Kiddie Migraines: A Headache in Your Stomach?

Migraineur. Sounds like a job for a senior specialist in some artisanal craft, doesn’t it? Such a misleadingly pleasant sounding word. However, ‘migraineur’  describes a more-common-than-you-think  entity affecting an invisible population of child and adult sufferers of the misery that is the migraine headache.  While migraines aren’t entirely understood, migraines in children (child migraineurs!) have been a bit of a mystery til recently.  Do kids get them? (you bet) How are they similar or different than in adults? (excellent question)  When should parents have their children see a health care provider or specialist for them? (Put down that cheese, and read on!).

First, what is a migraine? To paraphrase the International Headache Society’s definition, a migraine is a recurrent headache that occurs sometimes with(or without) a raft of associated sensations called auras, lasting from two to 48 hours.  Migraines are thought to occur as a peculiar cascade of nerve excitement and inflammation over the cortex of the brain, accompanied by changes in blood flow to those areas. All in all, things get funky as migraines come to town, manifesting  in all sorts of ways.

In grownups, migraines are classically felt as dull, pounding pain on one side of the head.  Veterans can feel them coming on, with associations of vision changes, numbness or tingling, pukiness, or unique fogginess prior to the headache onset. Migraine sufferers will often describe their discomfort as medium to extreme, and often runs with associated nausea, and extreme sensitivity to light, and sound.  Health care providers can often discern these headaches by their pattern, triggers and frequency…and by the fact that sufferers almost invariably find solace in a quiet, dark room with the curtains drawn.  Ah, such is the advantage of my adult care provider colleagues!  The diagnosis may be made so much easier by the ability of the migraineur to relate their experience themselves.

Kids are different

In children, migraines present themselves in markedly different ways, and, the developmental status of a child make the detective work a bit more of a veterinary experience. As a classic 1962 study in Sweden found, lots of kids have had headaches (about 40% by 6 years old, and 70% by age 15)  Migraine headaches are the most common type. They occur in 10% of younger children, and about 1/4 of teens.

Clinical pearl: Parents or health care providers should suspect migraines when there are recurring episodes of symptoms that are making kids miserable.   Extra high levels of suspicion should be applied for kids with strong histories of carsickness, or a family history of migraines (up to 70% of young migraineurs have a relative who suffer them!).

Oddly enough, headaches may be a transient, or event absent feature of migraine in children.  While adults may point to a one-sided headache, kids may perceive pain on both sides of their head, and confuse the diagnosis (tension headache? sinus infection?).  Apediatric migraine experience, associated with any number of symptoms, can last up to 3 days. That is a long time to be miserable.  While the particulars may vary from child to child, kids who get these spells tend to look the same each time .

At a migraine’s onset, parents may notice a certain pattern of behavior, including fatigue, irritability or hyperactivity.  These aura type sequences may be important to watch for, as they may offer a window of taking measures or medication to head off (or, in medical parlance, “abort”) a blooming migraine episode. Thereafter, things may progress to pallor, odd facial expressions, confusion, sleepiness, or prolonged bouts of nausea and vomiting. Yeesh.

Parents and kids can often discern activities that trigger migraine ‘attacks.’  As this excellent NYT article suggests, the  zipquick lifestyle of tweens and teens can be a cause of migraines in itself. Insufficient sleep, skipped meals, hydrating poorly, being stressed out or rundown can precipitate an episode. For teen girls, the hormone surges of their periods may bring on migraines. Working with kids to chart or calendar when a headache starts, and what they were doing (eating? exercising? studying for a test?) can help suss out when the triggers are less clear.

In all, medical science is catching up to what families with kids who suffer migraines have long known: Migraines can be extremely debilitating, formative experience. Children may miss significant amounts of school, or perceive that they are different , keeping them from the runnings around of childhood.

Research suggests that the most effective approach migraines is a lifestyle and stress management overhaul.  Getting sufficient sleep, eating and hydrating well, and avoiding triggers (including Xbox, computers, and texting!)  are a great start. Even better: kids learn ways to reduce stress  in a manner suited to a child’s age…This beats medications any day! Yoga, exercise, meditation, massage, or guided imagery are easily adopted techniques that parents can take on with their kids.  Firstline home therapies help too: ibuprofen, rest and chill time (in a dark, quiet room!) will get most children straightened out and flying right.

For any parent concerned their child may have a migraine should consult with their child’s health care provider.  A careful history and an examination of the child help make the diagnosis, and therapies can be suggested that are appropriate and safe. Ideally, parents and provides can develop a Migraine Plan, including how to prevent episodes, and what to do at home or school if an episode is suspected. Children with more complicated symptoms (vision loss, or muscle weakness during migrainous episodes, or severe symptoms that don’t respond to first line therapies) may require a consultation with a neurologist or migraine treatment center.

For the younger migraineur, take heart. About half of all children of elementary school age or younger will see their symptoms cease at the onset of puberty. For kids who develop migraines during their teen years, tend to have them into adulthood, with their severity and frequency waning over time. For all kids and teens with migraines, we parents and care providers will do well to respect the fact that migraines affect children of preschool age and older (at least)…and that they deserve our attention and efforts to prevent them.

photo above by snarkist [/link http://media.photobucket.com/image/migraine/snarkist/migraine.jpg?o=15]

Cartoon below by me.

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