Migraines in children from toddlers to teens

This article discusses migraine headaches and how they present in children from toddlers to teenagers.

A toddler is having bouts of projectile vomiting, quite frequently but not every day. Fearing something is "terribly wrong" with her daughter's digestive system, her mother takes her to the doctor. Within 20 minutes, the pediatrician has traced the girl's symptoms to motion sickness – she gets sick every time she rides in the car, or shortly after. Although she's never had a headache, by age 3 the girl is diagnosed with the neurological disorder called migraine.

What Is Migraine?

A simple definition is a “recurrent, episodic headache, or head pain, that typically lasts between two and 72 hours untreated,” says Andrew Hershey, chair and a professor of neurology at Cincinnati Children's Hospital Medical Center​​​​. For some people,​ migraine comes with nausea or vomiting, while others experience light and sound sensitivity. Headaches are usually throbbing and partial​​ (involving one side of the head) and moderately or severely intense.​ Migraine has a strong genetic component.

Hershey, director of the CCHMC Headache Center, says while most migraine episodes come and go, they can evolve into chronic migraine: “About a third of our patients get to the point that the headache just never leaves them.”

At least 10 percent of kids have migraine, Hershey says.​ While the rate is about 4 percent in preschoolers, by late teens it affects up to 15 percent of boys and 20 to 25 percent of girls. The youngest patient Hershey ever treated started at 10 months old.

What Triggers Migraine​?

“Migraine is more than a headache. It’s a generalized disturbance of function that involves brain and body,” says Joel Saper,​ a neurologist and director of the Michigan Head Pain and Neurological Institute in Ann Arbor.

Although many people believe stress "causes" migraine, researchers are still working to determine the complex causes for the condition. What's known is that children have a variety of migraine triggers that can set off an episode, including food sensitivities, fatigue, bright lights, loud noises and sleep changes.​

In younger kids, non-headache signs or “migraine equivalents” can include stomach pain, episodes of dizziness, vertigo (spinning), visual disturbances and sudden mood changes, Saper says. Motion sickness is migraine equivalent, he notes, and it’s been recently established that colic in babies is a forerunner to migraine.

Before starting any kind of treatment, it’s crucial to pin down the diagnosis. Some 300 other medical conditions cause headache in kids, Saper says. Emotional causes also have to be ruled out – like school avoidance in a kid who’s anxious or being bullied.

For parents, Saper says it’s key to find a knowledgeable health care provider, whether it’s a specialist, family practice doctor, nurse practitioner or physician assistant.

Life With Migraine for Kids

Two decades ago, Cathy Glaser ​was concerned about her 3-year-old daughter Samantha, who was having cyclical bouts of vomiting and upset stomach. Through careful questioning, the pediatrician traced the episodes to motion sickness.

Glaser knows a lot about migraine. “We like to say my daughter was doomed since both parents have migraine. It runs through both of our families,” says Glaser, who eventually started the Migraine Research Foundation in New York.

Although Samantha was stoic, Glaser could always tell when she had a migraine coming on. “I could look into my daughter’s eyes and see she was getting a headache,” she says. “I could look at her face – she was ashen. All of a sudden those sparkly child’s eyes were absolutely dead. And her whole affect changed.”

Migraine invaded every aspect of Samantha’s childhood, and she visited the emergency room several times a year. It hijacked family trips. On their way to a family reunion at Hersheypark in Pennsylvania, they were forced to pull off the New Jersey Turnpike, because Samantha was green with motion sickness.

School presents many challenges for kids with migraine. Glaser says that as a parent, you need to be your child’s advocate. And you have to be proactive.

“I used to go to school every year at the beginning, or before, with a doctor’s note about migraine and my own daughter’s treatment explain when she raises her hand and says, ‘I need to take my medication now,’ they need to let her go,” she recalls.

Samantha “didn’t want to miss her life,” Glaser says. Even as an 8-year-old, she would say “Mom, I can be alone and feeling horrible, or I can be at school with my friends feeling horrible. I choose school.”

Every summer Samantha's parents sent her off to sleep-away camps, ​and every time they got calls in the middle of the night to come get her – the camp couldn’t handle it. “This is the life of a child who has regular headaches who insists on living the life of a kid,” Glaser says.

Sameness Helps

Boys and girls get headaches equally until age 12 or 13 – but when girls start their periods, the picture changes. Migraine is an “estrogen-vulnerable” disorder, Saper explains. Hormone cycling in girls and later women – from menstruation, oral contraceptives and menopause – can make migraines worse. Boys are more likely to grow out of migraines than girls.

As she entered her teens, Samantha developed menstrual migraine. (She also gets weather headaches, when there’s a change in barometric pressure or a storm’s coming on.)

