Migraines in children

This article discusses how migraines manifest themselves in children.

Migraines aren't just a problem for adults -- about 6 percent of children and more than one-quarter of teens aged 15 to 17 have migraines, according to the American Migraine Foundation (AMF).

"There are many things that can be done if your child suffers from migraine, or if you suspect that he or she does," foundation chair Dr. David Dodick, a professor of medicine at the Mayo Clinic College of Medicine in Scottsdale, Ariz., said in an AMF news release.

If you suspect your child has migraines, take him or her to a doctor to be assessed and receive treatment if necessary. Options include treatment to stop the pain and prevent a migraine from getting worse, along with measures to prevent or reduce the frequency, severity and duration of migraines.

If your child is prescribed a migraine medication, it's important for you to make sure he or she takes the medicine as directed. Inform your doctor if there are changes in your child's migraines, such as becoming more frequent or severe. A new treatment approach may be required, according to the headache experts.

A number of factors may contribute to your child's migraines, such as too little or too much sleep or stress. Parents need to help their children follow healthy lifestyles and cope with stress. Recent research in stress management suggests that a type of counseling called cognitive behavioral therapy can benefit children with chronic headache, according to the AMF.

Other potentially helpful stress-control techniques include relaxation therapy and biofeedback.

Keeping a migraine diary can help youngsters understand why they get migraines and how to prevent them. The diary tracks migraines, the severity, how long they last, what patients were doing before and during the migraine, and what foods they ate.

Mobile phone apps may be an ideal way for children and teens to tracks their migraines and to take their medications as prescribed, the experts suggested.

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Common treatments for migraines

This article provides information on migraine headaches and discusses treatments for migraine headaches.

Suffering from migraines can have a seriously negative impact on both your work and social life, but what exactly causes those splitting headaches?

Men, women and children can suffer from migraines. Some people may have a migraine as often as a few times a week, whereas others might only experience them occasionally.

According to the NHS, there are several types of migraine. These include:

• Migraine with aura – where there are warning signs before the migraine begins, such as seeing flashing lights.

• Migraine without aura – where the migraine occurs without warning signs.

• Migraine aura without headache, also known as silent migraine – where an aura or other migraine symptoms are experienced, but a headache does not develop.

Although the exact cause of migraine is unknown, triggers are thought to include hormonal, emotional, physical, dietary, environmental and medical changes to your usual routine.

If you suffer from regular migraines it is important to visit your GP, as some experts have found migraines to indicate other underlying health issues such as abnormal blood vessel structure in the brain.

Migraine remains undiagnosed and under-treated in at least 50% of patients, and less than 50% of migraine patients consult a physician – but your GP could really help you to reduce your suffering.

GPs can help you to identify the triggers of your migraine and also prescribe medication to help you manage your condition like painkillers, triptans (medications that can help reverse the changes in the brain that may cause migraines), or anti-emetics (medications often used to reduce nausea and vomiting).

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Facts about migraines

This article details facts about migraines, and discusses some tips for treatment.

While many people turn to prescription drugs to try to control migraines once they start, there aren’t any that are terribly effective and none that will stop the migraines before they happen. There is, however, another option and it doesn’t involve taking medication.

The Problem

Almost 5 million people in the U.S. experience at least one migraine attack a month. More than 11 million people blame migraines for causing moderate to severe disability and 91 percent of them can’t function normally during migraine attack, according to the American Migraine Study, which also reveals that the average migraine sufferer misses two days of work per year.

It’s an expense both in terms of career—lost work—and medical costs. Migraine sufferers use 2.5 times the amount of prescription drugs and have six times as many diagnostic tests and services as nonsufferers. The average monthly health cost of a migraine sufferer is 60 percent higher than that of people who don’t suffer from migraines, according to the National Institutes of Health.

According to The Migraine Trust, migraine often occurs for the first time in teens and young adults but is most common in the 30-something age group.

Who Can Help

Specially trained neuromuscular dentists can perform a dental procedure that can help. They use special equipment to find the optimal resting position of the jaw and create an orthotic—which looks like an athlete’s mouth guard. When inserted into the mouth, it can change your bite. Many treated this way find their chronic migraines are prevented.

Why It Works

That’s because chronic moderate to severe headaches, including migraine, are a common indicator of malocclusion, or a bad bite, commonly called TMD or jaw joint disorder.

“That’s particularly true of headaches that are focused behind the eyes, near the temples, around the jaw and ears, or at the back of the head in the area of the neck and shoulders,” explains Mark Duncan, clinical director at LVI Global, where many of the dentists train.

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How to help children with migraines

This article looks into how parents can help their children who have migraine headaches, and discusses the benefits of cognitive behavioral therapy.

