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.

Read more here

Common migraine triggers to avoid

This article discusses seven common migraine triggers that those prone to migraines should avoid.

It’s estimated that 28 million americans suffer from migraines. Migraines are intense headaches that are often accompanied by nausea, vomiting and sensitivity to light. They don’t simply come and go; each migraine can last between four hours and three days. Most migraine sufferers know to avoid certain things like dairy, alcohol and food with excessive additives, but there are other external factors that could trigger a migraine. Here are some to watch out for.

1. Change in Routine

For some migraine sufferers, routine is key to keeping the headaches at bay.  Change in sleep patterns, work hours or even holidays can create stress and lead to migraines.

2. Stress

As mentioned above, migraines and stress are strongly linked. Some people report migraines start when stress reduces, sometimes leading to “weekend headaches” after a stressful work week.

3. The Environment 

High altitude, weather changes and humidity can all trigger migraines.

4. Computer Screens

Both the posture you take when sitting in front of a computer and the glare from the screen can lead to migraine pain. Be sure to sit comfortably to avoid muscle tension and use an anti-glare screen.

5. Lack of Food

Insufficient food is one of the main dietary triggers of migraines. Avoid missing meals or snacking on treats high in sugar. Eating small, nutritious snacks throughout the day can help control migraine attacks.

6. Hormonal Change (In Women)

Fluctuation in estrogen may cause headaches in women who suffer from migraines. These women often report an increase in migraines immediately before or during their menstrual cycle, when there is a major drop in estrogen levels.

7. Sensory Overstimulation

Bright lights, loud noises and unusual smells, including perfume and secondhand smoke can trigger migraines. 

Migraine triggers are unique to every individual, and can happen as early as 6 to 8 hours prior to a migraine attack.

Read more here

Patch to Treat Migraines Approved by FDA

A battery-powered patch was recently approved by the FDA. This patch helps with the symptomatic relief of migraine-related nausea and the migraine headaches.

The FDA has approved the Zecuity (sumatriptan) skin patch system for adults who have migraines with or without aura. The single-use, battery-powered patch offers relief of migraine-related nausea as well as migraineheadaches.

Of the 16 million U.S. adults with migraines, 8 million have migraine-related nausea and typically avoid use of oral medications.

"In addition to severe headache pain, migraine patients [come in] with other significant symptoms, which commonly include migraine-related nausea," says Lawrence C. Newman, MD, director of the Headache Institute at St. Luke's-Roosevelt Hospital in New York, in a news release from the manufacturer, NuPathe Inc.

When applied to the upper arm or thigh during a migraine and activated with a button, the patch delivers the medicine through the skin, bypassing the stomach. It delivers 6.5 milligrams over four hours.

In studies of 800 migraine patients who used more than 10,000 patches, the treatment safely and effectively relieved migraine pain, migraine-related nausea, and sensitivity to light and sound within two hours.

• After two hours, 18% of patients using the Zecuity patch had no more headache, compared with 9% of those using a placebo patch. 
• After two hours, 53% of patients using the Zecuity patch had some headache relief, compared with 29% of those using a placebo patch.
• After two hours, 84% of patients using the Zecuity patch had no more nausea, compared with 63% of those using a placebo patch.

"Migraine-related nausea can be as debilitating as migraine headache pain itself," says researcher Stephen D. Silberstein, MD, professor of neurology and director of the Jefferson Headache Center in Philadelphia. "Treatments bypassing the [gastrointestinal] tract may be the best way to treat these patients."

The most common side effects, which occurred in more than 5% of patients, were pain at the patch site, tingling, itching, warmth, and discomfort. Other side effects -- often associated with these migraine drugs, called triptans -- included "atypical sensations," pain, and other pressure sensations in 2% of the people taking Zecuity.

People considering the patch should talk with their doctor, because conditions such as heart disease or uncontrolled high blood pressure would disqualify them from taking the drug.