With migraine, “Sameness helps,” Saper says. Sleep is a big issue, and regular bedtimes and waking times are important. If kids have trouble sleeping, he says melatonin “is a particularly good medicine” to help.

Some children with migraine are food sensitive. “What they eat may make a difference, whether it be the gluten, cheese or dairy products – there’s a long list,” Saper says. Kids shouldn’t miss meals or skip breakfast.

Dehydration can also trigger migraines, and healthy habits include drinking plenty of water or other non-caffeine drinks. Exercise also helps, and so do relaxation and stress-management techniques. 

Not Your Parents’ Headache

For migraine that goes beyond a headache or two a month, research suggests the best approach combines medication and cognitive behavioral therapy. The two main drug categories are medications for treatment and for prevention.

NSAIDs such as Aleve and Ibuprofen are used to break acute headaches in kids, Hersey says ­– aspirin should be avoided because of the risk of liver problems. And parents and patients should be alert to overuse. For prevention, the drugs amitriptyline and topiramate are most commonly prescribed.

At Cincinnati Children’s Headache Center, after kids undergo a neurological and headache exam, the team comes up with a multipronged treatment plan, including medication choices and learning healthy habits. Kids with chronic headaches return for cognitive behavioral therapy, which takes about six weeks to absorb.

Part of the goal is getting kids to accept that they have a chronic illness and teaching them to manage their own care, Hershey says: “We often say to the kids, ‘It’s your headache – it’s not your mom and dad’s.”

Scott Powers, a pediatric psychologist at the center, is working with his team to fine-tune a migraine app that kids can use to track their episodes and symptoms electronically. The app also allows researchers to better connect the dots between triggers and headache timing.

College and Migraines

With the importance of regular sleep, healthy eating habits and keeping stress on an even keel – what could possibly go wrong when kids with migraine leave for college?

But when the time came, Samantha insisted on going away to a big school, Glaser says. After much discussion they agreed that Samantha would go to a school within driving distance, near a hospital and with a well-staffed campus health center.

“Her view about college was ‘I want to stop being 'Migraine Girl,'" Glaser recalls her daughter saying. “’I want to stop being defined by my disease.’” 

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Headaches in children

This article discusses headaches in children, which is becoming more prevalent as the school year begins.

As the school year approaches and begins, many parents may start to hear their children complain about headaches.

According to Nick DeBlasio, MD, a pediatrician in Cincinnati Children's Hospital Medical Center's Pediatric Primary Care Clinic, about 10% of school-aged children and 15-27% of teens experience them from time to time.

Headaches can be triggered by a number of different things. Here are the most common causes of occasional headaches in children:

Inadequate hydration. Not drinking enough fluids is one of the biggest causes of headaches. This is especially true when the weather gets warmer and kids become more active outside and lose fluid through sweating. If this is the case, the cure might be as simple as having your child drink more water.

Diet. Does your child eat regular meals? Skipping one meal, like breakfast, can trigger a headache. It's also important to make sure that your child is eating a well-balanced diet with lots of fruits and vegetables. Too much caffeine and certain foods can cause a headache as well.

Sleep. Kids in middle and high school typically need at least 10-12 hours of sleep a night. Not sleeping enough at night can cause a headache. And getting less than 10 hours isn't enough to feel well-rested.

Stress. We all experience stress from time to time, and children and teens are no exception. If your child is under a lot of pressure from school, or experiencing big changes at home like a divorce or a big move, a headache can result.

Vision problems. If your child is unable to see what's happening at the front of the classroom, he might be straining his eyes to see far away, which can result in a headache. A vision test can give you a better understanding of whether or not your child's headaches are being caused by vision problems.

Family history. Your child is more likely to have headaches if a parent gets them as well.

If your child has a headache, try giving her water and over-the-counter ibuprofen. Follow the instructions on the package for the appropriate dosage and do not give it to your child more than three times in a week. If it persists for a few days or worsens, call your child's pediatrician.

Fortunately the majority of headaches in children are not a cause for alarm. However, there are a few instances which require a little more investigation. If your child's headaches have become more frequent or severe, if he wakes up in the morning of the middle of the night from it, or if the headache causes vomiting, it's best to have your child evaluated by your pediatrician.

He or she will perform a physical exam and decide if any tests need to be done. Brain MRIs and CT scans are rarely needed. If your pediatrician suspects a migraine, she might refer your child to a neurologist who is familiar with medications to help prevent and treat them.

And if your child or teen is suffering from chronic headaches and migraines, recent research by Cincinnati Children's found that adding cognitive behavioral therapy to treatment of pediatric migraines improves relief.

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How to spot migraine headaches

This article discusses how to spot a migraine headache from other types of headaches.

