MHNI

Questions in the following section on children and adolescents with headache disorders are answered by Joel R. Saper, MD, Alvin E. Lake III, PhD, and 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.

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.

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.

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).

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.

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.

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.