How Are Headaches Diagnosed In A Child
The healthcare provider will ask about your childs symptoms and health history. He or she may also ask about your familys health history. He or she will give your child a physical exam. The physical exam may include a neurological exam.
Your child may be asked questions, such as:
When do headaches happen?
How long does the pain last?
Do changes in position such as sitting up cause the headache?
You may be asked questions about your child, such as:
Does your child have changes in walking?
Does your child have changes in behavior or personality?
Is your child having trouble sleeping?
Does your child have a history of emotional stress?
Is there a history of injury to your child’s head or face?
If a more serious condition is suspected ,your child may also have tests, such as:
MRI. This test uses large magnets and a computer to make detailed images of organs and tissues in the body.
CT scan. This test uses X-rays and a computer to make detailed images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.
Spinal tap . This test measures cerebrospinal fluid pressure. It may also be used to check for an infection in the CSF.
Headaches In Children And Adolescents
DONALD W. LEWIS, M.D., Eastern Virginia Medical School, Norfolk, Virginia
Am Fam Physician. 2002 Feb 15 65:625-633.
Headaches are common during childhood and become more common and increase in frequency during adolescence. The rational, cost-effective evaluation of children with headache begins with a careful history. The first step is to identify the temporal pattern of the headacheacute, acute-recurrent, chronic-progressive, chronic-nonprogressive, or mixed. The next step is a physical and neurologic examination focusing on the optic disc, eye movements, motor asymmetry, coordination, and reflexes. Neuroimaging is not routinely warranted in the evaluation of childhood headache and should be reserved for use in children with chronic-progressive patterns or abnormalities on neurologic examination. Once the headache diagnosis is established, management must be based on the frequency and severity of headache and the impact on the patient’s lifestyle. Treatment of childhood migraine includes the intermittent use of oral analgesics and antiemetics and, occasionally, daily prophylactic agents. Often, the most important therapeutic intervention is confident reassurance about the absence of serious underlying neurologic disease.
How Effective Are These Preventive Strategies
Many of the approaches described above have not yet been tested in scientific studies with children and teenagers. But several studies have looked into more comprehensive treatment packages. The biggest study, carried out in the U.S., involved a total of 135 children and teenagers between the ages of 10 and 17 who had chronic migraine. People are considered to have chronic migraine if they have migraine symptoms on more than 15 days per month.
In this study, cognitive behavioral therapy combined with was compared with simple patient education. The cognitive behavioral therapy consisted of ten one-hour-long group sessions in which the children and teenagers learned things like
- how their behavior and feelings affect pain,
- how to distract themselves from the pain,
- how they can organize and adapt their activities to make them more manageable,
- how to recognize harmful thoughts and replace them with more useful positive thoughts, and
- how to relax using .
The parents attended a few of the sessions so they could help their children apply what they had learned.
The children and teenagers who simply had patient education classes learned about the causes and possible triggers of migraines and the treatment options. But they weren’t given any advice on how to cope better with the pain. As well as having cognitive behavioral therapy or attending simple patient education classes, all of the children in the study took the medication amitriptyline for preventive purposes.
Also Check: Excedrin Product Locator Tool
What Causes A Migraine
Until recently, migraine was thought to be caused by the changing size of blood vessels in the brain. These changes either increase or decrease blood flow, which then trigger other changes. Today, migraine is thought to be a brain malfunction a disorder that mainly affects the brain and nerves but also affects blood vessels. The malfunction is caused, in part, by the release of chemicals in the brain. One of these chemicals is serotonin. This cycle of changes cause inflammation and the pain of the migraine.
Migraine is genetic, meaning it tends to run in families. Some 60% to 70% of people who have migraine headaches also have an immediate family member who have or may have had a migraine.
A migraine can cause great discomfort, disability, and interfere with activities. However, they do not usually cause damage to the body. Migraine headaches are not related to brain tumors or strokes.
What Else Can I Do To Prevent Migraines
While there are no sure ways to keep from having migraine headaches, here are some things that may help:
Eat regularly and do not skip meals.
- Keep a regular sleep schedule.
- Exercise regularly. Aerobic exercise can help reduce tension as well as keep your weight in check. Obesity can contribute to migraines.
- Keep a migraine journal to help you learn what triggers your migraines and what treatments are most helpful.
Don’t Miss: How To Get A Migraine
Migraine Headache In Children Medical Treatment
Medical treatment of migraine headaches in children is based on the following: education of children and parents or caregivers about migraine triggers, creation of a plan of immediate treatment for the attacks, and consideration of preventive medicines or measures for children with frequent migraines.
The doctor should also assure parents that the headache is not caused by a brain tumor or other life-threatening condition. A regular bedtime, strict meal schedules, and not overloading the child with too many activities are important. Helping the child recognize migraine triggers is helpful but often difficult. Ridding migraine triggers reduces the frequency of headaches in some children but does not completely stop occurrences.
