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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Children are more likely to develop PTSD if mother has PTSD

An Israeli study finds that a child is more likely to develop PTSD if his or her mother has PTSD.

A Ben-Gurion University of the Negev (BGU) study indicates that children are more likely to develop Post Traumatic Stress Disorder (PTSD) if their mother is already afflicted.

In the study published in the Journal of Depression & Anxiety, while fewer than 10 percent (8.4 percent) of the mothers were suffering from PTSD, more than a fifth (21 percent) of their children presented PTSD symptoms. Children who developed PTSD symptoms also had more psychosomatic complaints such as constipation, diarrhea and headaches.

"This study reinforces the existing body of knowledge regarding the importance of evaluating and treating parental responses in time of stress," the researchers explain.

"Parents are often the key to understanding children's responses generally and specifically in times of stress. The study also highlights the close interrelations between 'body and soul' among children and adults."

In the study, some 160 mothers of preschool children were interviewed about symptoms exhibited by their children and their own responses during Operation Cast Lead. More than 750 rockets were fired into Southern Israel from Gaza from December 2008 to January 2009.

Working with the Preschool Psychiatric Unit at Soroka University Medical Center, the BGU researchers examined the relationship between PTSD symptoms and socio-demographic, family attributes and psychosomatic symptoms among children exposed to Grad missile attacks in Beer-Sheva, Israel.

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Brain Cooling May Prevent Epilepsy Induced by Trauma

A study in rats showing brain cooling after trauma may prevent seizures brought on by the trauma.

In the weeks, months and years after a severe head injury, patients often experience epileptic seizures that are difficult to control. A new study in rats suggests that gently cooling the brain after injury may prevent these seizures.

"Traumatic head injury is the leading cause of acquired epilepsy in young adults, and in many cases the seizures can't be controlled with medication," says senior author Matthew Smyth, MD, associate professor of neurological surgery and of pediatrics at Washington University School of Medicine in St. Louis. "If we can confirm cooling's effectiveness in human trials, this approach may give us a safe and relatively simple way to prevent epilepsy in these patients."

The researchers reported their findings in Annals of Neurology.

Cooling the brain to protect it from injury is not a new concept. Cooling slows down the metabolic activity of nerve cells, and scientists think this may make it easier for brain cells to survive the stresses of an injury.

Doctors currently cool infants whose brains may have had inadequate access to blood or oxygen during birth. They also cool some heart attack patients to reduce peripheral brain damage when the heart stops beating.

Smyth has been exploring the possibility of using cooling to prevent seizures or reduce their severity.

"Warmer brain cells seem to be more electrically active, and that may increase the likelihood of abnormal electrical discharges that can coalesce to form a seizure," Smyth says. "Cooling should have the opposite effect."

Smyth and colleagues at the University of Washington and the University of Minnesota test potential therapies in a rat model of brain injury. These rats develop chronic seizures weeks after the injury.

Researchers devised a headset that cools the rat brain. They were originally testing its ability to stop seizures when they noticed that cooling seemed to be not only stopping but also preventing seizures.

Scientists redesigned the study to focus on prevention. Under the new protocols, they put headsets on some of the rats that cooled their brains by less than 4 degrees Fahrenheit. Another group of rats wore headsets that did nothing. Scientists who were unaware of which rats they were observing monitored them for seizures during treatment and after the headsets were removed.

Rats that wore the inactive headset had progressively longer and more severe seizures weeks after the injury, but rats whose brains had been cooled only experienced a few very brief seizures as long as four months after injury.

Brain injury also tends to reduce cell activity at the site of the trauma, but the cooling headsets restored the normal activity levels of these cells.

The study is the first to reduce injury-related seizures without drugs, according to Smyth, who is director of the Pediatric Epilepsy Surgery program at St. Louis Children's Hospital.

"Our results show that the brain changes that cause this type of epilepsy happen in the days and weeks after injury, not at the moment of injury or when the symptoms of epilepsy begin," says Smyth. "If clinical trials confirm that cooling has similar effects in humans, it could change the way we treat patients with head injuries, and for the first time reduce the chance of developing epilepsy after brain injury."

Smyth and his colleagues have been testing cooling devices in humans in the operating room, and are planning a multi-institutional trial of an implanted focal brain cooling device to evaluate the efficacy of cooling on established seizures.

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Link Between Childhood Trauma and Neurological Changes

Recently, a link has been discovered between trauma during early childhood and neurological changes, a link that has been previously difficult to find.

It is well known that violent adults often have a history of childhood psychological trauma. Some of these individuals exhibit very real, physical alterations in a part of the brain called the orbitofrontal cortex. Yet a direct link between such early trauma and neurological changes has been difficult to find, until now.

