Clinical Program Highlights: Headaches in Children
Headaches, even migraines, are quite common in childhood and can be alarming to parents and disruptive to home and school life. Headaches associated with febrile illness, tension-type headaches, migraine headaches and concussions occur routinely in children and do not generally indicate a serious health problem. Most children with headaches do not require anything more than a good neurologic exam. Rarer causes of headaches in children include blood clots, brain tumors and increased spinal fluid pressure (pseudotumor cerebri) that can be identified by pediatric headache specialists based on symptoms and a detailed examination. Those findings are generally confirmed by tests such as MRI.
Illnesses with fever, such as strep throat, can also trigger headaches in children. Because chemicals released by the body to fight the infection may play a role in triggering headaches, they usually resolve with treatment of the underlying illness. When the infection is under control, the body no longer releases these substances and the headache resolves. During cold season, a small number of children may have resolution of the triggering illness, but continue to have headaches. This is called new daily persistent headache and can be treated with medications used to treat migraines.
Tension-type headaches occur in school-age children for the same reasons as in adults and are generally treated by addressing the underlying trigger, such as school stress, poor diet or sleep habits. This type of headache does not generally require testing or medication. Non-medication-based therapies such as biofeedback training may be helpful for children and adolescents with frequent tension-type headaches and may help to prevent overuse of over-the-counter medications. Tension-type headaches frequently occur in the forehead region, are described as band-like or squeezing and are usually not severe. They do not generally stop a child’s activities.
“Migraine headaches occur in 5 to 10 percent of the pediatric population.”
Before puberty, they are slightly more common in boys than girls, but become much more common in girls after puberty. These are medium to severe headaches that are associated with nausea and light and sound sensitivity. Some children vomit with their migraines, which makes it hard to take oral medicine. Some children may also have vertigo (spinning sensation) with migraines.
Lightheadedness and sensitivity to smells are also common symptoms of migraine headaches. Only 20 percent of children have neurologic symptoms (aura), such as seeing spots or flashing lghts, or having tingling of a limb before or during their migraine. A small percentage of children, about 1 to 4 percent, may have chronic migraine, which means more than 15 days of migraine per month for more than three months. This may still be a common, rather than worrisome, cause of headaches in children. There are many effective treatments for this condition and many patients may benefit from evaluation by a pediatric headache specialist to determine the appropriate course of action.
Headaches caused by increased pressure in the brain, such as those caused by tumors, clots or pseudotumor, get progressively more severe and more frequent over a few months of time. Children who have these conditions of ten have abnormal neurologic examinations within a few months of starting to complain of headaches. Early warning signs include unexplained vomiting, progressive blurry vision, double vision, morning headache, balance problems and seizures. A thorough neurologic examination can often indicate whether these diagnoses are a concern and further testing is necessary.
Challenges in Migraine Treatment:
- Affects school performance and attendance.
- Many people view patients with migraines as having mood or emotional problems rather than a medical problem so they are sometimes not appropriately treated.
- Because there is only one migraine treatment with an indication in the adolescent population, there is often reluctance on the part of primary care providers to treat, thus delaying care and increasing suffering.
- Possible difficulties getting insurance companies to pay for these medications or getting pharmacists to dispense them.
- Strong advocacy by the physician for the patient with the schools – completing chronic health forms and explaining to patients their rights related to accommodations for medical conditions in public education.
- Continued educational resources offered locally and nationally in the form of articles and symposia.
- There are currently ongoing clinical trials in adolescents of migraine treatments already approved by FDA for use in adults – additionally, there are several upcoming clinical trials planned for 2012 and 2013, which may provide further evidence – based treatment of pediatric headache.
The Headache Program constitutes a collaborative effort between and among the Phoenix Children’s Division of Neurology, the Emergency Department, inpatient pediatricians, the Pain Program, Psychology, Psychiatry and other pediatric specialists who collaborate to address the complicated issues and needs of children who suffer from disabling headaches.
For more information, please contact BNI at PCH at: (602) 933-0970.