A headache diary can be used to record triggers and features of attacks. Triggering factors that occur up to 12 hours prior to an attack should be noted. Other important factors to include are as follows:
- Date and time the attack began
- Type and location of headache pain
- Symptoms before the headache
- All food and drink consumed prior to the attack
- Bedtime, wake time, and quality of sleep prior to the attack
- Menstrual periods
- Medications taken and their side effects
Unfortunately, even the most diligent person cannot always identify specific migraine triggers.
Prevention and Therapy
When Should I Take My Child To The Doctor
It may be obvious, particularly if you have migraine yourself, that your childs symptoms are typical of migraine. If attacks have obvious causes, symptoms respond to painkillers, and your child is otherwise fit and well, it is probably not necessary to seek a doctors advice. However, you should make an appointment for your child to see a doctor if there is any doubt about the nature or cause of the headaches, if your child seems generally unwell, or if the headaches are interfering with daily activities.
In particular, it is very important to see a doctor in the following circumstances: Headaches start under age 7 The headache changes An unaccountable increase in frequency, severity and duration of attacks Recent school failure Balance or co-ordination problems Failure to grow/attain normal developmental goals
You May Like: Are Migraines A Symptom Of Pregnancy
Migraine Headache In Children More Medical Treatment
An estimated 20% to 50% of migraineurs are sensitive to foods. These dietary triggers are thought to cause a change that provokes a migraine attack. Helping children learn to recognize and avoid these triggers is helpful but often difficult. The following are some common dietary triggers:
Both OTC and prescription medications can trigger or worsen migraine headaches. Cimetidine , estrogen , histamine, hydralazine , nifedipine , nitroglycerin , ranitidine , and reserpine are examples of medications that can increase migraine frequency.
Excessive use of OTC pain medications and analgesics can cause occasional migraine attacks to convert to analgesic-abuse headaches or drug-induced headaches that do not respond to treatment. Children with migraines should avoid frequent or long-term use of NSAIDs, acetaminophen, triptans, or ergotamines. Migraineurs who have been treated for a long time with amphetamines , phenothiazine , or propranolol should avoid sudden withdrawal from these medications because migraine headaches may result.
In children who have an inborn tendency for migraine headaches, attacks can occur as a result of psychological , physiological , or environmental triggers. Physical exertion and travel or motion can be triggers.
Is Abdominal Migraine Common In Adults
Children and teens who have abdominal migraine are more likely to have migraine attacks as adults. One study found that 7 out of 10 children with abdominal migraine went on to have migraine attacks as an adult.2
Abdominal migraine is less common in adults but it does occur, most often in people with a family history of migraine. In both children and adults, the person is healthy in between episodes.1-3
Also Check: How Common Are Visual Migraines
What Are The Symptoms Of Migraine In Children And Teens
For children and teens, sensitivity to light and sound are two telltale symptoms of impending migraine.
Migraine headaches also tend to be bilateral at this age. This means that the pain is present on both sides of the head.
Generally, migraine attacks are also shorter for people in this age group. The average length for adolescents lasts about 2 hours.
Adolescents may experience chronic daily migraine, which is one of the most disabling types. This means that they experience headache days per month. Each headache day is characterized by a migraine headache that lasts more than 4 hours.
This recurrence must happen for more than 3 months for the condition to be considered chronic.
- caffeine withdrawal or too much caffeine
- foods that contain nitrates, such as hot dogs and lunch meats
- foods that contain monosodium glutamate, which is a flavor enhancer found in some fast foods, broths, seasonings, spices, Chinese food, and ramen noodles
- foods that contain tyramine, such as aged cheeses, soy products, fava beans, and hard sausages
- sulfites, which are chemicals that are commonly used as preservatives
- aspartame, which is found in sweeteners such as NutraSweet and Equal
Other foods sometimes considered to trigger migraine attacks include:
- tannins and phenols in black tea
- apple skins
Ask your teen to record the frequency and intensity of their migraine symptoms in a journal.
Because of this, your family history may be able to help guide your doctor to a diagnosis.
How Do I Know If My Teens Headaches Are A Sign Of Something More Serious
If your teen is experiencing severe symptoms such as sudden loss of balance, numbness, paralysis, speech difficulties, or seizures, seek medical attention right away. Call your family doctor he or she may want you to go straight to the emergency room.
Most headaches are easily treatable and are not a sign of a more serious medical problem. Headaches may improve as your teen gets older. However, if your teens headaches are becoming more frequent, the pain and symptoms are getting worse, and/or pain medicines do not seem to be helping, its time to visit your family doctor.
He or she will ask about your teens health history and details about their headaches. Keep a detailed log to track their headache triggers, symptoms, frequency, and treatments. Your doctor will perform a physical exam. He or she will look for problems with your teens temperature, breathing, pulse, and blood pressure. If they suspect a central nervous system problem, they will order or perform a CT scan or MRI test to look for abnormal areas in the brain.
In rare occasions, chronic, progressive headaches can be a sign of a serious underlying medical problem in your teen. These conditions could include:
- Brain infections.
- Meningitis .
- Hydrocephalus .
- Blood clots.
- Head trauma.