Publishing in the January 15 edition of Translational Psychiatry, EPFL Professor Carmen Sandi and team demonstrate for the first time a correlation between psychological trauma in pre-adolescent rats and neurological changes similar to those found in violent humans.

"This research shows that people exposed to trauma in childhood don't only suffer psychologically, but their brain also gets altered," explains Sandi, Head of EPFL's Laboratory of Behavioral Genetics, Director of the Brain Mind Institute, and a member of the National Centers for Competence in Research SYNAPSY. "This adds an additional dimension to the consequences of abuse, and obviously has scientific, therapeutic and social implications."

The researchers were able to unravel the biological foundations of violence using a cohort of male rats exposed to psychologically stressful situations when young. After observing that these experiences led to aggressive behavior when the rats reached adulthood, they examined what was happening in the animals' brains to see if the traumatic period had left a lasting mark.

"In a challenging social situation, the orbitofrontal cortex of a healthy individual is activated in order to inhibit aggressive impulses and to maintain normal interactions," explains Sandi. "But in the rats we studied, we noticed that there was very little activation of the orbitofrontal cortex. This, in turn, reduces their ability to moderate their negative impulses. This reduced activation is accompanied by the overactivation of the amygdala, a region of the brain that's involved in emotional reactions." Other researchers who have studied the brains of violent human individuals have observed the same deficit in orbitofrontal activation and the same corresponding reduced inhibition of aggressive impulses. "It's remarkable; we didn't expect to find this level of similarity," says Sandi.

The scientists also measured changes in the expression of certain genes in the brain. They focused on genes known to be involved in aggressive behavior for which there are polymorphisms (genetic variants) that predispose carriers to an aggressive attitude, and they looked at whether the psychological stress experienced by the rats caused a modification in the expression of these genes. "We found that the level of MAOA gene expression increased in the prefrontal cortex," says Sandi. This alteration was linked to an epigenetic change; in other words, the traumatic experience ended up causing a long-term modification of this gene's expression.

Finally, the researchers tested the efficacy of an MAOA gene inhibitor, in this case an anti-depressant, to see if it could reverse the rise in aggression induced by juvenile stress, which it did. Going forward, the team will explore treatments for reversing physical changes in the brain, and above all, attempt to shed light on whether some people are more vulnerable to being effected by trauma based on their genetic makeup.

"This research could also reveal the possible ability of antidepressants -- an ability that's increasingly being suspected -- to renew cerebral plasticity," says Sandi.

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MRIs Show Signs of Brain Injuries Missed in CT Scans

MRIs can show signs of traumatic brain injuries that cannot be seen in CT scans. 

The second best test is a history and exam by a specialist. 

The most sensitive test is a parent saying that their child is not right. JR

Hospital MRIs may be better at predicting long-term outcomes for people with mild traumatic brain injuries than CT scans, the standard technique for evaluating such injuries in the emergency room, according to a clinical trial led by researchers at the University of California, San Francisco (UCSF) and the San Francisco General Hospital and Trauma Center (SFGH).

Published this month in the journalAnnals of Neurology, the study was led by UCSF neuroradiologist Esther Yuh, MD, PhD and followed 135 people treated for mild traumatic brain injuries over the past two years at one of three urban hospitals with level-one trauma centers: SFGH, the University of Pittsburgh Medical Center and University Medical Center Brackenridge in Austin, Texas as part of a study called NIH-funded TRACK-TBI (Transforming Research and Clinical Knowledge in Traumatic Brain Injury).

All 135 patients with mild traumatic brain injuries received CT scans when they were first admitted, and all were given MRIs about a week later. Most of them (99) had no detectable signs of injury on a CT scan, but more than a quarter (27/99) who had a "normal" CT scans also had detectable spots on their MRI scans called "focal lesions," which are signs of microscopic bleeding in the brain.

Spotting these focal lesions helped the doctors predict whether the patients were likely to suffer persistent neurological problems. About 15 percent of people who have mild traumatic brain injuries do suffer long-term neurological consequences, but doctors currently have no definitive way of predicting whether any one patient will or not.

"This work raises questions of how we're currently managing patients via CT scan," said senior author on the study Geoff Manley, MD, PhD, the chief of neurosurgery at SFGH and vice-chair of the Department of Neurological Surgery at UCSF. "Having a normal CT scan doesn't, in fact, say you're normal," he added.

Better Precision Tools Needed for Head Injuries, Doctors Say

At least 1.7 million Americans seek medical attention every year for acute head injuries, and three quarters of them have mild traumatic brain injuries -- which generally do not involve skull fractures, comas or severe bleeding in the brain but have a variety of more mild symptoms, such as temporary loss of consciousness, vomiting or amnesia.

