Headaches and Migraines in Children
Headaches are really common in children and we see this problem frequently as general paediatricians. Of the children who get referred to us, over 90% of these have chronic (that is, long standing) headache. This is not to say that 90% of kids have persistent headaches, but more I suppose a reflection on the fact that by the time they get referred to a specialist, most of the simple methods to control pain have been tried, and parents/kids/GPs are looking for something further to help.
Specifically today I wanted to talk about migraines – but to do that I need to give you a bit of background about headaches generally…
So when a child presents with chronic headaches, the easy and common thing for parents to do is PANIC!! But you shouldn’t. Brain tumours (let’s face it – that’s what you were thinking of weren’t you!?) that obstruct the flow of CSF (cerebrospinal fluid – or the fluid that sits around your brain and spinal cord to cushion it) are uncommon.
CAUSES OF HEADACHE
As you would totes be aware already, there are HEAPS of things that could potentially cause a headache:
- Lack of sleep or sudden changes in sleep patterns
- Skipping meals/being hungry
- Too much screen time
- Vision/sight problems
- Certain medications (ie as a potential side effect)
- Strong odours
- Caffeine or caffeine withdrawal
- For older girls – menstruation/hormone changes
- Certain foods such as cheese, nuts, chocolate, ice cream, fatty or fried food, lunch meats, hot dogs, yoghurt, aspartame, MSG and then for adults, alcohol)
So given that headaches are so common in kids, most parents want to know what the RED FLAGS signs are – or, when do you need to be worried about a headache in your child? This is what I generally advise:
- Sudden onset or severe headache
- Increasing frequency or severity of headache
- Weakness in the arms or legs
- Headache that wakes a child from sleep
- Early morning headache associated with vomiting
Differential diagnosis “What are the things it could be?”
- Chronic headache
- Raised intracranial pressure
- Benign intracranial hypertension
I would have to write another blog about each of these conditions (let me know if you want to know about them – I can definitely blog about them at some later stage), but today I wanted to focus on MIGRAINES.
What might your doctor do to investigate and differentiate between these diagnoses?
First thing’s first – your doctor will take a thorough history from you about your child’s headaches.
They’ll ask things like (but not limited to):
- How often do they occur?
- Where is it most painful?
- What time of day do they happen?
- How long do they last? How quickly do they come on?
- What makes it worse (aggravating factors)? Better (relieving factors)?
- What other symptoms happen with the headache (eg vomiting, nausea, sensitivity to light/sound etc)?
- How much sleep has been had/not had?
- What kind of foods does the child usually eat on an average day? Has there been any changes to this of late?
- Is there anything stressful going on in the child’s environment recently? For example – at home, moving house, death of a pet/family member, family conflict or parental separation or at school, bullying, change of usual teacher, friendship troubles etc.
They will then do a full examination, to see if they can find signs that might point towards a cause. And then, they might order some investigations (eg blood tests, scans etc).
How do you know if it is a migraine?
Migraines are headaches that typically last anywhere between 4-72 hours that mostly occur with nausea and vomiting as well as an over-sensitivity to light or sound. The pain of a migraine headache is throbbing in nature and worsens with normal activity.
Sometimes migraines are associated with auras. Auras are warning symptoms that can occur before the migraine occurs. They are commonly reported as visual disturbances such as flashing lights, or changes in smell or perception.
Treatment of migraine
There are a couple of “arms” to migraine treatment – firstly, aimed at RELIEVING the headache itself and the symptoms that go with it and then PREVENTING it from happening. Usually, the earlier you get onto treatment, the more effective it is.
- Pain relief – things like paracetamol and ibuprofen (not aspirin in children under 12 years of age)
- Medication to treat nausea and vomiting
- Other specific migraine treatments that are not strictly “pain killers” but act to stop the migraine
- Preventative treatment – for children who suffer from frequent migraines
It is also important to AVOID TRIGGERS for your child’s headaches. Examples might be:
- Getting glasses to reduce eye strain if they are needed
- Getting adequate sleep
- Avoiding/minimising stress
- Ensuring adequate hydration
So I hope this post has helped you to teach you a little about dealing with your little one’s (or not-so-little-ones as the case may be) headaches and has been useful in helping you to understand what migraines are and how we manage them.
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For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds”