Anyone who experiences frequent or severe headaches can tell you they’re no fun – which is why it’s even worse when your child is the one with the headache. Dr. Ann Pakalnis helps you decipher the cause and offers up treatment suggestions.
What are the different types and causes of pediatric headaches?
The two main types of what we call “primary headaches” in children and adolescents are migraines and tension headaches. They are fairly different and are diagnosed because they have different presentation and symptoms.
At our multidisciplinary headache clinic at Nationwide Children’s Hospital, we see a predominance of migraine headaches. Migraines have a genetic component. About 80-90 percent of patients with migraines have a genetic link – a family member who has migraines.
Migraines are the more severe headaches. Children with migraines miss school or family gatherings with those types of headaches because they are associated with nausea and, often, sensitivity to light and sound. They’ll want the TV off and they don’t want to hear people talking. About 10 percent of school-age children and a little bit more adolescents experience migraines.
Tension headaches are more common, but they’re a little less severe and they’re not associated with nausea or vomiting. At the clinic, we don’t see them as often because they’re not as disruptive to daily life. Oftentimes tension headaches tend to be worsened by stress and poor sleep patterns. Tension headaches are not associated with that genetic component.
What systems in the brain/body cause migraines?
As far as we know, migraine headaches are both a biochemical and a neurologic condition. People have migraines because they have a genetic susceptibility to have low levels of a biochemical called serotonin. Serotonin levels are also related to depression, but people with migraines also tend to have low levels of serotonin. They have more frequent headaches if their levels of serotonin are lower, and poor sleep or dehydration can lower serotonin. That’s another reason why you want to work on good sleep and good fluid intake.
How do I know when to take my child to the doctor about a headache?
Take your child to the doctor if you notice that your child is starting to have recurrent, severe headaches more than three to four times per month. one thing that is helpful to doctors is if the parents could start keeping a diary or log of the headaches: when they occur, how they respond to over-the-counter medication or significant increases in frequency or severity.
Things that we tend to be more concerned about are headaches in the back of the head or headaches that wake a child from sleep at night, and certainly those with a lot of nausea and vomiting, or if the child complains of numbness or weakness with the headache or changes in vision.
Typically migraine and tension headaches do not occur in the back of the head. It’s an unusual location for a migraine or tension headache. Headaches in the back of the head or those that wake a child from sleep could be caused by a more serious neurologic issue. It’s very rare, but sometimes there are more complex problems.
What over-the-counter drugs are safe to give my child for headaches?
We generally like to use ibuprofen first. It works very well and the duration of action is long. Ibuprofen tends to work better for migraines than Tylenol. Tylenol is probably a good second choice. Sometimes we will recommend naproxen or Aleve for migraines.
I think the most important factor that we stress at the headache clinic are the lifestyle issues. Good nutrition, good sleep habits and less caffeine – all those things are the first-line treatment for headache disorders.
Are there other at-home remedies that you would recommend?
There are other treatments we use for children that you can do at home, including biofeedback and relaxation therapy. These treatments involve visual imagery and breathing exercises in which children probably 8-9 years of age and older can participate. Typically psychologists or social workers have the training to provide advice about these treatments. We like to minimize the amount of prescription medicines used if possible.
What treatments are currently available for children who have recurrent/severe headaches or migraines?
There are several prescription medicines that are approved for abortive treatment – to use at the time the headache begins. Triptans such as Maxalt and Axert are specifically used for migraine headache pain. Some people have headaches that are so frequent that at times they need to take a medicine every day. That’s another treatment that we tend to use on some occasions.
What are common migraine triggers and/or how can I help my child identify triggers?
I think the most important migraine triggers that we see are stress and sleep, and that can be good stress or bad stress. Good stress can include events such as a taking vacation. Other triggers are poor sleep, dehydration, and, in teenage girls, hormonal changes.
What signs/auras should I teach my child to observe so I can initiate treatment?
Rarely, some children (10-15 percent), will have an aura with migraine headaches. Some will have vision loss or changes or numbness in an arm or a leg. It’s important to take the abortive medicine then, at the first sign of the headache or as close to the onset of the headache as possible. You have the best chance of treating the headache if it’s dosed early either with over-the-counter medications or triptans.
Oftentimes we recommend the parents carry the medicine or send a physician’s note so that their child can take the medicine at school.
The last thought:
Keep track of the frequency and severity of your child’s headaches, as well as any associated symptoms. See a doctor if they become debilitating or frequently interrupt your child’s daily life.
Have questions you would like to have answered by an expert? Send them to editor@healthynewalbany.org.
Dr. Ann Pakalnis
Ann Pakalnis, MD, is an attending neurologist at Nationwide Children’s Hospital and a professor of Clinical Pediatrics and Neurology at The Ohio State University College of Medicine. Pakalnis is director of the Comprehensive Headache Clinic at Nationwide Children’s. Her clinical and research interests involve the diagnosis and management of headache and the identification of co-morbid disorders linked to migraine.
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