Monday, August 05, 2013

Treating migraines in children

This article discusses how common migraine headaches are in children and discusses the many possible causes for them.

Migraine headaches are actually common in childhood and adolescence. It’s estimated that about 5 percent of children have migraine headaches. There is evidence that migraines are genetic disorder, occurring in families.
Migraines may occur as a result of changes in blood vessel diameter. Constriction or spasm of blood vessels to the brain and surrounding structures may decrease blood flow to these areas. Researchers believe that migraines are due to inflammation of the nervous system involving serotonin receptors (serotonin is a particular kind of neurotransmitter in the brain) . This can result in a severe headache, as well as other neurological symptoms such as visual changes, difficulty speaking, weakness or numbness in one part of the body, tingling sensations, and others.
Other symptoms can include nausea, vomiting, abdominal pain, and a sensitivity to light (photophobia). Toddlers and infants can have symptoms such as cyclical vomiting (sometimes called abdominal migraine) and torticollis (spasm of the neck muscles resulting in head tilt).
Several factors can trigger migraines, including: food, caffeine, sun, stress, menses, oral contraceptives, fatigue or stress.
There are several types of migraine. The classic type is preceded by auras (seeing rainbows/halos around lights or flashing lights), followed by headache pain, which can take up to 60 minutes to begin. The common type migraine, most prevalent in children, is not preceded by auras.
Most children who get migraines will appear to be in normal health during a physical examination. However, it’s important that they are examined in order to rule out other causes of headache.
One of the simplest things I do is to examine patients’ eyes. Oftentimes children complaining of headaches have vision problems and need prescription lenses. I also examine the mouth carefully to make sure that my patients do not have dental abcesses causing pain. Additionally, sinus infection can cause headaches in children as well as adults.
The two most serious causes of headache that a health care provider should rule out are meningitis or brain lesions (tumors).
Meningitis involves symptoms such as fever and neck stiffness along with a headache.
A brain tumor would involve symptoms such as morning headaches that improve throughout the day as well as weakness, double vision, difficulty walking and personality changes.
Children with complicated migraines (marked by neurological symptoms that persist after termination of the headache) may need special brain imaging (called a MRI or magnetic resonance imaging) to rule out brain abnormalities.
There are several things that can be done to prevent migraines and treat migraine pain: First it’s often helpful to create a “headache diary.”
The parent or older child can make note of the timing of the headache, what the child was doing at the time the headache struck, whether there were certain foods eaten or medications being taken.
I also suggest that parents eliminate or minimize certain headache triggers. Some foods, especially nitrite-containing foods (including hot dogs, bologna, luncheon meats), aged cheeses, chocolate and caffeinated beverages (including tea, coffee and many sodas) which can all trigger migraines. I encourage families to limit (preferably eliminate) these items. Sun is also an important trigger. I recommend that children who experience migraines regularly wear sunglasses outside and sit in parts of the class room with the least sun glare. Some patients may get relief by taking a nap in a dark room.
There are several medications that can be used to treat migraines. Acetaminophen and ibuprofen can be effective for many children. Aspirin and aspirin-containing medications (such as Excedrin) should be avoided in children under 14 years of age due to the risk of developing Reyes Syndrome (a life threatening liver condition).
There are also medications used to prevent migraines, including propranolol, some antihistamines and tricyclic antidepressants. Some children also are given anti-nausea medications if they have severe nausea or vomiting with their migraines. There are other medications for migraine, however, they have not been extensively studied in children.
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