To summarize, the knowledge required by clinicians to dispense proper headache education and counsel their patients on behavioral and lifestyle interventions, we reviewed the link between migraine and its common triggers. We assessed the following factors: stress, sleep poverty, and alimentation. To date, there is no concrete evidence that strongly indicates the effectiveness of headache education.

Stress within the family and in school environments is linked to migraines in children and adolescents. These stresses can exacerbate a migraine, which in turn reduces further functioning [29,34], impairs the health-related quality of life [28,89], and affects relationships with colleagues [90]. Ensuring healthy family dynamics as part of routine consultations may reduce unnecessary stressful burdens on children and adolescents and improve their physical complaints [25]. Understanding that migraines are associated with family [91] and building better relationships to form a solid support system will reduce migraines in affected children. Proper and timely assessment of psychiatric comorbidities may alleviate the patient’s added stress due to the connection between migraines and psychiatric comorbidities, such as depression and anxiety. Psychiatric comorbidities can deteriorate a home environment, and a worsening home situation increases the likelihood of future migraine development.

The association between sleep and migraine is supported by evidence, barring the conundrum of whether sleep is a trigger or an effect of migraine. The assessment and adjustment of sleep habits are always recommended for children suffering from migraines. According to the National Sleep Foundation, the recommended sleep times are 9–12 hours for children (6–12 years) and 8–10 hours for teenagers (13–18 years) [92]. After adjusting the time of sleep and maintaining good sleep hygiene, children with persistent migraines should be screened by polysomnography to identify possible sleep disorders. We conjecture that sleep education plays a significant role in the success of migraine treatment.

The current evidence on dietary triggers of migraine is limited, but several large population-based studies have exhibited a negative view of the efficacy of restrictive diets or weight-loss interventions [93,94,95]. Rather than avoiding diet-related triggers, it is more important to avoid skipping meals and instead eat a well-balanced diet. The Headache Diaries prospectively gathers information on potential triggers, including behavioral, dietary, and environmental factors, to identify individual triggers [73]. However, completely avoiding all potential headache triggers is unlikely because of their diversity, and attempting to do so could result in a very restricted lifestyle [96]. Limiting all triggers can be stressful and harmful, far outweighing any potential benefits and lowering the threshold for migraine development [17]. Present trends in migraine management are thought to be more important in managing triggers than avoiding them [97,98]. We recommend that physicians should not solely advise children and their caregivers to ‘avoid stress’, but also counsel them to respond to incentives through instruction and ‘coping mechanisms’, similar to those for adult migraine patients [99,100]. A recent observational study showed that pediatric migraine patients practiced fewer pain-coping strategies [33]; we advocate that children with migraines need to be taught child-appropriate coping methods. The role of the parents/caretakers around the child with a migraine is also important. By creating optimal and healthy environments, they need to explore what kind of lifestyle is appropriate for the affected child. The child’s lifestyle should be tailored to his/her individual needs, including getting regular exercise, eating a proper diet, and sleeping on a regular schedule (Figure 1). And they need to learn the mechanisms of migraines, the fact that a migraine is a disorder of the brain that involves altered sensory processing [101], and that lifestyle habits can decrease the risk of developing a headache attack.

While it is critical to encourage good sleep hygiene and ensure healthy family relationships, a physician should also emphasize the importance of a balanced diet and should not advise more food restrictions than necessary. To prevent migraines, affected children and their parents/caretakers must manage stress, sleep, and diet—overall following a balanced lifestyle; this is essential for the health of the child and the family.