Archive for Sunday, October 19, 2003

Splitting headaches

Children suffer from migraines, doctors say

October 19, 2003


The lightheaded feeling warns Austin Williamson that it's coming. Then come the floating spots before his eyes; the pounding, throbbing, pain in his head; the nausea.

Some migraines are so severe the Longmont, Colo., resident confines himself to bed. His worse migraine lasted two weeks.

"It feels like a vise on your head," he says.

Austin is only 15, and he's been having migraines since he was 10. There's a misconception that migraine headaches only occur in adults, says Dr. Alan Seay, who runs the Pediatric Neurology and Headache Clinic in Denver.

Studies show that migraines -- pulsing headaches -- occur in 3 percent to 10 percent of children under age 18. By the time a child is 18, the frequency is the same as for adults, about 10 percent to 12 percent. Incidence of migraines is equal in girls and boys before puberty. After puberty, girls are three times more likely to get them than boys.

The disorder causes neurons in the brain stem to become unstable and fire when they shouldn't. It results in the release of certain proteins, which cause a painful dilation of blood vessels. Migraines have been diagnosed in children as young as 4 and probably occur in younger children who can't articulate what they are feeling, Seay says.

Overall, migraines are underdiagnosed because the childhood symptoms go unrecognized or are misdiagnosed as sinus infections or as imaginary.

"I don't go a week in the clinic where I am not told the kid is making it up," says Dr. Glenn Merritt, director of the Pain Clinic at Children's Hospital in Denver.

Tough diagnosis

Merritt says it's harder to diagnose migraines in kids because their symptoms don't follow the classic rules. Unlike adults, kids can have migraines on both sides of the head instead of on one side. In addition, vomiting may be a child's only symptom.

Adults are not the only people to suffer from migraines, doctors
say. Three to 10 percent of children under age 18 also suffer from
the pulsing headaches that are often accompanied by nausea,
lightheadedness and other symptoms.

Adults are not the only people to suffer from migraines, doctors say. Three to 10 percent of children under age 18 also suffer from the pulsing headaches that are often accompanied by nausea, lightheadedness and other symptoms.

Typical symptoms may include a throbbing pain on one or both sides of the head, increased sensitivity to light or sound, nausea, upset stomach and loss of appetite. Migraines in children usually range from less than an hour to two to three days, but sometimes they can last for weeks or months.

But better understanding of the genetic illness, new medications and alternative treatments have given those children diagnosed new hope. Some of the newer daily medications work to prevent migraines, while others are taken at the time of a migraine to relieve pain. Other methods such as relaxation techniques and biofeedback are also used to help control pain, as well as some herbal remedies that are on the market.

Although migraines are genetic, certain triggers will set them off. For instance, doctors agree that certain foods trigger migraines in some kids. Those that contain tyramines -- including red wine, chocolate, pickled foods and fermented cheeses such as brie -- are known to affect blood level stability, especially in those whose blood vessels are already unstable, says Dr. Bob Rountree, a family practice physician in Boulder, Colo. Rountree says when treating migraines, the first approach is to identify the trigger and eliminate it. He recommends kids try an elimination diet where they go off wheat, corn, dairy, eggs and nuts for three weeks to see if it helps. Foods can be slowly reintroduced to determine the triggers.

Stress among triggers

Another common trigger is stress. At Children's Hospital's Pain Clinic, a team evaluates a child, says Merritt. Occupational and physical therapists determine whether posture or chronic muscle tension are trigger factors, a psychologist evaluates stresses in the child's life and a medical history and physical are given to rule out rare but more serious ailments. After the evaluations, the team sets up a treatment plan. Treatments depend on the frequency and severity of the headaches, doctors say.

For less debilitating headaches, over-the counter drugs such as ibuprofen might be used to treat the inflammation of blood vessels after a headache starts.

For headaches that send kids to the hospital, prescription medications such as triptans, a generic class of medications, are used. They are designed to specifically relieve migraine pain and work by reversing the effect of the neuropeptides, chemicals released by nerve endings that cause the wall of the blood vessels to swell.

Kids in severe pain may be treated with Depacon, in an intravenous drip that can speed up pain relief. Prescription medications used to prevent migraines include propranolol, amitriptyline, topiramate and valproate, which work by stabilizing nerve membranes in the central nervous system. Preventive medications must be taken on a daily basis for several months at a time and are used by adults and by children at an age- and weight-appropriate dose. Seay and Merritt both say it's important to treat migraines early.

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