Nearly 2% of the pediatric population suffer from chronic migraine. Yet, the Food and Drug Administration (FDA) has not approved a therapy for treatment of chronic migraine in children or adolescents. So, how does your child's neurologist or headache specialist treat your precious one's head pain?

One study in JAMA suggests a combination treatment regimen of both medical and behavioral therapy. Before reviewing this study, let's understand the basics of what a chronic migraine is.

What is a chronic migraine?

According to the second edition of the International Classification of Headache Disorders (ICHD-II), chronic migraine is defined as a migraine headache that occurs at least 15 days a month for more than 3 months. Additionally, the headaches of chronic migraineurs must have at least two of the following features:

• One-sided location
• Pulsating
• Moderate or severe intensity of pain
• Head pain is exacerbated by daily physical activity (i.e. walking around your home)

During a migraine attack, an individual must have at least one of the following:

• nausea and/or vomiting
• photophobia AND phonophobia

Study Overview

Purpose: To compare two regimens for treating children and adolescents with chronic migraines.

• Cognitive-Behavioral Therapy (CBT) + amitriptyline
• Health education + amitriptyline

Amitriptyline (Elavil)  is an tricyclic antidepressant that works by blocking the re-uptake of two neurotransmitters in the brain, serotonin and norepinephrine.  It is a sedating medication and typically taken at bedtime. It is FDA approved as a migraine preventive medication for adults.Cognitive-behavioral therapy entails learning how to identify headache triggers and cope with them in a more adaptive, less stressful manner.

Methods: 135 children and adolescents, between the ages of 10 and 17, who suffered from chronic migraine and scored greater than 20 on the Pediatric Migraine Disability Assessment Score (PedMIDAS) participated in the study.

The participants were randomly assigned to either the CBT + amitriptyline group or the health education + amitriptyline group. Each participant underwent 8 weekly therapy sessions that were one-hour in duration. The participants and their parents were blinded as to whether they were receiving CBT versus health education during these sessions. All of the participants were given a dose of amitriptyline of 1mg/kg/day at dinner time. The children and adolescents were allowed to take medication for acute migraine abortion, like NSAIDs and triptans. They were not allowed to use them for more than 3 times per week. Finally, the participants maintained a headache diary to record various headache measures such as headache occurrence, duration, and associated symptoms.

Results: The two main outcomes measured were number of days per month of headache occurrence and headache disability. By 20 weeks, participants in the CBT + amitriptyline group achieved a ≥50%percent reduction in days with headache when compared to the health education + amitriptyline group (66% versus 36%). This also held true at the 12 month follow-up, with 86% in the CBT + amitriptyline group having a ≥50% reduction in headache frequency versus 69% of the health education + amitriptyline group.

In terms of migraine disability, by the 12 month follow-up, 88% of the CBT + amitriptyline participants had a PedMIDAS of less than 20 points versus 76% of the headache education + amitriptyline group.

What Does This Mean?

The use of cognitive-behavioral therapy with amitriptyline in children and adolescents with chronic migraine reduced migraine frequency and disability, when compared to health education with amitriptyline. This suggests that CBT be considered as a reasonable and effective treatment for chronic migraine in the pediatric population.

If your child suffers from chronic migraine, discuss the use of a behavioral intervention, like CBT, with his or her healthcare provider so you can be an informed parent and remain proactive in your child's health.

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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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Migraine Severity May Be Determined by Blood Protein

Research has shown that measuring the level of adiponectin, a protein in your blood can predict the severity of migraines. Not clear about clinical use of this- JR

In a small, preliminary study of regular migraine sufferers, scientists have found that measuring a fat-derived protein called adiponectin (ADP) before and after migraine treatment can accurately reveal which headache victims felt pain relief.

A report on the study of people experiencing two to 12 migraine headaches per month, led by researchers at Johns Hopkins, is published in the March issue of the journalHeadache.

"This study takes the first steps in identifying a potential biomarker for migraine that predicts treatment response and, we hope, can one day be used as a target for developing new and better migraine therapies," says study leader B. Lee Peterlin, D.O., an associate professor of neurology and director of headache research at the Johns Hopkins University School of Medicine. She cautioned that larger, confirmatory studies are needed for that to happen.

Experts estimate that roughly 36 million Americans, or 12 percent of the population, suffer from debilitating migraine headaches that last four hours or longer. Migrainesare defined as headaches with at least two of four special characteristics: unilateral or one-side-of-the-head occurrence; moderately to severely painful; aggravated by routine activity and of a pounding or throbbing nature. Sufferers generally also feel nauseated or are sensitive to light and sound. Women are three times as likely to get migraines as men.

Such complicated diagnostic criteria mean that diagnosis is tricky, a fact driving efforts, Peterlin says, to find better diagnostic tools.

