Kids and Migraines
By Jeanie Lerche Davis
Nov. 12, 2001 -- One day, Tyler Upchurch was just a regular kid growing up in Muskogee, Okla. The next day, things were very different.
"He woke up and said he had a really bad headache," recalls his dad, Bill. "It just came on all of sudden."
That headache lasted every single day -- every hour -- for six months.
"It was pretty scary," Tyler tells WebMD.
"You don't know what to think," says Bill. "All these possibilities run through your mind ... brain tumor, you just don't know what. It worried us to death."
They tried the family physician, the hospital emergency room, a neurologist, then a child neurologist referred Tyler to Diamond Headache Clinic in Chicago, where the boy finally got the treatment he needed.
Tyler, his parents were told, was suffering from a rare form of migraine headache.
A Migraine Pioneer
Kids, of course, will try practically anything to get out of school -- the mysterious stomachaches, etc. Even Tyler's emergency room physician didn't take the boy's headaches seriously.
And that's the way it is for many children battling migraines. Their families -- even their doctors -- "ignore the headaches as passing phases of childhood or attention-getting behavior," writes Seymour Diamond, MD, author of the newly released book Headache and Your Child.
He's considered a legend in migraine treatment. Founder and director of the Diamond Headache Clinic in Chicago -- the largest and oldest private headache clinic in the U.S. -- he is author of over 300 scientific papers and more than 20 books on headache.
Diamond has been studying migraines for more than 30 years -- and not just professionally: His two daughters developed migraines when they hit puberty; his mother-in-law also "had headaches all the time," says daughter Merle, now a neurologist and associate director of the Diamond Headache Clinic. "We were a headachy family," she says.
Back then -- in the 1960s and '70s -- migraine sufferers didn't get any respect from doctors, she says.
"Migraine was not a valid neurological complaint," she says. Even in medical school, she remembers a neurologist saying, 'Your dad takes care of crazy people.' "
"My dad has done more to open doors for migraine patients -- for all patients with headaches -- in getting proper diagnosis and treatment," she says. "He took criticism for quite a few years. He went out on a limb, said this is something real, and patients need to be respected."
The problem was, "we didn't have effective treatments," she says. "When doctors don't have effective treatments, they make it the patient's fault. They say quit your job -- you'll be OK if you have less stress in your life -- instead of recognizing it as a genetic disorder that creates disability."
Truth is, migraine is a hereditary disease; if one parent has migraines, the children each have a 50% chance having them. And if both parents suffer, a child has 75% likelihood. While gene therapy has not been developed for migraine, there are some "marvelous migraine medications," Diamond tells WebMD.
Does Your Child Have Migraines?
Toddlers -- even babies - can develop migraines.
"Parents look back, they realize there were symptoms," Diamond says. "But it's not until a child learns to talk -- at age 3 or 4 -- that they can express that their head hurts."
Chronic headaches restrict an adult's lifestyle -- socializing, working, eating, sleeping, sex -- causing anxiety and depression. But in children, chronic pain has more far-reaching effects on personality and skill development, he says.
"Kids don't understand what is going on, they don't know what to tell people about it," Diamond tells WebMD. "Migraine can cause depression, withdrawal, psychological problems in children."
Since headaches can develop into a chronic problem, they should be attacked medically early in life, he says. Your child may not have to take medication. "Things can be done with and without medicine," says Diamond.
Head pain in children under age 10 is likely migraine or an organic disease -- like a brain tumor, he says.
"Nobody should slight or minimize the symptoms of a child under 10 years old who complains of headache," he says, adding one caveat: "If someone in the family complains of headaches all the time, the child is probably mimicking them."
Parents must look for behavioral clues. "The child may be playing, then all of a sudden stop playing, bring his arms up to his head," he says. There may be dizziness, nausea, vomiting, carsickness.
In fact, he says, kids who suffer from carsickness -- even without headaches -- will likely develop migraines later in life.
As with Tyler, "a migraine can be severe enough that kids miss school because of it," says Diamond, and it can disrupt their daily lives, their relationships with friends.
"They invite another kid over to play, then all of a sudden say 'I can't do it today,'" he says. "They hibernate. They go to sleep."
"Food is often the trigger for a child's migraine," says Diamond, "especially cheese, peanut butter, and hot dogs."
Migraines in young children typically start at the end of the school day, he says. In adolescents, they occur at lunch time. Older adolescents -- ages 15, 16, 17 -- generally awaken with their migraine headaches.
After age 10, a child's head pain may be a tension headache rather than migraine, says Diamond.
"Children build up anxieties, tensions, frustrations easily after age 10," he says. "There are peer pressures, other factors that could cause stress. Younger children just don't have those tensions in their lives."
Until puberty, boys are more likely than girls to have migraines; when the monthly hormone shifts hit young girls, they begin having more migraines, says Diamond.
Treatments That Work
Automatic reaction for a child's headache pain: Reach for the Tylenol, Advil, ibuprofen. But parents should pay attention to how much their kids are taking, says Diamond. Too many over-the-counter headache medicines can create what's known as "rebound headaches" -- a daily headache pattern caused by caffeine in the medication.
Whether the headaches are migraines or tension headaches, rebound headaches make the problem worse, he says.
"If a child is taking them more than twice a week, they are in danger of developing rebound headaches," Diamond says.
In fact, a recent study in the Journal of Child Neurology found that of 26 adolescents -- all with chronic headaches -- 16 were taking pain medication daily. But two months after stopping all pain medication, the children reported suffering headaches for fewer than three days a month.
"We have marvelous migraine medications now," says Diamond.
They are the same migraine drugs given to adults: "reversal" drugs that stop the migraine's onset, preventive drugs, and drugs that provide pain relief after migraine is in full force, he says. "We may lessen the dose, depending on the size of the child. None of these are dangerous drugs."
Studies -- including several at The Cleveland Clinic -- are looking at the effects of these medications on children.
One study of more than 500 children ages 12 to 17 found that drugs that abort the migraine -- called triptans -- are "effective and safe" in treating migraine in children, says A. David Rothner, MD, director of the pediatric and adolescent headache clinic at The Cleveland Clinic. A follow-up study conducted one year later again showed similar results.
For kids who have mild, infrequent migraines, doctors often will combine ibuprofen and acetaminophen, Rothner tells WebMD. Others will treat symptoms like nausea and vomiting with various medications, including a drug called Zofran used by chemotherapy patients. Because sleep triggers serotonin release, it seems to be the body's natural coping mechanism, he says. Sedatives like Benadryl are sometimes prescribed to promote sleep.
But medications aren't the only answer. Biofeedback worked for Tyler.
A form of self-hypnosis, biofeedback helps a child control -- as amazing as it may sound -- the blood flow in his body. It's a strategy that helps about 75% of the time, says Diamond.
Tyler learned biofeedback pretty quick, he says. To do it, he closes his eyes and focuses on relaxing those parts of his body that become tense during migraine attacks. He listened to classical music while learning biofeedback. Now, he says he can just think about that music while he tries to relax.
"Biofeedback is not the answer for all, but it's a wonderful adjunct and helps a great number of kids," says Diamond. "It can work instead of medicine, but some children need both."
If you think your child might have migraines, go first to your pediatrician or family physician, he advises.
"But it should be somebody who takes a thorough headache history, who wants a calendar of when headaches occur," he says. His book includes a list of about 30 questions the doctor should be asking.
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