 Headache Related Topics
Frequently Asked Questions
Click here to read
the content disclaimer
Children/Adolescents and Headaches
(by Joel R. Saper, MD, Alvin E. Lake III, PhD,
& Robert L. Hamel, PA-C)
How early in childhood can a migraine
show up?
A migraine can occur very early in the course of the life of a child, as young as
1-2 years of age or may be even earlier. Colickiness in children may be one of the
early signs of migraine. In fact, a large number of infants who are colicky go on
to have migraines in later life. Early and significant motion sickness may also
be a sign of early migraine tendency. Up to 39% of children and 70% of adolescents
experience at least an occasional headache. Migraine headaches can begin at any
time during childhood and may affect up to 5% of all school-age children.
Back to Top |
Back to FAQs
Does gender play a
role in the development of headaches?
Yes. In children aged 9-12, boys and girls have an equal number of headaches, but
12 years later, between the ages of 21 and 24, women comprise 80% of the headache
sufferers. This is due primarily to the impact of estrogen on certain brain centers
and blood vessels, and hormonal milestones, such as menstruation, pregnancy, the
use of oral contraceptives, and menopause, on the body. All are associated with
a change in headache patterns, usually a worsening of headaches.
Back to Top | Back to FAQs
Can individuals who suffer an occasional
migraine during their youth develop daily headaches later in life?
Yes. Research at the Institute has shown that migraine often appears to go through
an evolution and may become a progressive disease that worsens over time. This seems
more likely in young girls than boys, probably due to the estrogen connection.
Back to Top | Back to FAQs
What are symptoms that children with headaches
show which are not expressed in adult headache sufferers?
Children with migraine will frequently experience a variety of non-headache symptomatology,
including episodic dizziness, staggering, abdominal pain, nausea, vomiting, light
sensitivity, mood change, irritability, personality change, confusion, anxiety,
blurred vision, distress, stuffy nose, and a fever that may run as high as 104°
F. These may occur periodically and may be unassociated with a headache. Many of
these children will eventually experience more typical headaches during their later
years. These non-headache symptoms are referred to as migraine equivalents.
Four specific medical syndromes which are considered to be migraine equivalents
are abdominal migraine (recurring bouts of stomach pain), cyclic vomiting
(recurring bouts of vomiting), benign paroxysmal vertigo (recurring attacks
of dizziness) and benign torticollis (recurring episodes of wry or twisted
neck).
Back to Top | Back to FAQs
What are the characteristics
of childhood migraine?
Children may experience migraine auras, which are symptoms that typically signal
the onset of a migraine attack. Auras can affect vision, sensation, balance, muscle
strength and control. Most children with migraine, however, do not experience an
aura before their migraine attacks.
The head pain associated with migraine can occur on one or both sides of the head
and most commonly occurs in the forehead or temples. The pain is often of moderate
to severe intensity and has a pulsating quality. Migraine attacks in children can
be brief and may last only one hour, but some attacks can last up to two days in
duration.
Approximately 50-75% of children who experience migraine will stop having attacks
between adolescence and early adulthood, but some will go on to redevelop migraine
headaches later in life. Approximately 20% of adults who have migraine headaches
report the onset of their first migraine attack before the age of 10 years old.
Back to Top | Back to FAQs
How common are headaches in school
age children?
Headaches during the school year can create difficult problems for students, parents,
and teachers. Concerns may include how to manage a severe headache at school, relate
to peers, cope with homework when it hurts to read, and even whether to attend school
or not. Fears of failure or falling behind can emerge when headaches become more
frequent or severe. Parents may struggle with whether they should push their children
or excuse them from activities. Teachers and administrators may question how to
respond and what to reasonably expect in school performance.
Migraine affects 2%-5% of children below the age of 12 and increases to 10% by late
adolescence. The percentage of children with frequent or severe headache
rises from 1% below the age of 10 to 5% between the ages of 10-17. Headaches sufficient
to cause functional impairment affect about 1 out of 10 children between
the ages of 9-18.