The U.S. Centers for Disease Control and Prevention (CDC) estimates that far more mild traumatic brain injuries may occur each year in the United States but the true number is unknown because only injuries severe enough to bring someone to an emergency room are counted.

Most of those who do show up at emergency rooms are treated and released without being admitted to the hospital. In general, most people with mild traumatic brain injuries recover fully, but about one in six go on to develop persistent, sometimes permanent disability.

The problem, Manley said, is that there is no way to tell which patients are going to have the poor long-term outcomes. Some socioeconomic indicators can help predict prolonged disability, but until now there have been no proven imaging features, or blood tests for predicting how well or how fast a patient will recover. Nor is there a consensus on how to treat mild traumatic brain injuries.

"The treatment's all over the place -- if you're getting treatment at all," Manley said.

The new work is an important step towards defining a more quantitative way of assessing patients with mild traumatic brain injuries and developing more precision medical tools to detect, monitor and treat them, he added.

If doctors knew which patients were at risk of greater disabilities, they could be followed more closely. Being able to identify patients at risk of long-term consequences would also speed the development of new therapeutics because it would allow doctors to identify patients who would benefit the most from treatment and improve their ability to test potential new drugs in clinical trials.

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How To Prevent Sports Concussions Among Children

A great article from the New York Times discusses ways to prevents concussions in children by sport.

This fall, about three million children younger than 14 are playing organized tackle football in the United States. Is that a good thing?

For many parents and coaches, that means three million children are getting some pretty serious exercise, hanging out with old friends and making new ones, and unplugging from technology, for a few hours at least.

I see those positives. Yet if it were my call, those millions would be playing touch football instead. Many would be learning the fundamentals of tackling and other football skills. But they would not be playing tackle football until they turned 14.

The reason is simple. Tackle football is too dangerous for youngsters. Exposure to head trauma is too risky. What we know about football and the vulnerabilities of children’s brains leads me to this conclusion. More worrisome is what we don’t know. How will the hits absorbed by a 9-year-old today be felt at 30, or 50?

I’ve been treating young athletes for concussions and other head trauma for four decades. In an average year, I’ll meet with patients to discuss their concussion symptoms 1,500 times or more. I’ve treated children for concussions in any sport you can name, and a few you wouldn’t think of. I’ve seen pole-vaulters, BMX riders and tennis players. Not that long ago, I treated a young man injured playing Ultimate Frisbee.

I’m not in favor of abolishing any sport for children, football included. Sports have too much to offer young people. There is nothing like being part of a Little League team or competing as a swimmer, tennis player or golfer to promote perseverance, sportsmanship, fair play, to keep fighting until the last point in the match or the last out. These are traits that carry us through life’s challenges.

In light of what we now know about concussions and the brains of children, though, many sports should be fine-tuned. But many parents and coaches are satisfied with the rules as they are. They like seeing youngsters in helmets and pads, and watching them slide headfirst into second base. The closer the peewee games resemble those of the professionals, the happier we are. It’s natural for a parent or a coach. Even a neurosurgeon.

But children are not adults. Their bodies are still maturing. Their vulnerabilities to head trauma are far greater.

A child’s brain and head are disproportionately large for the rest of the body, especially through the first five to eight years of life. And a child’s weak neck cannot brace for a hit the way an adult’s can. (Think of a bobblehead doll.) A child’s cranium at 4 is about 90 percent the size an adult’s. That’s important to a discussion of concussions and concussion risk.

We cannot eliminate head trauma from youth sports. What we can change is our mind-set so protecting the head and the brain is always a top consideration.

The guiding principle should be that no head trauma is good head trauma. Let’s re-examine youth sports and take steps to keep young athletes safe. I would like to see these changes written into the rules across the country.

SOCCER Many parents and coaches are surprised to learn that soccer is not among the safer sports for head trauma. It is actually one of the riskiest. In 2010, more high school soccer players sustained concussions than did athletes in basketball, baseball, wrestling and softball combined, according to the Center for Injury Research and Policy in Columbus, Ohio.

Most of that risk comes from one play: heading the ball. When two or more leap to direct the ball with their heads, a number of collisions can occur with heads, shoulders and elbows. From a neurological standpoint, nearly all are bad. About 90 percent of the patients I see with soccer head trauma and concussion are related to heading accidents.

It’s an easy call for me: take heading out of soccer until the players are 14.

ICE HOCKEY The progressive leadership of USA Hockey and Hockey Canada have done most of the heavy lifting in this sport. Hockey Canada outlawed checking to the head throughout amateur hockey. In 2011, USA Hockey approved a ban on body checking before the age of 13. I would extend the ban on body checking to 14. (The previous rule permitted body checking for players as young as 11.)