Migraines are severe headaches that are extremely tough to deal with, but how would you know if you  are suffering from a migraine or just a normal headache? Well, here are the symptoms of a migraine that can help you tell it apart from just another headache.

The symptoms vary

It is important to realize that the symptoms of migraines are extremely subjective – they differ from person to person. Moreover, there are actually three phases to a migraine – before the onset of the condition called prodrome, during the episode and after the episode (postdrome). Here is what you might experience in all three states.

Before a migraine starts

Some people report experiencing depression, irritability, excessive hunger, thirst, feeling of euphoria (in some cases), and restlessness and nervousness.

Another phenomenon of a migraine is that some people notice an aura. People notice this about thirty minutes before a migraine strikes and it usually appears as wavy lines, or a bright flashes of light. Some of them also experience a ‘pins-and-needles’ sensation down one’s hands, arms and face.

During the migraine:

This is usually the most painful and debilitating part of the condition. A person suffering from it will notice the following symptoms:

• Throbbing pain on one or both side of one’s head
• Pain behind the ears
• A headache that is extremely severe and inhibits normal activity
• Pain that gets worse with normal, everyday activity
• Nausea and vomiting
• Pain that gets worse when there is light, too much sound, and sensitivity to some smells.

While these are the most common symptoms, there are other uncommon symptoms like tingling around the face, arms and shoulders, inability to speak and experiencing temporary weakness on one side of the body.

After the migraine:

After the migraine has passed patients usually feel tired, fatigued and in some cases dizzy. There are rare cases where some people feel euphoric after an episode of migraine.

But, not all headaches are migraines:

While these are the most common symptoms of a migraine, a severe headache can also be a sign of other more serious conditions. If you experience sudden ‘thunderclap’ (extremely painful) headaches, a headache with fever, confusion and disorientation or those kinds of headaches that get worse on coughing or exertion etc, visit your doctor  immediately. They could be a sign of something far more serious.

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Headaches in children

This article gives a lot of information on headaches in children.

Why do children get headaches?

Headaches in children are common and usually not serious.  Causes include migraines, stress and tension headaches, trauma, sinus disease and eye problems.  Certain foods with nitrate preservatives and MSG (monosodium glutamate) can trigger headaches.  Brain tumors in children as a cause for headaches are extremely rare, and are usually associated with additional neurologic symptoms such as dizziness and lack of coordination.

How are children with headaches evaluated?

Children should have a thorough physical examination with a pediatrician.  He/she may order additional tests or refer to a neurologist.  It is helpful to keep a headache diary so that possible triggers (certain foods or activities) can be discovered.

If no obvious medical cause for the headaches is found by the pediatrician, a referral to an ophthalmologist is required to perform a complete eye exam.  The entire visual system should be examined.  This includes refractive error (the need for glasses), eye alignment, and binocularity (the ability to use both eyes together).  During this examination the pupils should be dilated.

 How do eye problems cause headaches in children?

Hyperopia (farsightedness) requires extra effort to focus clearly while reading.  This can sometimes lead to fatigue and headache.  Glasses can reduce the effort required to see clearly at near and improve the headache.

The decreased ability to pull the eyes toward each other when viewing near objects (convergence), particularly while reading, may cause headaches.  This is called convergence insufficiency, and symptoms include the doubling of images or words, blurred vision, fatigue, and headaches which worsen with prolonged reading.  Glasses are sometimes prescribed.  At home eye exercises, sometimes with the help of computer software, can help treat convergence insufficiency.  Expensive in office eye exercises are rarely indicated.

 Acute infections and inflammatory diseases of the eyes can cause headaches.  These problems are often accompanied by redness of the eye and/or eyelid and light sensitivity (photophobia).  Acute glaucoma can cause headaches, but rarely affects children.  A complete exam by an ophthalmologist can rule out these conditions.

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Study shows that more stress means more headaches

A study shows that having more stress in your life means you get more headaches.

A new study provides evidence for what many people who experience headache have long suspected—having more stress in your life leads to more headaches. The study released today will be presented at the American Academy of Neurology's 66th Annual Meeting in Philadelphia, April 26 to May 3, 2014.

For the study, 5,159 people age 21 to 71 in the general population were surveyed about their stress levels and headaches four times a year for two years. Participants stated how many headaches they had per month and rated their stress level on a scale of zero to 100.

A total of 31 percent of the participants had tension-type headache, 14 percent had migraine, 11 percent had migraine combined with tension-type headache and for 17 percent the headache type was not classified. Those with tension-type headache rated their stress at an average of 52 out of 100. For migraine, it was 62 out of 100 and 59 for those with migraine and tension-type headache.