Headache can affect how well a child does in school. About 37% of children with
migraine note poor school performance during headache. Most identify difficulty
concentrating in class and on homework. One pediatric practice identified school
problems in 46% of their adolescent headache patients. Another recent study found
that young headache patients rank "school" among their most potent headache triggers
- ahead of "parents" and other common triggers such as weather, lack of sleep, or
missed meals. School-related noise and bright lights emerge as a consistent problem
for the headache-prone student. Peer problems such as frequent bullying or harassment
are also associated with more frequent and severe headaches.
In the 1989 National Health Interview Survey, headache ranked third as a cause of
school absence, accounting for over 82,000 days of missed school per week. Children
with frequent or severe headaches miss an average of 3.6 school days per year per
child. However, about 10% of young people with migraine miss over 2 school days
per month, and roughly 1% miss 2 days per week. Children between the ages of 7-17
with chronic daily headache who were treated in a pediatric specialty practice missed
an average of 6.3 days per month, or about 57 days over the school year.
When school absences escalate, school attendance and performance can cause as much
distress as the headache itself. The student may begin avoiding school or homework
due to pain; absences and incomplete assignments increase; the student falls farther
behind; peers start asking questions or teasing the student; teachers question the
legitimacy of the headaches; and schools may pressure a student about the number
of absences. The student may come to believe, "If I have trouble with studying or
going to school with a headache, why go at all?" and stop attending. Parents may
find themselves in conflict with each other or the school.
In such cases, effective treatment must focus on two areas at the same time: 1)
headache control; and 2) a plan to manage school-related issues.
Back to Top | Back to FAQs
How should headaches be handled in
the school setting?
For headaches severe enough to interfere with functioning, it is crucial that parents,
student, health care providers, and school personnel communicate with each other,
and agree on a plan for managing severe headaches. The treating physician should
provide the school with a clear diagnosis and a practical headache management plan.
If medication is required during the school day, the school needs to understand
this as well as the limits on frequency of drug use. Overuse of certain pain medications
can lead to analgesic rebound headaches, where headaches increase in frequency and
severity as the patient becomes dependent on the drug. Drug use should be closely
monitored by parents. In turn, parents need to understand the school's medication
policy so they can advocate for their child while working within the system. If
possible, a quiet location for relaxation and a brief break from class may help
keep the child in school and allow a return to the classroom when the pain is under
control.
Back to Top | Back to FAQs
Should children attend school with severe
headaches?
Most headache specialists believe it is important for a young person with frequent
headaches to stay in school, normalize activity, and learn to function in the presence
of pain even if the pain is severe. Research reveals that the more emotional distress
a parent shows to a child in pain, the more upset the child becomes. Compassionate
acknowledgment of the pain can be combined with calm but firm expectations about
schoolwork and attendance.
The normal parental instinct is to comfort a child in pain. It may seem cruel to
force a child to study or attend school with a severe headache. However, students
who continue to attend despite the headache learn to conquer headache-related fears,
overcome personal obstacles, maintain involvement with their peers, develop a "can
do" attitude, and earn the respect of others and themselves. In contrast, students
who primarily avoid activities due to pain can become increasingly isolated, depressed,
and see themselves as failures.
When attendance and school performance suffer due to frequent, severe headaches,
ongoing treatment with a specialist in headache-related behavior should be part
of the overall management plan, with an emphasis on developing a return to school
plan. In some cases, selecting 1 or 2 classes that the student will consistently
attend every day, even when in pain, can serve as a foundation for gradually increasing
school involvement.
Back to Top | Back to FAQs
Is MHNI treating more adolescent
patients now compared to 10 years ago? If yes, why do you think this is occurring?
I am not sure if MHNI is seeing a greater number, but the cases of adolescent headache
that we do see are more complicated. Most of the adolescents that come to the Institute
experience daily headache and often miss a lot of school, family, and social life.
Many factors must be considered in adolescent headache, including hormonal changes
(in both boys and girls) as well as the stress of teenage life. In some cases family
discord, illicit drug use, and the same factors that affect adults with headaches
must be considered. Headaches can be due to multiple biological and at times emotional
factors that interplay to create disabling problems for some young people. Dietary
factors are sometimes very important, including delayed or missed meals or specific
food "triggers."