BASEBALL AND SOFTBALL Batting helmets are mandatory at every level of baseball, yet it’s surprising how little we do to ensure that they stay on. Some youth leagues around the country have mandated chin straps for years. All youth and high school leagues should require them.

In addition, headfirst slides should be eliminated. When a child’s head plows into an ankle or a shin, the leg always wins. Worse are home-plate collisions in which the head of the base runner can crash into the catcher’s hard shinguards.

FIELD HOCKEY AND GIRLS’ LACROSSE

I have heard that girls would be emboldened to play more aggressively if helmets were required in these sports, and that the net effect would be more injuries, not fewer. I say hold officials accountable for enforcing the rules, and that will not happen.

In lacrosse, some officials now favor something like a bike helmet to protect the top of the head. That is not good enough. When helmets that cover the entire head are required, fewer young women will sustain concussions.

Field hockey rules state that players should not raise their sticks above the knee. But that rule is broken in every game, often resulting in concussions, eye injuries, cuts, broken noses and more. Helmets are needed, although they do not have to be as robust as football helmets.

]I would expect resistance to these recommendations from parents of the 16,000 players in Pop Warner football’s tackle division for 5- to 7-year-olds, for example. But let’s begin the debate.

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Study claims sleep deprivation lowers risk of post-traumatic stress disorder

If I was in colorado, I would advise modest sleep restriction for anyone traumatized by last weeks shooting. JR

A new study claims that a lack of sleep after a traumatic event reduces the risk of PTSD. This can help reduce the negative effects resulting from a traumatic event.

Sleep deprivation in the first few hours after exposure to a significantly stressful threat actually reduces the risk of Post-Traumatic Stress Disorder (PTSD), a new study has revealed.

The study revealed in a series of experiments that sleep deprivation of approximately six hours immediately after exposure to a traumatic event reduces the development of post trauma-like behavioural responses.

As a result, sleep deprivation the first hours after stress exposure might represent a simple, yet effective, intervention for PTSD.

Approximately 20 percent of people exposed to a severe traumatic event, such as a car or work accident, terrorist attack or war, cannot normally carry on their lives.

These people retain the memory of the event for many years. It causes considerable difficulties in the person’s functioning in daily life and, in extreme cases, may render the individual completely dysfunctional.

“Often those close to someone exposed to a traumatic event, including medical teams, seek to relieve the distress and assume that it would be best if they could rest and “sleep on it,” Prof. Prof. Hagit Cohen, director of the Anxiety and Stress Research Unit at BGU’s Faculty of Health Sciences, said.

“Since memory is a significant component in the development of post-traumatic symptoms, we decided to examine the various effects of sleep deprivation immediately after exposure to trauma,” Cohen said.

In the experiments, rats that underwent sleep deprivation after exposure to trauma, later did not exhibit behaviour indicating memory of the event, while a control group of rats that was allowed to sleep after the stress exposure did remember, as shown by their post trauma-like behaviour.

“As is the case for human populations exposed to severe stress, 15 to 20 percent of the animals develop long-term disruptions in their behaviour,” Cohen said.

“Our research method for this study is, we believe, a breakthrough in biomedical research,” Cohen added.

The new study was published in the international scientific journal, Neuropsychopharmacology

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Sleep Might Help Deepen Traumatic Memories

Your emotional response to a disturbing image or traumatic event is weaker if you remain awake afterward, while sleep reinforces unpleasant emotional memories, according to new research.

The experiments involving 68 female and 38 male volunteers aged 18 to 30 also found that people who saw an unsettling image or traumatic event and then went to sleep are as upset as they originally were if they see the picture again or experience a flashback, but not those who stayed awake.

"We found that if you see something disturbing, let's say an accident scene, and then you have a flashback or you're asked to look at a picture of the same scene later, your emotional response is greatly reduced, that is, you'll find the scene far less upsetting, if you stayed awake after the original event than if you slept," Rebecca Spencer, a neuroscientist at the University of Massachusetts Amherst, said in a university news release.

"It's interesting to note that it is common to be sleep-deprived after witnessing a traumatic scene, almost as if your brain doesn't want to sleep on it," she added.

The study results may make sense from an evolutionary standpoint because this type of response would help our ancient ancestors survive by preserving negative emotions and memories of life-threatening situations, thus helping them avoid similar situations in the future, the researchers explained.

Spencer also said the "findings have significance for people with post-traumatic stress disorder, for example, or those asked to give eyewitness testimony in court cases."

The study appears in the current issue of the Journal of Neuroscience.

Read more: http://www.nlm.nih.gov/medlineplus/news/fullstory_120932.html