Columnists :: Kids Health With Dr Jack
Kiddie Migraines: A Headache in Your Stomach? by Jack Maypole, MD
MySouthEnd.com ContributorThursday Apr 26, 2012 Migraineur. Sounds like a job for a senior specialist in some artisanal craft, doesn’t it? Such a misleadingly pleasant sounding word. However, ’migraineur’ encapsulates a more-common-than-you-think entity affecting an invisible population of child and adult sufferers. It’s the misery known as the migraine headache.
A migraine is a recurrent headache, lasting two to 48 hours, that is sometimes accompanied by a raft of associated sensations (called auras). Migraines occur as a peculiar cascade of nerve excitement and inflammation over the cortex of the brain, accompanied by changes in the brain’s blood flow.
In children, special challenges abound: migraines present themselves in markedly different ways, and, the developmental status of many of kids makes history-taking more of a veterinary experience. As a classic 1962 study in Sweden found, lots of kids have had headaches (about 40% by 6 years old, and 70% by age 15). Migraine headaches are the most common type, occur in 10% of younger children, and about 25% of children in their teen years.
Parents or health care providers should suspect migraines when there are recurring episodes of symptoms that are making kids miserable. Unexplained illnesses without fever, that recur between periods of wellness? Be wary. Extra high levels of suspicion should be applied for kids with strong histories of carsickness, or a family with a history of migraines (up to 70% of pedi migraineurs have a relative who suffer them!).
Oddly enough, headachesmay be a transient, or event absent feature of migraine episodes in children. While adults may point to a one-sided headache, kids may perceive pain on both sides of their head, and muddle the diagnosis (tension headache? sinus infection?). More often, children may have a unique pediatric migraine experience, associated with any number of vague or specific symptoms, lasting up to 3 days. That is a long time to be miserable. Kids who get these spells tend to look the same with each go around .
At the onset of a migraine episode, parents may notice a certain unusual behavior in their children, including fatigue, irritability or hyperactivity. These aura-like sequences may be important to watch for, as they may offer a window of taking measures or medication to head off (or, in medical parlance, abort) a nascent migraine. Thereafter, things may progress to any number of issues, including pallor, odd facial expressions, confusion, sleepiness, or prolonged bouts of nausea and vomiting.
Parents and kids can learn triggers for migraine ’attacks.’ For many kids, a zipquick lifestyle can be a cause of migraines in itself. Insufficient sleep, skipped meals, hydrating poorly, or being stressed out or rundown can precipitate an episode. For teen girls, the hormone surges of their periods may bring on migraines.
In all, medical science is catching up to what families with kids who suffer migraines have long known: Migraines can be extremely debilitating, formative experience. Young children may perceive that they are different than their peers due to the magnitude of the impact migraines can have on their ability to participate in the runnings-around of childhood. School age children may miss significant amounts of school.
When a diagnosis is made, evidence suggests that the most effective approach hands down is a lifestyle and stress management approach. Getting sufficient sleep, eating and hydrating well, and avoiding triggers (including Xbox, computers, and texting!) WHILE learning ways to reduce stress tailored to a child’s age and interest beat medications any day. Yoga, exercise, meditation, massage, or guided imagery are easily adopted techniques that parents can take on with their kids (healthy anyway, right?). For many children with occasional migraine problems, additional and timeproven therapies make for the first line of treatment: ibuprofen, rest and chill time (in a dark, quiet room!) get kiddos straightened out and flying right.
For any parent with a question or concern that their child may have a migraine should consult with their child’s health care provider. A review of their story and an examination of the child will help with the diagnosis, and therapies can be suggested that are appropriate and safe. Ideally, parents and provides can develop a Migraine Plan, including how to prevent them, if/how to abort them at their onset, and what to do at home or school if an episode is suspected. Children with more complicated symptoms (vision loss, or muscle weakness during migrainous episodes, or severe symptoms that don’t respond to first line therapies) may require a consultation with a neurologist.
For the younger set, take heart. About half of all children of elementary school age or younger will see their symptoms cease at the onset of puberty. For kids who develop migraines during their teen years, most will carry them into adulthood, with their severity and frequency waning over time. For all kids and teens with migraines, we parents and care providers will do well to respect the fact that migraines happen and that they deserve our attention and efforts to prevent them.
Jack Maypole, MD is director of Pediatrics at the South End Community Health Center, and Director of the Comprehensive Care Program at Boston Medical Center, a clinic for children with complex and chronic illness. Portions of his articles are drawn from his blog found at thefastertimes.com/pediatrics.