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Monday, September 6, 2010

Article: Migraines in Children Are Often Overlooked -

Migraines in Children Are Often Overlooked -

August 30, 2010, 5:30 pm

Returning to Classrooms, and to Severe Headaches

Stuart Bradford

For kids around the country it's back-to-school time. But for many of them, it's also the return of headache season.

Doctors say frequent headaches and migraines are among the most common childhood health complaints, yet the problem gets surprisingly little attention from the medical community. Many pediatricians and parents view migraines as an adult condition. And because many children complain of headaches more often during the school year than the summer, parents often think a child is exaggerating symptoms to get out of schoolwork.

Often the real issue, say doctors, is that changes in a child's sleep schedule, including getting up early for school and staying up late to study, as well as skipping breakfast, not drinking enough water and weather changes can all trigger migraines when the school year starts.

"In many areas people just don't think kids can get migraines," says Dr. Andrew Hershey, professor of pediatrics and neurology and director of the headache center at Cincinnati Children's Hospital Medical Center. "But kids shouldn't be missing activities and having trouble at school because they're having headaches. If it happens, it shouldn't be ignored."

Migraine is an inherited neurological condition characterized by severe, often disabling headache pain. During a migraine attack, a number of changes occur throughout the brain causing dilation of blood vessels; severe pain; increased sensitivity to lights, sounds and smells; nausea and vomiting; and other symptoms. It's estimated that about 10 percent of young children and up to 28 percent of older teenagers suffer from migraines. (Hormonal changes during puberty can also be a trigger.)

But childhood migraine often doesn't show up the same way as an adult migraine. While adult migraines often last four hours or more, in a child, the duration of a migraine can range from as little as one hour up to 72 hours. In adults, migraines typically settle on one side of the head, but in children migraine pain is often felt across the front of the forehead or on both temples rather than on just one side. As a result, childhood migraines are often dismissed as sinus headaches.

Complicating matters is that sometimes pediatric migraines don't involve headache pain. Instead, the child may have abdominal pain, vomiting or feelings of vertigo.

Around the country, only about 20 centers focus on pediatric migraine, forcing parents to seek the advice of pediatricians with little experience treating migraine or neurologists who specialize in adult care.

"The presentation is different enough that it can be missed by an adult neurologist," says Dr. Philip Overby, assistant professor of neurology and pediatrics at Children's Hospital at Montefiore in the Bronx. "Kids 3 years old can be having a migraine; even a 5-year-old will struggle to provide a history of what they're experiencing."

Parents often have a hard time distinguishing between real pain and the imaginary maladies that young children sometimes invent. Dr. Hershey tells the story of a 6-year-old boy with daily headaches, whose parents thought he was just trying to avoid school. His parents finally sought treatment and by the time he was in the third grade the headaches were under control. "He was a different kid, more active and happy all the time," said Dr. Hershey. "The parents realized he really had been having headaches, but they had been denying it."

But parents also say they have struggled to find doctors who take a child's headache complaints seriously. When Cathy Glaser's daughter began suffering migraines as a toddler, her New York pediatrician couldn't help. By the age of 15, her daughter was virtually disabled by migraines, but finally found help at the Michigan Headache and Neurological Institute in Chelsea, Mich.

The experience prompted Ms. Glaser to help create the Migraine Research Foundation. The group's "For Our Children" initiative raises awareness and money for pediatric migraine research. The group's Web site,, also offers a list of headache centers that treat children. "It's astounding that so little attention is being paid to such a disabling and socially expensive problem," she says.

And some of the newest and most effective migraine treatments and preventive drugs have yet to win Food and Drug Administration approval for pediatric use. For instance, a class of migraine drugs called triptans, which narrow blood vessels in the brain, have been lifesavers for migraine patients, but so far only one has been approved for pediatric use in the United States. (Three such drugs are approved for pediatric use in Europe.) Even so, many adult migraine treatments have been used off label for years in children.

Janet Podell of Highland Park, N.J., says her daughter Hannah began suffering from migraines around age 8. The pain later became so debilitating that Hannah missed two years of school. Finally, the family found a doctor who prescribed a combination of drugs. Although Hannah, now 20, still gets migraines, they are essentially under control.

"It was two years of utter misery which changed her life and the family's life very drastically," says Ms. Podell. "She lost two years of her early adolescence."

Dr. Hershey treats pediatric patients with a three-pronged approach. It starts with immediate pain relief, using either ibuprofen or a triptan drug. Because frequent use of over-the-counter pain relievers can set off a "rebound" effect, leading to more headaches, treatment should be discussed with a doctor.

Second, he says, children who have more than one headache a week may need preventive therapy, like low doses of antidepressants or anti-seizure drugs that have been shown to prevent adult migraines. And lifestyle changes like exercise, drinking more water, getting adequate sleep and not missing meals are essential.

"These are kids who are often staying up late to study and getting up early to get to school and frequently skipping meals," says Dr. Overby. "I can't say it's typical that you can completely cure headaches just by lifestyle measures alone, but if you don't address those things as well you'll never be able to control them."

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Personal Web site for John C Kim: KIDDOC.ORG

I am a pediatrician specializing in General Pediatrics, International Adoption Medicine, and in the diagnosis and coaching of families pursuing joy.