And like other triptans, Zecuity may be associated with potentially life-threateningserotonin syndrome (changes in mental status, rapid or slow heart rate, neuromuscular and gastrointestinal problems), mainly when used together with SSRI and SNRI antidepressants.

Read more here

Link Between Women and Migraines

This article discusses the basics of migraine headaches and why there is such a strong link between women and migraines.

THE fact that three out of every four persons struck with a migraine are women has resulted in this condition being considered the most common disabling problem faced by women globally that results in them having to see a doctor.

Here are some of the most common questions women ask about migraines.

What are migraines and who gets them?

It is a severe type of headache that is accompanied by other changes apart from just pain. For example, some persons might feel nauseous, some persons may actually vomit and, some persons may have visual changes like blurred vision or flashing lights. Some persons also have numbness on one side of their body.

While the causes of migraines are still not known, researchers say that those with a family history of migraine are more likely to have it. This is also the case for those who have a history of depression, anxiety, stroke or high blood pressure.

Why do more women than men suffer from migraines?

Researchers have noted that migraines mostly affect women who are between the ages of 15 and 55 years old. However, there are no definitive reasons as to why. "It could be hormonal, but I couldn't give you a good explanation for that," said Dr Campbell.

What are some of the things that trigger migraines?

Food allergies, bright lights, loud nights, strong odours, weather changes, hormonal changes during menstruation, lack of or too much sleep, stress and anxiety, caffeine, skipped meals, alcohol can be triggers.

Food additives like dyes are usually important triggers. For some people it's chocolate, for others, citrus. MSG is a culprit too.

What is the difference between a migraine headache and a bad tension headache?

There are several other types of headaches besides migraines. There is the tension headache, for example, which is less severe and debilitating.

"For a tension headache, the presentation is going to be different. That has to be a sort of a clinical diagnosis, but usually with a tension headache, the headaches come as a result of spasm of the muscles in the head," explained Dr Campbell. "But to determine which is which, one ought to be examined by a physician."

What can I do to ease my migraine pain?

While there is no cure, there are certain medications that can help to ease the pain. It is always important to be diagnosed by a doctor who can prescribe these treatments. However, magnesium, fish oil and guinea hen weed are generally helpful. The doctor said she personally uses guinea hen weed.

"I get the root of the guinea hen weed, wash it, chop it up, throw rum on it, and if I feel a headache coming on, I inhale it," she said.

Read more here

How to tell if your headache is a migraine

This article discusses how to tell if your headache is truly a migraine or not. Also, it discusses good ways to try and alleviate migraines.

Have you ever wondered why your headache just won’t go away? It could be because you’re not treating it correctly. There are several types of headaches, which we often confuse with one another. Each is marked by different symptoms and characteristics. In order to properly treat a headache, you must be able to identify which type of headache you’re experiencing.

Tension Headache: Tension headaches are the most common type of headache, and as many as 30 to 78 percent of the general population experience them during their lifetime. This type of headache appears periodically and can last from 30 minutes to several days. The pain is a mild to moderate pressure or tightness, which typically doesn’t interfere with daily activities. Over-the-counter pain medications can be used to treat tension headaches.

Sinus Headache: This type of headache consists of constant pressure or tenderness over the sinus areas including the cheekbones, forehead and nose. The defining factor of a sinus headache is the presence of nasal discharge, congestion, facial swelling, ear sensations or fullness and in many cases a fever. Treatments for sinus headaches can include decongestions, pain relievers or antibiotics in the case of an infection.

Cluster Headaches: This type of headache is the least common type of “headache” and its cause is unknown. Cluster headaches reoccur over a period of time. Periods can last for several weeks to months then disappear. Each attack is short lasting, severely painful and typically localized to one side of the head. There are no warning signs for a cluster headache. Treatments are available through your health care professional.

