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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Attention Deficits Seen in Babies who Develop Autism

Babies who have deficits in attention have a higher occurrence of eventually developing autism.

Researchers at Yale School of Medicine are able to detect deficits in social attention in infants as young as six months of age who later develop Autism Spectrum Disorders (ASD). Published in the current issue of Biological Psychiatry, the results showed that these infants paid less attention to people and their activities than typically developing babies.

Katarzyna Chawarska, associate professor at the Yale Child Study Center, and her colleagues investigated whether six-month-old infants later diagnosed with ASD showed prodromal symptoms -- early signs of ASD such as an impaired ability to attend to social overtures and activities of others. Before this study, it had not been clear whether these prodromal symptoms were present in the first year of life.

"This study highlights the possibility of identifying certain features linked to visual attention that can be used for pinpointing infants at greatest risk for ASD in the first year of life," said Chawarska. "This could make earlier interventions and treatments possible."

Chawarska and her team administered an eye-tracking task to 67 infants at high risk for developing autism, and 50 low-risk infants. The three-minute video was designed to capture the ebbs and flows of social events, depicting a woman engaged in several familiar activities such as making a sandwich, looking at toys, or speaking. While making sandwiches, the actress occasionally looked at the camera and tried to engage the babies by making eye contact and saying "How are you, baby?" "You are so cute!" and "Did you see the tigers?" There were no breaks in the video to re-engage or re-center the babies' attention, requiring them to attend to whatever they found interesting in their visual field, as they would in real-life social situations. Chawarska and her team used eye-tracking technology to monitor how often the infants looked at the scene, the toys, the woman, and her eyes and mouth.

Compared with the control groups, six-month-old infants later diagnosed with ASD looked less at the social scene, and when they did pay attention to the scene, they spent less time monitoring the woman's face. The team is now working on determining the specific causes that lead to decrease of social attention in infants with emerging social vulnerabilities.

"This work is highly consequential for identifying new treatment targets and early intervention strategies," said Chawarska.

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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.

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ADD and ADHD and its Mimics in Children with Down Syndrome

This article from the National Down Syndrome Society discusses the similarities between symptoms of ADHD, Down Syndrome, and other issues in children.

Attention deficit hyperactivity disorder, or ADHD, is a commonly diagnosed childhood problem. ADHD is characterized by consistent demonstration of the following traits: decreased attention span, impulsive behavior, and excessive fidgeting or other nondirected motor activity.

 All children, including children with Down syndrome, display these traits from time to time. But the child with Down syndrome may exhibit these traits more often than other children his age.  

How Common Is ADD in Children With Down Syndrome? 

The frequency of ADHD in children with Down syndrome is not known with certainty. However, ADHD-like symptoms are more common in young children with Down syndrome compared to children from the general population. Compounding symptoms such as stereotypy (repetitiveness), anxiety or extreme irritability in the presence of ADHD-like symptoms may indicate another disorder such as autism, bipolar disorder or obsessive compulsive disorder.

Uncomplicated ADHD is common in younger children with Down syndrome. However, many school age children with ADHD frequently have other behavioral conditions including oppositional defiant disorder, disruptive behavior disorder or obsessive compulsive traits.

Does That Mean That Your Child Has ADHD?

It may, but more often it means that a medical problem needs to be addressed, or that your child's educational program or communication method needs some adjustment. In children with Down syndrome who have difficulty paying attention, ADHD is a diagnosis of exclusion. Other problems must be ruled out first. 

What Are Medical Problems That Can Look Like ADHD? 

HEARING AND VISION ISSUES

In order for a child to pay attention to classroom material, she has to be able to hear and to see it. Both hearing and visual problems are common in children with Down syndrome. Ear infections are overwhelmingly common and, even if treated, can cause hearing loss for weeks. People with Down syndrome have middle ear structural abnormalities that can cause lifetime mild to moderate hearing loss.

Both near- and far-sightedness are common in individuals with Down syndrome, as well as cataracts and "lazy eye."