Unfortunately we also often see young people who present with new daily persistent
headache. These headaches are particularly difficult to treat.
Back to Top | Back to FAQs
Are medications used to
treat adolescent headache similar to medicines used to treat adult headache?
Yes and no. There are not as many medications used to treat adolescents as adults.
In simple terms, some of these medications are "too strong" for children. Others
have not been adequately tested. Several of the triptans have been tested in adolescents
and young people and found to be safe and effective. However, there have been relatively
few medication-oriented studies published concerning adolescents and the treatment
of headache. Experience has shown that several medications can be quite safe, including
preventive agents such as beta blockers, cyproheptadine, and several others, as
well as medicines for acute treatment including the triptans, Midrin, ergots, and
others. Antihistamines may also be used for acute pain.
Aspirin should not be used in children under
the age of 15 years old since a potentially fatal condition called Reyes syndrome
can occur.
As children become adolescents there are more options available, but the choice
of medications often depends on the size and weight of the child, associated illnesses,
a history of adverse effects, as well as age.
Generally speaking, the treatment of headaches in children over the age of 12 years
old is similar to treatment of headache in an adult.
If your child has frequent headaches or reoccurring
attacks of neurological or other medical symptoms, see your family physician or
pediatrician immediately.
Back to Top | Back to FAQs
What non-medication
therapies or techniques have been helpful in treating adolescent headache sufferers?
Many children respond well to non-medication
treatment approaches. Treatment generally includes biofeedback and relaxation therapy,
life-style adjustments including a migraine diet,
maintaining a regular routine and schedule, exercising, and avoiding known headache
triggers.
The following suggestions have been found to be helpful:
- Regular time for waking and going to bed. Anyone who has had teenagers will
know how difficult this can be. Yet is seems clear that for adults as well as kids
a regular waking and sleeping schedule is important.
- Regular meals. Adolescents tend to skip meals or have irregular eating patterns.
This can provoke headache. Maintaining "sameness" is important.
- Regular exercise. This does not necessarily mean competitive sports, which
may be excellent exercise, but another source of stress. Adolescents should exercise
for fun and fitness which can help reduce stress and associated headaches.
- Cognitive behavioral techniques can help the adolescent use his or her intellectual
ability to see the headache as a solvable problem, not a never-ending misery. These
techniques can give a person a sense of control over what can be an unpredictable
and discouraging illness. It may help the person who tends to overreact emotionally
from becoming overwhelmed by negative feelings.
- Relaxation techniques also can impart a sense of control by teaching the
adolescent to be aware of muscle tension. Through these methods the adolescent can
learn how to relax tight muscles. Biofeedback can be especially helpful in this
regard.
Back to Top | Back to FAQs
Are there other headache
types which may affect children and adolescents?
A rare but frightening condition is the hemiplegic
migraine which is a typical migraine headache associated with complete
or partial paralysis on one side of the body.
The paralysis can last from hours to days in duration, followed by a full recovery
of strength. An attack of hemiplegic migraine
can be triggered by minor head trauma such as that experienced in sports, or by
other typical migraine triggers. Hemiplegic
migraine attacks can occur in young children and may persist into adulthood. It may be a hereditary condition.
A basilar migraine is also an unusual
migraine type but it too can be associated with dramatic and frightening symptoms.
It occurs more frequently in teenage girls.
Some of the dramatic symptoms which are associated with basilar migraine include
complete or partial loss of vision, ringing in the ears, dizziness or spinning sensation
and loss of balance. Blackouts and confusion
can also occur. Children or adolescents may
be wrongly accused of being intoxicated because they may stagger or appear confused
during a basilar migraine episode.
Back to Top | Back to FAQs
Are headache researchers
beginning to study treatments for adolescent headache sufferers?
Adolescent headache has been a very quiet area of research. There will be more triptan-oriented
research published in the near future, but we also need more and better studies
of preventive medicine. Topiramate may eventually be confirmed as an effective agent
for adolescents. A recent study showed that adolescents with significant headache
problems often experience as much, or more, emotional and school-related impairment
as children with rheumatoid arthritis and cancer.
Back to Top | Back to FAQs
|