Drugs aren't the only way neurologists treat children with migraine, says Donald W. Lewis, M.D., a pediatric neurologist with the Children's Hospital of the King's Daughters, in Norfolk, Va. “When young patients visit my clinic, we stress a healthy lifestyle first and fore-most. We encourage daily exercise, plenty of sleep, and reduced stress. Children are often over-scheduled with activities,” says Dr. Lewis.
Migraine headaches are both common and under-recognized in children, says Dr. Lewis. About five percent of grade-schoolers and 15 percent of teenagers experience frequent headaches. On average, migraines begin at about age seven in boys and 11 in girls, with their frequency increasing throughout adolescence. Dr. Lewis believes there's a certain amount of denial among adults when kids complain about headaches. “Many adults don't realize that children can even have headaches.”
Stress Often Triggers Migraine in Children
Figure. Dr. David Ro...Image Tools
Children often have an inherited predisposition to headaches, but other factors, such as stress, anxiety, depression, environmental causes, and food ingredients alone may trigger migraine attacks or make them more painful.
Just like adults who are driven to headaches by too many demands at work, the anxiety of school can manifest itself as headaches in kids. David A. Rothner, M.D., a pediatric neurologist who has been treating children with headaches for more than 30 years at the Cleveland Clinic, says he recently began treating a second grader who began having four headaches a week last November. It wasn't long before the patient and physician were able to relate the headaches to problems in school, and make a plan for alleviating them. He has also observed that his young patients have fewer recurring headaches in the summer.
Susie, a 15-year-old migraine sufferer in Virginia Beach, Va., gets headaches three or four times a month. In addition to her monthly menstruation, loud sounds and bright lights can trigger a migraine, she says. When she's in school and feels a headache coming on, she heads to the nurse's office for a dose of ibuprofen.
While weekly headaches are a fact of life for Susie, she has managed to reduce the frequency since she began having them about three years ago. “Last year was more stressful academically” and her headaches became more frequent, she recalls.
Common Pain Relievers Are Safe and Effective for Children
When children can't beat migraines on their own, neurologists say that over-the-counter pain relievers like ibuprofen (Advil, Nuprin, Motrin, Midol, and others) and acetaminophen (Tylenol, Liquiprin, Mapap, and others) are safe and effective for acute migraine, if not taken more than three times a week, and when dosage directions are followed. (Dr. Rothner is concerned, though, because studies show 23% of children overuse these medications, often without their parents knowledge.)
“As pediatric neurologists, we are confident that these common headache treatments used by adults are also safe and effective for children,” says Dr. Lewis.
Sumatriptan (Imitrex) nasal spray, which requires a prescription, is also considered a safe and effective migraine treatment for adolescents. In a study of children over age 12, the medication relieved pain within two hours for most patients. Sumatriptan is most helpful if taken within 30 minutes after a headache starts. Side effects include nausea, dizziness, flushing, a bad taste in the mouth, and muscle weakness.
None of the newer oral triptan medications frequently prescribed as an acute or preventative therapy for adults are known to be equally safe and effective for young children and adolescents. Nor are they Food & Drug Administration approved for use by children, says Dr. Rothner. The one drug considered likely to be an effective preventative therapy for children, flunarizine, is not available in the United States.
These findings came from 2004 guidelines prepared by the American Academy of Neurology and the Child Neurology Society which were widely distributed to U.S. physicians. The experts reviewed and evaluated 30 years of studies and articles relating to both acute and preventative migraine treatment for children. Children in the studies ranged in age from 3 through age 18.
More Research of Acute Medications Needed
Additional research needs to be done to provide conclusive evidence that these newer drugs can be safely used to treat children, says Dr. Rothner. Most of the studies with the stronger drugs for acute migraine relief and prevention were designed for adults. “Kids are not just small adults,” says Dr. Lewis, adding that until proven safe, pediatricians will err on the side of caution in prescribing these medications to young migraine sufferers.
Kids Respond Well to Non-Drug Treatments
On the bright side, children tend to respond better than adults to behavioral changes, so Dr. Lewis prefers to explore other approaches before putting a child on medication. He stresses the importance of a healthy lifestyle incorporating good nutrition, adequate sleep, and exercise. Biofeedback therapy has also been beneficial in helping kids with frequent headaches, he says.
Biofeedback is a form of complementary and alternative medicine that uses specialized equipment to track and monitor body signals. In biofeedback therapy, patients are taught to control body responses such as brain activity, muscle tension, heart rate, and blood pressure. Typically, a therapist attaches painless sensors to a patient's body which “feed back” information such as muscle tension, skin temperature, and breathing patterns to a computer. The therapist helps the child interpret the accompanying responses and manage them.
Watch for Warning Signs of Serious Illness
Sometimes headaches can be the symptom of a more serious neurological condition. Dr. Rothner advises parents to be watchful and to bring the child to a physician when observing a worsening headache or any headache accompanied by neurological symptoms such as:
* vision problems
* abnormal behavior
* loss of balance
All of those things are warning signs that it's not simply a headache,” says Dr. Rothner.
FOR MORE INFORMATION
The following organizations have resources for parents and caregivers dealing with pediatric migraine.
American Academy of Neurology www.aan.com
“AAN Guideline Summary for Patients, Parents, and Caregivers for the Treatment of Migraine Headache in Children and Adolescents” can be downloaded from www.aan.com/professionals/practice/pdfs/Headache_Peds_Patients.pdf
Child Neurology Society www.childneurologysociety.org
“Parents/Patients/Partners:Web-based Informational Resources” www.childneurologysociety.org/lnk_001.asp?lss=9
American Headache Association www.ahsnet.org
“Recognizing Headaches in Students” can be downloaded from http://ahsnet.org/resources/student_headaches.php
American Academy of Pediatrics www.aap.org
“A Minute For Kids Audio File: Migraines in kids and teens” www.aap.org/healthtopics/commonillness.cfm