RULING OUT SIGNIFICANT HEARING AND/OR VISUAL LOSS AS A CAUSE OF ATTENTIONAL PROBLEMS

To monitor hearing, an auditory brainstem response test (ABR) or otoacoustic emission (OAE) should be performed early in the child's life (by three months of age at the latest) as a baseline. Hearing screens should be performed annually until three years of age, and every other year thereafter. Children with abnormal hearing evaluations should be seen by an ear-nose-throat physician (otolaryngologist) to manage treatable causes of hearing loss.

A child with Down syndrome should be evaluated by an eye doctor during the first year of her life, and yearly thereafter. Some children may need more frequent followup depending on their visual diagnosis.

GASTROINTESTINAL ISSUES

People with Down syndrome are at increased risk for an intestinal condition called celiac disease, which is a condition in which the body cannot process a protein found in wheat and certain other grains. While typical symptoms of celiac disease include loose stools, diarrhea, and poor weight gain, the condition often presents only with subtle effects on energy and behavior. People with Down syndrome are also predisposed to significant constipation, which when severe can cause abdominal pain, lack of appetite, and restlessness.

Current recommendations for gastrointestinal monitoring include screening for celiac disease between two and three years of age. This screening should include measurement of IgA antiendomysium antibodies, as well as total IgA. Your child's primary care provider will want to review your child's bowel status with you at each visit, as well.

THYROID ISSUES

About 30% of people with Down syndrome have thyroid disease at some point in life. Most have hypothyroidism, or underactive thyroid gland; a few have disease that results in overactive thyroid gland (Graves' disease). An underactive thyroid gland can, among other things, make a child very tired and apathetic.

Too much thyroid activity can cause agitation and restlessness. Therefore, both conditions can look like poor attention and behavior.

Because thyroid disease is so prevalent in this population, and because it is difficult for doctors to detect just by examining your child, an annual blood test for thyroid hormone is recommended by the Down Syndrome Health Care Guidelines.  

SLEEP ISSUES

Sleep disorders are extremely common in Down syndrome. These disorders are a group of conditions with many different causes but one thing in common: they all interfere with getting a good night's sleep. As a parent, you know that tired children can behave very differently from tired adults: they can become restless, whiny, and difficult to calm. And people of all ages have difficulty focusing and learning new information when they are sleep deprived.

Sleep apnea, or short periods of not breathing during sleep, is especially common. People with Down syndrome have small, often "floppy" airways, which can sometimes be completely or partially blocked during sleep by large tonsils and adenoids, or by the floppy walls of the airway collapsing as air is exhaled. Regardless of the cause of obstruction, the sleeper must awaken briefly to resume breathing. Some patients with sleep apnea awaken hundreds of times per night.

Symptoms associated with but not specific to sleep apnea include snoring, lots of "thrashing" while asleep, excessive daytime sleepiness, mouth breathing, and unusual sleep positions such as sleeping in a seated or hunched forward position.

Children suspected of having a sleep disorder should undergo a sleep study evaluation at an accredited sleep center.

What Types of Communication Difficulties Can Look Like ADHD?  

People with Down syndrome may have many barriers to effective communication. The receptive language skills of children with Down syndrome (how well they understand what is being said) are often much stronger than their expressive language skills (how well they can say it). Parents often comment, "He knows what he wants to tell us, he just can't seem to put the words together or we can't make out what he is saying." Classroom participation is thus more difficult, as well. The child may express his frustration by acting out or by inattention.

What Types of Educational Problems Can Look Like ADHD?  

Children with Down syndrome have a wide range of learning styles. Your child's educational team may need to try more than one method of presenting material before finding the one that works best for your child. If material is presented in a way that is not compatible with a child's learning style (for example, oral lectures for a student who needs visual aids and prompts) that child may appear bored, fidgety, and hyperactive.

The level of the material may also be a problem. If a child is presented with concepts that are too difficult for his cognitive level, he might "tune out" and appear inattentive. A child who is bored with overly easy material also may attend poorly and act out.

What Types of Emotional Issues Can Look Like ADHD?

Because of the communication problems discussed above, people with Down syndrome may have difficulty talking about things that make them sad or angry. Major life changes such as loss or separation may prompt decreases in appropriate behavior at school or work.

What Are the Next Steps?

If you are concerned about decreased attention span, impulsive behavior, and excessive fidgeting or other non-directed motor activity in your child, it is appropriate to consult your pediatrician, a developmental and behavioral pediatrician or child psychiatrist.

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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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