For each type of headache, an increase in stress was associated with an increase in the number of headaches per month. For those with tension headache, an increase of 10 points on the stress scale was associated with a 6.3-percent increase in the number of headache days per month. For migraine, the number of headache days per month went up by 4.3 percent, and 4 percent for those with migraine and tension headache. The results were adjusted to account for factors that could affect the number of headaches, such as drinking, smoking and frequent use of headache drugs.

"These results show that this is a problem for everyone who suffers from headaches and emphasize the importance of stress management approaches for people with migraine and those who treat them," said study author Sara H. Schramm, MD, of University Hospital of University Duisburg-Essen in Germany. "The results add weight to the concept that stress can be a factor contributing to the onset of headache disorders, that it accelerates the progression to chronic headache, exacerbates headache episodes, and that the headache experience itself can serve as a stressor."

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Study: Cognitive behavioral therapy can help kids with migraines

A study shows that symptoms of chronic migraines in children are reduced with cognitive behavioral therapy (CBT).

Among children and adolescents with chronic migraine, the use of cognitive behavioral therapy (CBT) resulted in greater reductions in headache frequency and migraine-related disability compared with headache education, according to a study appearing in the December 25 issue of JAMA.

"In adults, more than 2 percent of the population has chronic migraine and in children and adolescents the prevalence is up to 1.75 percent. In pediatric patients who seek care in headache specialty clinics, up to 69 percent have chronic migraine; however, there are no interventions approved by the U.S. Food and Drug Administration for the treatment of chronic migraine in young persons. As a result, current clinical practice is not evidence-based and quite variable," according to background information in the article.

Scott W. Powers, Ph.D., of Cincinnati Children's Hospital Medical Center, and colleagues randomized 135 participants (79 percent female) 10 to 17 years of age diagnosed with chronic migraine (≥ 15 days with headache/month) and a Pediatric Migraine Disability Assessment Score (PedMIDAS) greater than 20 points (disability score range: 0-10 for little to none, 11-30 for mild, 31-50 for moderate, >50 for severe) to CBT (n = 64) or headache education (n = 71). The study was conducted in the Headache Center at Cincinnati Children's Hospital between October 2006 and September 2012; 129 participants completed 20-week follow-up and 124 completed 12-month follow-up. The interventions consisted of 10 CBT or 10 headache education sessions involving equivalent time and therapist attention; CBT included training in pain coping, modified to include a biofeedback component. Each group received amitriptyline; follow-up visits were conducted at 3, 6, 9, and 12 months.

On average, at the beginning of the trial, participants reported 21 of 28 days with a headache and a PedMIDAS of 68 points, indicating a severe grade of disability. From pretreatment to posttreatment, CBT resulted in a decrease of 11.5 headache days vs. 6.8 days with headache education. At 12-month follow-up, 86 percent of CBT participants had a 50 percent or greater reduction in days with headache vs. 69 percent of the headache education group; 88 percent of CBT participants had a PedMIDAS of less than 20 points (mild to no disability) vs. 76 percent of the headache education group.

"Now that there is strong evidence for CBT in headache management, it should be routinely offered [to younger people] as a first-line treatment for chronic migraine along with medications and not only as an add-on if medications are not found to be sufficiently effective. Also, CBT should be made more accessible to patients by inclusion as a covered service by health insurance as well as testing of alternate formats of delivery, such as using online or mobile formats, which can be offered as an option if in-person visits are a barrier," the authors write.

System barriers may affect the likelihood of CBT being implemented as a first-line treatment for pediatric chronic migraine, writes Mark Connelly, Ph.D., of Children's Mercy Hospitals and Clinics, Kansas City, in an accompanying editorial.

"Creative means of delivering CBT for pediatric chronic migraine (e.g., via telehealth or Internet-based programs, using behavioral health consultants in primary care offices) will be necessary for reducing current access and referral barriers that could be encountered by many families and physicians. Widening the availability of interdisciplinary models of training and treatment delivery also will be important for helping ensure that children with chronic migraine routinely receive combination therapies rather than being referred for psychological therapy only after other approaches fail."

"Ideally with the efforts of the health care community and other relevant stakeholders, the suggestion by Powers et al to consider CBT along with medication as a first-line treatment for chronic migraine in children will be implemented into practice well before the typical translation gap. Additional studies are warranted, however, to identify methods of preventing chronic migraine development and to determine the medications and combination therapies that further maximize improvements in health and quality of life outcomes for children and adolescents with chronic migraine."

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Pediatric emergency department visits due to headaches depend on the month

A study that looked at monthly changes in emergency department visits for children caused by headaches shows that children are more likely to go to the emergency department after they return to school from winter or summer breaks. The authors believe this is due to a change in daily lifestyle.

