Migraines in children?

The word "migraine" might not come to mind when you're talking about children's headaches, but unfortunately, the debilitating condition can happen in our younger population.

Adam Rappoport, MD, a pediatric neurologist with Wolfson Children's Hospital and Nemours Children's Health, Jacksonville, said, "Headaches are the single most common problem we evaluate during office visits. It's very rare for us to go a full day without seeing a child who has them. Most often, they are brought on by stress or anxiety, diet, or lack of sleep. For some, migraines may be the diagnosis."

Migraines are defined as intense headaches, causing severe pain, throbbing, pounding or pulsating, usually on one side of the head. In adults, they may lead to visual disturbances (auras, decreased peripheral vision) and often cause nausea, vomiting, and sensitivity to light and sound. Migraines can last anywhere from four hours to two days.

According to the National Headache Foundation, up to 20% of children ages 5 to 17 in the United States (10.3 million) are prone to headaches. Approximately 15% of these kids experience tension-type headaches, and 5% are coping with migraine disease.

Migraines have been reported in kids as young as 18 months old. Boys suffer from migraines more often before puberty, but as children age, girls have them more frequently, most likely due to hormones and the onset of their menstrual cycle.

Diagnosis begins with discussion

Dr. Rappoport said he always starts with a conversation about the child's history of headaches and a physical exam. The discussion will center on identifying (or ruling out) possible secondary causes of headaches, gathering information about family history of headaches, and pinpointing causes of stress or anxiety, diet or sleep problems.

Children's migraines may have slightly different signs than adults. Head pain may be present, but not as severe as other symptoms: unexplained nausea or vomiting, abdominal pain, or dizziness.

Warning signs of an impending migraine can include:

• Loss of appetite
• Irritability
• Yawning
• Food cravings
• Lethargy
• Social/emotional withdrawal
• Mood swings
• Sensitivity to light, touch, smell and sound

In some cases, sleepwalking or talking and night terrors may occur.

Relief is out there

Treatment for childhood migraines can vary depending on the child's age and the frequency and severity of the occurrences. The first step is to try to avoid triggers.

"For treatment, the three areas we like to address are lifestyle, vitamins and supplements, and medicines," said Dr. Rappoport. "First and foremost, we look at the modifiable changes, like eating healthy and limiting caffeine, getting enough sleep, and decreasing stress. This may help prevent the onset of migraines."

For vitamins and supplements, "Magnesium, COQ10, and Riboflavin, which is a B-vitamin, can contribute to prevention and relief," he said. As always, parents and patients should consult with their physician before starting any supplements.

Over-the-counter medicines pain relievers can help ease discomfort and offer some relief from nausea and vomiting. Prescription medications may be needed for more painful or long-lasting migraines.

Dr. Rappoport and colleagues at Wolfson Children's Hospital are conducting clinical research into innovative treatment options, including a new medication for the acute treatment of migraines aimed at increasing serotonin.

Working together to manage the pain

So, if your child has migraines, will he or she suffer from them for life?

"Unfortunately, we don't have a way to predict who will have migraines, or for how long. For some people, migraines disappear when they are 18 or 19. I do try to tell patients that if we start a medicine, they likely won't be on it for the rest of their life. We work with them on a medical plan."

If your child is experiencing headaches, Dr. Rappoport recommended a visit to the pediatrician, who can then make a referral to a neurologist, if needed.

"Our job is to look at the history and symptoms and then work with the family to figure out how to best manage the headaches."

The pediatric neurology team with Nemours Children's Health, Jacksonville, and Wolfson Children's Stys Neuroscience Institute provide expert care for a wide range of neurological conditions, including chronic headaches. To learn more, call 904.697.3600.

Source: National Headache Foundation.