Migraines: Migraines are less common than tension headaches. Migraines can last from four to 72 hours on average. Symptoms of a migraine include moderate to severe pain affecting daily activities, nausea, vomiting, light and sound sensitivity and aura. Aura is a warning symptom that can occur before, during or after the onset of a migraine, consisting of blurred vision, blind spots, flashing dots or lights and other visual disturbances. Aura’s typically last 20 to 30 minutes.

More than 29.5 million Americans suffer from migraines, with women being affected three times more often than men. One of the reasons women are affected more by migraines is because hormone changes serve as a migraine trigger. Many women experience migraines before or during their menstrual cycle.

Identifying a Migraine

The ID Migraine Questionnaire, developed by Dr. Richard Lipton, is a simple three question test used to determine if you’re suffering from migraines or another type of headache. According to his research, if two of the three criteria are present, a migraine is likely 93 percent of the time, and if all three are present a migraine diagnosis is 98 percent likely.

• In the last three months, how disabling are your headaches; do they interfere with your ability to function? (Are you missing work, school and family activities?)
• Are your headaches ever associated with nausea?
• Are your headaches ever associated with sensitivity to light?

Migraines are often misdiagnosed as sinus headaches since they have similar symptoms. According to the American Headache Society Committee on Headache Education, 90 percent of the time a self-diagnosed sinus headache is a migraine. Less than half of all migraine sufferers have received a diagnosis of migraine from their health care provider. If you have headaches that continuously interfere with your daily life and that don’t respond to over-the-counter medicines, you may be suffering from migraines. Visit your health care professional to get the proper treatment.

Strategies for Living with Migraines

Migraine sufferers vary in their sensitivity to specific foods, and triggers to foods may take anywhere from 30 minutes to 72 hours to develop, making them often very difficult to pinpoint, says the National Headache Foundation. Experts recommend keeping a daily journal of food intake and activity can help pinpoint specific triggers. By doing this you may be able to determine a pattern and prevent future migraines. This can be time consuming, but is helpful to both you and your health care professional when determining the right course of treatment for you.

The second strategy is preventing and coping with your headaches through lifestyle change. Several triggers are out of your control including the weather, travel and odors such as cigarette smoke, but many common triggers can be controlled by adapting certain habits. Long Beach Memorial encourages you to focus on the common triggers, such as, sleep, diet, exercise, hydration and stress management.

Sleep – Feeling well-rested may keep a headache at bay. It is ideal to get eight hours of sleep each night. Try not to sleep in too late on the weekends and sleep too little on the weekdays. Make it a habit to go to bed and wake up at regular times all week long.

Diet – Keeping your meals routine also can help you avoid headaches. Delaying or skipping meals can cause your blood sugar to dip, causing the “hungry headache.” To avoid this, you should eat balanced meals throughout the day. The best diet consists of as many fresh foods as possible. You should include a good protein source at each meal/snack (i.e., milk, meat, fish) and should avoid eating high sugar foods by themselves, says the American Headache Society Committee on Headache Education. Alcohol and caffeine both can be triggers for headaches; each should be used in moderation.

Exercise - Exercise can help you fight other headache triggers such as anxiety, poor sleep, sadness, stress, and waist and weight gain. Aerobic level activity leads to an increase in natural body joy and pain control chemicals according to the American Headache Society Committee on Headache Education. However, too strenuous of exercise also can lead to a headache. Moderation is the key. For proper walking techniques visit MemorialCare.org/LiveHealthy.

Hydration - Dehydration is a risk for a headache. Weather is a headache trigger, so hydration is especially important on hot days. Prevent dehydration by drinking plenty of water.

Stress - Stress is the most commonly recognized trigger of headaches says the National Headache Foundation. Anything that increases your emotional and physical stress level can trigger a headache. Factors related to stress include anxiety, worry, shock, depression, excitement and mental fatigue. You can’t always avoid stress, but you can alter the way you respond to it. For more tips on stress management visit MemorialCare.org/LiveHealthy.

Read more here