At what age do migraines typically onset?

Age of Onset for Migraines

Migraine typically begins at or around puberty, with the mean age of onset being younger than 8 years in children, though approximately half of all individuals who will develop migraine experience their first attacks before age 20. 1, 2

Typical Age Distribution

The onset of migraine follows a characteristic age pattern:

• Early childhood (before age 6): Approximately 24% of pediatric migraine patients have their first attack during this period 3
• School age (6-10 years): Another 57% of children develop migraine during these years, representing the peak onset period 3
• Adolescence and young adulthood: The remaining cases typically manifest before age 20, with half of all lifetime migraine sufferers beginning their attacks by this age 2
• Mean age at onset: Studies consistently report a mean onset age of approximately 7 years and 4 months (±3 years) in pediatric populations 4

Clinical Significance of Age at Onset

Earlier onset carries prognostic implications that warrant attention:

• Children who develop migraine before age 6 have a significantly less favorable long-term prognosis, with higher rates of persistent disease into adulthood 5, 3
• The earlier the disease begins, the more likely an unfavorable clinical course will develop 3
• Conversely, patients presenting at age ≥12 years at first medical evaluation have a 3-fold increased risk of chronic migraine 10 years later (odds ratio = 3.0) 4

Red Flags for Atypical Presentations

Onset after age 50 years should immediately raise suspicion for secondary causes rather than primary migraine, as migraine typically remits with older age while secondary headache disorders increase in incidence 6

• Late-onset migraine (after age 40) requires thorough investigation to exclude underlying pathology 6
• When migraine-like symptoms first appear in middle age, secondary headache disorders must be systematically excluded 6

Genetic and Familial Patterns

Migraine demonstrates strong heritability with important generational trends:

• Family history is positive in approximately 77.5% of pediatric migraine patients 3
• Children with affected parents develop migraine at significantly younger ages than their mothers or fathers did (P < .001), suggesting anticipation or changing environmental factors 7
• A positive family history strengthens diagnostic suspicion, particularly when symptoms begin at or around puberty 1

Pediatric-Specific Considerations

Migraine in children differs from adult presentations in several key aspects:

• Attack duration is shorter in children under 18 years (2-72 hours) compared to adults (4-72 hours) 8
• Headache is more often bilateral in children rather than unilateral 9
• Gastrointestinal symptoms are commonly prominent in pediatric migraine 8, 9