Pediatric Headaches

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.

Children, like adults, experience headache and as in the case with adults, there are hundreds of potential causes for headache, some of which are very severe.  The most important first step is to make certain that a headache problem in a child does not reflect a serious disease.  Diseases may include simple conditions such as sinus, ear, or dental problems or more severe disease including tumors.  Children may be affected by metabolic, infectious, or toxic disorders as can adults.  Thus, the first step in effective treatment of children and adolescents with headaches is to obtain an accurate and reliable diagnosis.  The proper treatment follows the proper diagnosis

How early in childhood can a migraine occur?

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. Hormonal milestones, such as menstruation, pregnancy, the use of oral contraceptives, and menopause 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.

Are there symptoms that children with headaches show that are less likely 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 that 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 neurological 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.

Does MHNI evaluate and treat many adolescents with headache?

Yes. Many of the adolescents that come to the Institute experience daily headache and often miss many days of school or cannot go to school at all; family and social life is also disrupted. Other children have only occasional severe attacks.

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, recreational 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."  Some patients may have gluten sensitivity.

Are there unusual headache types that may affect children and adolescents?

Yes. 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 that 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.

Also, some children experience severe repetitive attacks involving an eye or temple on one side, and can have up to 10-20 attacks a day.  The attacks resemble "cluster headaches" found in adults.  Some of these are associated with tearing, nasal drainage, and eye pain during the attack.  Paroxysmal hemicrania is one such pattern and can be effectively treated if properly diagnosed.  Other rare headache patterns affect children as well.