome analysis and food sensitivities panels, can screen for dysbiosis and immune-mediated food intolerances that increase the risk for migraines.
  • Environmental toxin panels assess the chemical burden in the body, which is important for patients with multiple chemical sensitivities. 
  • There is no one-size-fits-all approach to migraine relief that works for everyone. Incorporating these tests into migraine protocols paves the way for effective, individualized treatment plans that can reduce the burden of migraine headaches on teenagers.
The information provided is not intended to be a substitute for professional medical advice. Always consult with your doctor or other qualified healthcare provider before taking any dietary supplement or making any changes to your diet or exercise routine.

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Jaime Cloyd
Author
Dr. Jaime Cloyd ND
Naturopathic Physician based in the greater Seattle area
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