The objective of this article is to determine the monthly variation of emergency department (ED) visits for pediatric headache. The authors hypothesized youth have increased headache–related ED visits in the months associated with school attendance. In adolescents they found higher ED utilization in January and September, the same months associated with school return from vacation for a majority of children nationally. No significant reduction in the summer suggests that school itself is not the issue, but rather changes in daily lifestyle and transitions.

Methods

• Using a United States representative sample of ED visits in the National Hospital Ambulatory Medical Care Survey from 1997 to 2009, the authors estimated number of visits associated with ICD-9 codes related to headache, migraine, status migrainosus, or tension-type headache in 5- to 18-year-olds.
• Age-stratified multivariate models are presented for month of visit (July as reference).

Results

• There was a national estimate of 250,000 ED visits annually related to headache (2.1% of total visits) in 5- to 18-year-olds.
• In 5- to 11-year-olds, the adjusted rate of headache-related visits was lower in April (OR 0.42, 95% CI 0.20, 0.88).
• In 12- to 18-year-olds, there were higher rates in January (OR 1.92, 95% CI 1.16, 3.14) and September (OR 1.64, 95% CI 1.06, 2.55).

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Headaches and migraines in teens can be caused by chewing gum

Headaches and migraines in teenagers could be caused by or worsened by frequently chewing gum due to the joint between the jaw and the skull.

Teenagers are notorious for chewing a lot of gum. The lip smacking, bubble popping, discarded gum stuck to the sole give teachers and parents a headache.

Now, Dr. Nathan Watemberg of Tel Aviv University-affiliated Meir Medical Center has found that gum-chewing teenagers, and younger children as well, are giving themselves headaches too. His findings, published in Pediatric Neurology, could help treat countless cases of migraine and tension headaches in adolescents without the need for additional testing or medication.

"Out of our 30 patients, 26 reported significant improvement, and 19 had complete headache resolution," said Dr. Watemberg. "Twenty of the improved patients later agreed to go back to chewing gum, and all of them reported an immediate relapse of symptoms."

Right under our noses

Headaches are common in childhood and become more common and frequent during adolescence, particularly among girls. Typical triggers are stress, tiredness, lack of sleep, heat, video games, noise, sunlight, smoking, missed meals, and menstruation. But until now there has been little medical research on the relationship between gum chewing and headaches.

At Meir Medical Center's Child Neurology Unit and Child Development Center and community clinics, Dr. Watemberg noticed that many patients who reported headaches were daily gum chewers. Teenage girl patients were particularly avid chewers -- a finding supported by previous dental studies. Dr. Watemberg found that in many cases, when patients stopped chewing gum at his suggestion, they got substantially better.

Taking a more statistical approach, Dr. Watemberg asked 30 patients between six and 19 years old who had chronic migraine or tension headaches and chewed gum daily to quit chewing gum for one month. They had chewed gum for at least an hour up to more than six hours per day. After a month without gum, 19 of the 30 patients reported that their headaches went away entirely and seven reported a decrease in the frequency and intensity of headaches. To test the results, 26 of them agreed to resume gum chewing for two weeks. All of them reported a return of their symptoms within days.

Two previous studies linked gum chewing to headaches, but offered different explanations. One study suggested that gum chewing causes stress to the temporomandibular joint, or TMJ, the place where the jaw meets the skull. The other study blamed aspartame, the artificial sweetener used in most popular chewing gums. TMJ dysfunction has been shown to cause headaches, while the evidence is mixed on aspartame.

Gumming up the works

Dr. Watemberg favors the TMJ explanation. Gum is only flavorful for a short period of time, suggesting it does not contain much aspartame, he says. If aspartame caused headaches, he reasons, there would be a lot more headaches from diet drinks and artificially sweetened products. On the other hand, people chew gum well after the taste is gone, putting a significant burden on the TMJ, which is already the most used joint in the body, he says.

"Every doctor knows that overuse of the TMJ will cause headaches," said Dr. Watemberg. "I believe this is what's happening when children and teenagers chew gum excessively."

Dr. Watemberg says his findings can be put to use immediately. By advising teenagers with chronic headaches to simply stop chewing gum, doctors can provide many of them with quick and effective treatment, without the need for expensive diagnostic tests or medications.

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Study: Complementary & Alternative Medicine Use In Youth With Recurrent Headaches

A new study published in Pediatrics claims that children with chronic recurring headaches, especially those with another chronic condition, are more likely to use complementary and alternative medicine.

OBJECTIVE: To identify prevalence and patterns of complementary and alternative medicine (CAM) use among youth with recurrent headaches (HA) and evaluate associations with co-occurring health problems and limitations as well as with the use and expenditures for conventional medical care.

METHODS: Variables were constructed for youth aged 10 to 17 by using linked data from the 2007 National Health Interview Survey and the 2008 Medical Expenditures Panel Survey. Bivariate, logistic, and 2-part regression analyses were used.

RESULTS: Of the 10.6% of youth experiencing HA, 29.6% used CAM, rising to 41% for the many HA sufferers who also experienced difficulties with emotions, concentration, behavior, school attendance, or daily activities. Biologically based products (16.2%) and mind-body therapies (13.3%) were most commonly used, especially by the 86.4% of youth with HA experiencing at least 1 other chronic condition. Compared with non-CAM users, youth with HA who used CAM also had higher expenditures for and use of most types of conventional care.

CONCLUSIONS: CAM use is most common among youth with HA experiencing multiple chronic conditions and difficulties in daily functioning. Associations among CAM use, multiple chronic conditions, and higher use of conventional care highlight the need for medical providers to routinely ask about CAM use to meet the complex health needs of their patients and facilitate the optimal integration of care. Research is needed to identify models for coordinating complementary and conventional care within a medical home and to understand the health benefits or risks associated with CAM use in conjunction with conventional treatments for patients with HA.

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Childhood migraines

This article discusses migraines in children and the differences between them and adult migraines.

Headaches are a common complaint throughout childhood, but pediatricians have recognized that children have many different types of headaches, including migraines. Migraine headaches are best diagnosed by obtaining a detailed medical history and then conducting a thorough neurological exam.

Several characteristics of childhood migraines are quite different from those associated with adult migraines. While adult females have a higher incidence of migraine headaches, males predominate in the childhood population.

Childhood migraines often are shorter in duration than adult migraines and are less often unilateral (one-sided) than in adults. Only 25 percent to 60 percent of children will describe a unilateral headache, while 75 percent to 90 percent of adults have unilateral pain.

Children suffered from migraines don't typically have visual auras like adults, but may have a behavioral change with irritability, pallor, malaise, or loss of appetite proceeding the headache. Only about 18 percent of children describe migraine with an aura and another 13 percent may have migraines with and without auras at different times.

When taking a history, it's also important to ask about any family history of migraines, as these headaches seem to run in families. Children who develop migraines were often "fussy" infants, and they also have an increased incidence of sleep disorders, including night terrors and nightmares. Many parents and children who get migraines also report a history of motion sickness.

When children discuss their headaches, they often complain of feeling dizzy (although, after further questioning, this actually sounds more like being lightheaded than suffering from vertigo). They may also complain of blurred vision, abdominal pain, nausea and vomiting, chills, sweating, or even feeling feverish. Children with migraines appear ill, uncomfortable and pale, and will often have dark circles around their eyes.

It seems that migraine headaches in childhood may be precipitated by hunger, lack of sleep, and stress. Keep in mind that "stress" for a child may be positive, such as being excited, as well as negative.

Children with migraines will also tell you their headaches are aggravated by physical activity (including going up and down stairs, carrying a backpack, or even just bending over). Many complain of photophobia (light sensitivity) and phonophobia (sensitive to noises) and typically a parent will report that their child goes to bed in a dark room or goes to sleep when experiencing these symptoms.

Children with migraines don't watch TV or play video games during their headaches. They are quiet, may not want to eat, and may just want to rest. Nothing active typically "sounds" like fun to them.

To meet the diagnostic criteria for childhood migraine, a child needs to have at least five such "attacks." A headache log is useful, as these headaches may occur randomly and it's difficult to remember what each headache was like, or how long it lasted, without keeping a log.

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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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Causes of headaches in children

This article discusses the many possible causes of headaches in children ranging from normal to serious causes.

Children’s headaches can be related to ailments, from allergies to ear infections to sinus problems, and most of the time they don’t indicate a dangerous illness.

But for many parents, the shadow of a terrible diagnosis lurks in the corner of the darkened room where a headachy child is lying with a cool cloth on her brow.

Sometimes, children with headaches need neuroimaging — brain CTs or MRIs. But recently several large studies have raised concerns about CT scans done on children because the radiation from these scans can increase the risk of eventually developing cancer, though that overall risk is still very small.

Doctors are being asked to follow guidelines for judicious use of these scans, but many parents remain unaware of the risks and guidelines. A study in the journal Pediatrics looked at a huge group of children who each saw a doctor at least twice with headaches but had no injury or trauma. More than 25 percent of those children got CT scans, the researchers found.

Children who brought their aching heads into emergency rooms were more likely to get scans than children visiting their regular doctors or neurology clinics.