For the study, Peterlin and her colleagues collected blood from 20 women who visited three headache clinics between December 2009 and January 2012 during an acute migraine attack. Blood was taken before treatment with either sumatriptan/naproxen sodium (a drug routinely given to people with migraines) or a placebo. The investigators re-drew blood at 30, 60 and 120 minutes after the study drug was given. Eleven women received the drug and nine got the placebo.

The researchers measured blood levels of ADP, a protein hormone secreted from fat tissue and known to modulate several of the pain pathways implicated in migraine. The hormone is also implicated in sugar metabolism, insulin regulation, immunity and inflammation, as well as obesity, which is a risk factor for migraines.

Peterlin and her colleagues looked at total adiponectin levels and two subtypes or fragments of total ADP in circulation in the blood: low molecular weight (LMW)-adiponectin and high molecular weight (HMW)-adiponectin. LMW is comprised of small fragments of ADP and it is known to have anti-inflammatory properties, while HMW is made up of larger fragments of ADP and is known to have pro-inflammatory properties. Inflammatory pathways in blood vessels in the head are at work inmigraine headache.

The researchers found that in all 20 participants when levels of LMW increased, the severity of pain decreased. When the ratio of HMW to LMW molecules increased, the pain severity increased.

"The blood tests could predict response to treatment," Peterlin says.

At onset of pain -- even before study drug was given - the researchers could identify who would be a responder to treatment and who would not, as there was a greater ratio of HMW to LMW in those who would be responders as compared to those who were not.

After study treatment changes in adiponectin were also seen. Interestingly, in those patients who reported less pain after receiving study drug to treat the migraine - whether they got the active migraine medication or a placebo -researchers were able to see a decrease in total levels of ADP in the blood.

Peterlin says the findings indicate it may be possible to develop a treatment that would reduce levels of ADP or parts of adiponectin such as HMW or LMW adiponectin. She says should ADP prove to be a biomarker for migraine, it could help physicians identify who has migraine and know who is likely to respond to which type of medication. It also may help doctors make better medication choices and try alternate drugs sooner.

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Women With Migraine With Aura May Have Higher Risk of Heart Attack and Blood Clots

This article discusses health concerns for women who have migraines with aura. Such health concerns include cardiovascular problems such as heart attach and stroke.

Women who have migraines with aura, which are often visual disturbances such as flashing lights, may be more likely to have problems with their heart and blood vessels, and those on newer contraceptives may be at higher risk for blood clots, according to two studies released today that will be presented at the American Academy of Neurology's 65th Annual Meeting in San Diego, March 16 to 23, 2013.

The first study showed that migraine with aura is a strong contributor to the development of major cardiovascular events such as heart attack and stroke. The Women's Health Study involved 27,860 women, 1,435 of whom had migraine with aura. During the 15-year study, there were 1,030 cases of heart attack, stroke or death from a cardiovascular cause. The study examined the relative contribution of various vascular risk factors to these major cardiovascular events.

"After high blood pressure, migraine with aura was the second strongest single contributor to risk of heart attacks and strokes," said study author Tobias Kurth, MD, ScD, of INSERM, the French National Institute of Health and Medical Research in Bordeaux and Brigham and Women's Hospital in Boston. Kurth is also a Fellow of the American Academy of Neurology. "It came ahead of diabetes, current smoking, obesity, and family history of early heart disease."

Kurth cautioned that while people with migraine with aura have an increased risk, it does not mean that everyone with migraine with aura will have a heart attack or stroke. He said people with migraine with aura can reduce their risk in the same ways others can, such as not smoking, keeping blood pressure low and weight down and exercising.

The second study looked at women with migraine who take hormonal contraceptives and the occurrence of blood clots. The study involved women with migraine with and without aura who were taking both newer contraceptives such as the contraceptive patch and ring and older contraceptives. Of the 145,304 women who used the contraceptives, 2,691 had migraine with aura and 3,437 had migraine without aura.

Women with migraine with aura were more likely to have experienced blood clot complications such as deep vein thrombosis with all types of contraceptives than women with migraine without aura. For example, 7.6 percent of women with migraine with aura who used a newer generation combined hormonal contraceptive had deep vein thrombosis compared to 6.3 percent of women with migraine without aura, but the timing of the two events is not clear. The occurrence of blood clot complications was also higher in women with migraine who took contraceptives than women taking the contraceptives who did not have migraine.

"Women who have migraine with aura should be sure to include this information in their medical history and talk to their doctors about the possible higher risks of newer contraceptives, given their condition," said study author Shivang Joshi, MD, MPH, RPh, of Brigham and Women's Falkner Hospital in Boston and a member of the American Academy of Neurology.

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