Recommended Reading: Persistent Migraine Aura Treatment
What Types Of Headache Are Associated With Serious Illness
The child may have varying degrees of symptoms associated with the severity of the headache depending on the type of headache. Some headaches may be more serious. Symptoms that may suggest a more serious underlying cause of the headache may include the following:
A very young child with a headache
A child that is awakened by the pain of a headache
Headaches that start very early in the morning
Pain that is worsened by strain, such as a cough or a sneeze
Recurrent episodes of vomiting without nausea or other signs of a stomach virus
Sudden onset of pain and the “worst headache” ever
Headache that is becoming more severe or continuous
Personality changes that have occurred as the headache syndrome evolved
Changes in vision
The symptoms of a headache may resemble other conditions or medical problems. Always consult your child’s doctor for a diagnosis.
The Devastating Effects On Teens Who Suffer From Migraines
Migraines in teens can be disabling. They can cause frequently missed school days, a need to miss sports, work and other activities, and according to a University of Colorado at Denver study, teens who suffer from migraine headaches are also more likely to get lower grades and have a lesser chance of even graduating high school or attending college.
The results of the study found that migraines are an important obstacle to long-term academic success with sufferers having trouble attending school and concentrating on those days they are in school.
The teenage years are already a very difficult time in life, and with migraines they can seem impossible. With the natural response during a migraine attack to shut down and withdraw from the world, sufferers feel a sense of abandonment, which is extremely damaging during adolescence.
Surveys have found that almost every migraine sufferers life is negatively affected forcing them to avoid activities like:
- Doing chores around the home
- Taking part in favorite hobbies
- Spending time with family and friends
- Attending school
- Making future plans
A study in 2007 found that teens who suffer from migraines have a higher risk of suicide and also a greater chance of developing mental disorders in addition to the headaches. 21% were found to develop major depression and 19% were found to experience panic attacks.
Recommended Reading: How To Get A Migraine
What Role Do Tension And Stress Play
Tension and stress are considered to be potential migraine triggers. Psychological stress caused by things like your parents splitting up, problems at school or the changes associated with a move can make migraines more likely too. If you’re often affected by stress, it can be worth learning a relaxation technique to help you cope better with it. This also helps to prevents migraine attacks, or at least make them milder, in some children and teenagers. Young people who tend to get headaches or migraines when they feel stressed should also generally make sure that they have enough breaks during the day. Exercise and sports can help to manage stress too as long as the child enjoys it and is not under pressure to perform.
There are various relaxation techniques. The most common techniques are known as progressive muscle relaxation and autogenic training. Both of these techniques have to be learned and practiced either in classes or by teaching yourself. Progressive muscle relaxation involves repeatedly tensing and relaxing different muscles in your body. This is meant to relax and calm your body and mind. Autogenic training aims to help people enter a state of “self-hypnosis.” You sit or lie in various positions and focus on being aware of different parts of your body and feelings of calmness, heaviness, warmth or cold. The aim is to feel deeply relaxed and get rid of negative feelings.
What Is The Outlook For Children And Adolescents With Migraine
Treatment helps most children and adolescents with migraine. Fifty percent of children and adolescents report migraine improvement within 6 months after treatment. However, in about 60% of adolescents who experience their first migraine as an adolescent, the migraine may continue off and on for many years.
It should be noted that many of the medications listed in this handout have not been approved by the by the Food and Drug Administration for use in children and adolescents with headaches. This is a common practice in the field of medicine and is called off-label prescribing. It is one of the ways new and important uses are found for already approved drugs. Many times, positive findings lead to formal clinical trials of the drug for new conditions and indications.
Rehabilitation program. Some hospitals and/or other health care facilities offer inpatient headache management programs for children and adolescents ask your doctor if their facility offers such programs.
Patients typically accepted into these programs are those who have a chronic daily headache , missed an excessive amount of school, have overused over-the-counter medications, and have headache pain that is controlling their lives. The staff of such programs can include psychologists, pediatric rehabilitation specialists, occupational and physical therapists as well as access to a child psychiatrist. Stress factors are an important focus of this program not rapid changes in medications.
You May Like: When Do Pregnancy Headaches Stop
What To Do For Migraines In Teens How Are They Treated
In adults, medications are the focal point of migraine treatment. However, research shows that medications for migraines do not work as well in the pediatric population as they do in adults. Teenagers are in the middle of that spectrum, and sometimes, a different approach is needed.
The best treatment is prevention. Identifying triggers, or situations that lead to migraines, can help a teenager avoid migraines all together. For teenagers, stress, especially at school, is the most common trigger. This stress can be related to class work, after school activities, difficulty with friends, or bullying. Another common trigger is lack of sleep. Many teenagers are not getting the full eight hours of sleep they need per night, and that can make it easier for the brain to have a migraine attack. Hormones, caffeine, alcohol, changes in weather, and certain dietary items can all be triggers for some teenagers.
One way to identify triggers is to keep a migraine diary. The teenager should identify the factors around a migraine every time one happenshow much they slept the prior night, if it was a stressful day, what food they ate before the migraine, and so on. Over time, patterns will emerge, such as lack of sleep, different foods, or certain kinds of stress leading to many of the migraine attacks. Some of these triggers can be completely avoided. Certain foods, such as chocolate, caffeine, or alcohol, can be removed from a teenagers diet.