“However, even outside the emergency room, the use of CT scans was quite high,” said Andrea DeVries, a director of research at HealthCore, a subsidiary of the insurer WellPoint, and the lead author of the study. About two-thirds of the children who received CT scans did not visit an emergency room, she noted.

Who does need neuroimaging? Doctors worry about a severe headache that gets worse, and about any abnormalities on the physical exam or changes that suggest a pathology in the brain. These changes can range from disturbances in gait or eye movements to confusion and lethargy.

Though nausea and vomiting commonly go along with migraines, vomiting can also indicate increased pressure in the brain. It can be a danger sign in a child who has recently had a concussion.

Symptoms like these quickly push a headache into the realm of a neurological emergency. Headaches that wake children from sleep or occur on just one side also may be cause for concern.

For children whose headaches don’t fit a clear migraine pattern, an eye exam is an important diagnostic step, said Dr. Andrew Lee, a neuro-ophthalmologist at the Methodist Hospital in Houston. An exam is also critical if parents have noticed any crossing of the eyes.

In serious situations, the eye exam may reveal signs of increased pressure in the brain. On a more mundane level, an exam may find that a child’s headache is caused by eye strain.

“The mother and father might not notice till reading age, third grade or fourth grade,” Lee said. Headaches that come on at that age, and are made worse by homework or reading, can be treated with glasses to correct poor vision and exercises to strengthen the eye movements.

And then there’s concussion. A 2012 study that looked at children who had head trauma found that three months after their injuries, many reported headaches. Most of the time, these children improve, but some will have headaches for months, and a very small percentage may have them for more than a year.

Heidi Blume, a pediatric neurologist at Seattle Children’s Hospital and lead author of the study, invoked a “SMART” mnemonic for helping children deal with their recurrent headaches. S is for sleep, she said, and getting enough of it. M is for not skipping meals and drinking enough to be properly hydrated. A is for physical activity, because too much or too little can lead to headaches, and R is for relaxation. T is for triggers to avoid, like cigarette smoke or particular foods.

Children can take painkillers (acetaminophen, ibuprofen and others; children should not take aspirin). Those with migraines may also benefit from preventive medicines. Counseling and biofeedback are important: Headaches can be triggered by stress, and living with chronic pain can cause depression. One goal in headache clinics is getting children back to school and helping them navigate regular activities while still avoiding their triggers.

“Many, many kids will outgrow their bad headaches,” said Dr. Daniel Bonthius, professor of pediatrics and neurology at the University of Iowa. “Exactly why they got the headaches and exactly why they go away, modern medicine doesn’t really understand.”

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Tips to help headache and migraine pain

This article gives tips that can help lessen pain from headaches and migraines.

Migraines, considered to be the most debilitating of all headaches, affect 12% of the population worldwide and approximately 28 million people in the U.S.  Sufferers frequently live in fear of the next headache onset, experience a disrupted sense of well-being, have a restricted ability to work and can develop family and other relationship problems.

For relief, most turn to over-the-counter pain medication, including Tylenol, Excedrin and prescription medication. However, if taken too often - or incorrectly - for prolonged periods of time, these medications can lead to ulcers, gastrointestinal bleeding, medication-overuse headaches and even death. 

During June, which is Migraine and Headache Awareness Month, Accelerated Physical Therapy is encouraging headache sufferers to visit their physician and consider physical therapy as an integral part of treatment.

"We see many headache patients in our centers," explains Denise Schneider, PT, head of the Accelerated headache program.  "As specially-trained physical therapists, we are very successful in evaluating and treating headaches and, in some cases, reducing the pain to a point where medical intervention is no longer required."

Pharmaceuticals can play a role in treatment, but physical therapy can enhance and prolong their pain-reducing effects.  Medication sometimes does not resolve headaches caused by mechanical or soft tissue dysfunction or postural deficits.

"There are specific techniques we use, including soft tissue massage, head/space orientation exercises, deep neck muscle exercises, manual traction and joint-specific mobilizations that are highly beneficial," Schneider explains. 

Schneider offers these tips for migraine and other headache sufferers to try at home:

• Eat regular meals
• Get regular sleep
• Exercise regularly
• Avoid known triggers such as food and smells
• Use a good pillow
• Try hot showers or heating pad
• Try cold pack or ice
• Watch your posture
• Drink plenty of water

Schneider recognizes that physical therapy can't treat all headaches.  "It has to have a musculo-skeletal or mechanical component," she explains.  This is also why she recommends a medical evaluation first to rule out causes that may require medical intervention, such as a tumor, vascular disease of infection.

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Colic in infants may be an early sign of migraines

Colic in infants may be an indicator of migraine headaches.

Colic has long been believed to be gastrointestinal pain in babies, say doctors, but new research suggests it may actually be related to migraine headaches instead.

Could colic — bouts of frequent, inconsolable crying during an infant's first months of life — be an early symptom of a migraine? A study out today is the latest to suggest that the two common pain conditions may be connected.

According to the study in the Journal of the American Medical Association, children diagnosed with migraine headaches were more likely to have experienced colic as infants (72.6%) than those who did not have migraine (26.5%).

And the increased odds existed for the two major migraine subtypes, as well: migraines preceded or accompanied by an "aura" — sensory warning symptoms such as flashes of light or blind spots (69.7%) and migraine without aura (73.9%). This association was not found for children with tension-type headaches (35%).

Researchers analyzed health records and questionnaires completed by parents for 208 children ages 6 to 18 who were diagnosed as having migraines and compared them with information on 471 kids and teens who were not. A comparison group of 120 children diagnosed with tension headaches also was studied.

A study published last year found that mothers who suffer from migraines are more than twice as likely to have babies with colic than mothers without a history of migraines.

Often thought of as a disorder of adulthood, migraine is "one of the most common causes of primary headaches in children," according to the article, written by Silvia Romanello of the APHP-Hospital Robert Debré, Paris, and colleagues.

An accompanying editorial notes that the prevalence of migraine headache by age groups is 1% to 3% from ages 3 to 7; 4% to 11% from ages 7 to 11; and 8% to 23% from ages 11 to 15 years old. Colic occurs in about 16% to 20% of infants.

Much more than a headache, a migraine is a "brain condition that can produce a variety of neurological symptoms," ranging from nausea and vomiting to sensitivity to light, sound, touch and smell, to dizziness and extreme fatigue, says Andrew Charles, a professor of neurology and director of the Headache Research and Treatment Program at UCLA School of Medicine. He was not involved in the new study.

"We've assumed for some time that colic was a gastrointestinal phenomenon, but in fact, that may not necessarily be true," says Charles. "That's one of the things that may surprise people about this study. It points out the possibility that this may be more of a brain issue than a gut issue."

Brain chemicals that are also shared by the gastrointestinal tract may be involved, but the actual mechanism at work "remains quite a mystery," he says.

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Study: Children’s Headaches Rarely Indicate a Need for Eyeglasses

Study: Children’s Headaches Rarely Indicate a Need for Eyeglasses

This study discusses how headaches in children do not indicate that the child needs eyeglasses, a common misconception by parents.

A new study provides the first clear evidence that vision or eye problems are rarely the cause of recurring headaches in children, even if the headaches usually strike while the child is doing schoolwork or other visual tasks. Many parents assume that frequent headaches mean their child needs glasses, so they ask their doctor to refer their child for an eye exam. This study was conducted by pediatric ophthalmologists who wanted to find reliable answers for parents, family doctors and pediatricians facing this common health question.

The research is being presented today at the 116th Annual Meeting of the American Academy of Ophthalmology, conducted jointly this year with the Asia-Pacific Academy of Ophthalmology.

In this retrospective study, which was conducted at the ophthalmology clinic of Albany Medical Center in New York state, researchers reviewed the medical records of 158 children under age 18 who were seen at the clinic for frequent headaches from 2002-11. All of the children received complete eye exams by the clinic's ophthalmologists.

No significant correlation was found between their frequent headaches and a need for vision correction. The researchers reached this conclusion by comparing the results of the clinic's exams of the children with headaches to the records of their previous eye exams and other relevant medical care. Eye health and vision test results remained unchanged from earlier exams for 75 percent of the children. Also, children who already had eyeglasses were not found to need new prescriptions at the time they were seen at the clinic for headaches. Although about 14 percent of the children reported that their headaches occurred while doing visual tasks like homework, and about nine percent reported visual symptoms associated with their headaches, a need for vision correction did not appear to be the primary cause or a significant factor in any of these cases, according to the study.

The researchers considered it positive that most of the children's headaches resolved over time. Follow up reports from parents showed that headaches improved in 76.4 percent of all study subjects, including those who did and those who did not receive new vision correction prescriptions. Children who received new prescriptions were not more likely than others to have their headaches improve. Assessing the causes of the headaches and addressing the children's long-term outcomes were beyond the scope of this study.

"We hope our study will help reassure parents that in most cases their children's headaches are not related to vision or eye problems, and that most headaches will clear up in time," said Zachary Roth, M.D., who led the research team. "The information should also be useful to family doctors and pediatricians in caring for children and parents who have this common health concern."

About thirty percent of the children in the study had eye conditions that went beyond the need for vision correction, including strabismus (misaligned eyes) amblyopia ("lazy eye") or other rarer, more serious conditions. Seventeen percent had a family history of migraine. Because this was a retrospective study, the researchers were unable to connect these factors with headache causes.

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