Journal entry by Neurokids doc —
What parents need to know about different types of headaches in children…
An informative article by Dr. Aman PS Sohal
prevalence of a headache ranges from 20% in children younger than five
years, 37 to 51% in seven-year-old children, gradually increasing to 57 -82%
by 15 years of age. A headache may result in significant disability, including
missed school days and extracurricular activities, suboptimal participation in
regular activities, and loss of productivity.
What are the different causes of Headaches in Children?
There are various types of childhood headaches but the common ones which
are encountered in Pediatric Neurology Clinic are discussed below.
1. MIGRAINE:
Migraine headache is defined as multiple attacks, at least 4-5, of intense
unilateral (usually one-sided) headaches with a throbbing sensation.
These headaches, especially in younger patients, can be accompanied by
nausea, vomiting, insensitivity to bright lights and sound lasting from 1-72
hours.
Children may have associated “Aura” which includes visual symptoms e.g:
seeing zig-zag lines and patterns, rainbow colours, blurred vision, smell, or
speech changes etc. Younger patients may also have periodic variants such
as abdominal migraines (associated with tummy pains), cyclical vomiting,
vertigo and dizziness.
Why does my child have Migraine?
Migraines seem to be due to a combination of genetic susceptibility (60%-
70%) and environmental factors. Therefore a family history of a migraine is
important for your doctor. There are also a couple of theories: the vasogenic
theory and the neurovascular theory, with later being more “scientific”.
How can I treat Migraine?
It is very important that the parents seek the advice of a doctor who
experienced in managing headache in children who will carry out a proper
history taking and simple bedside tests, which include fundoscopy (checking
“back of the eyes”) before making a diagnosis of Migraine. Neuroimaging e.g.
CT or MRI Brain is not needed once a convincing history and normal
neurological examination are established.
The author recommends the 2-prong approach to manage a migraine which
includes lifestyle modification and medical management.
Recognition of certain trigger factors causing migraine and learning to avoid
these triggers e.g caffeine-containing food products is the key.
Apart from this, adequate hydration, a regular sleep schedule, stress
management, and regular exercise are very helpful remedies.
These lifestyle changes are under-rated but are extremely effective and
enough to stop the attacks at times. A headache diary is extremely important
to establish the frequency, intensity etc. of a migraine before embarking on
starting medications.
Once an attack starts, sooner the abortive medication is given, the more
effective it will be to decrease the intensity of the attack.
If a child is having to use abortive medications regularly or has two or more
Migraine attack per week, then prophylactic medication is recommended.
These medications are taken on a daily basis for a few months, following
which your doctor will slowly taper them off before completely stopping them.
2. TENSION HEADACHE
Tension headache can occur up to 15% of young people and are usually less
painful than migraines. These headaches have a “band-like” quality, are
shorter in duration, bilateral, usually in the temples. They are typically worse in
the afternoon and evening with a muscular component, especially in the neck
and upper back.
The treatment of tension headaches is usually conservative with an aim to
decrease the stress-related event giving rise to headaches. The author usually
treats these with simple over the counter medications like paracetamol and
Ibuprofen with an advice not to overuse these medications to avoid
“medication overuse headaches”.
3. CLUSTER HEADACHE
Cluster headaches are rare in children but are quite distinctive. Children with
cluster headaches have multiple severe headaches over a period of several
weeks or months, followed by relatively long headache-free intervals.
The pain is usually unilateral, frontal and watering of the eye on the side of
headache are common. The pain is so severe that children cannot lie still,
bang their head with their fists, or rock back and forth. The attack must be
recognised early and treated.
4. CHRONIC DAILY HEADACHE
The term chronic daily headache does not define any particular type of
headache, but children usually complain of “dull ache” to high-intensity pain on
a daily basis. The cause may include overuse of analgesic medications,
depression, poorly treated migraines or tension headaches. More often than
not there are underlying psychological issues which may aggravate the
headaches.
In Author’s opinion, these are by far the most difficult group to manage,
therefore a multi-disciplinary approach is important in the management.
It is important to discontinue overuse of analgesics and stick to various
lifestyle modifications mentioned above. Various medications have been used
with beneficial effects.
It is important to involve a Child Psychologist to unpick any underlying
psychological factor causing aggravation.
They would suggest various Relaxation techniques which increase both
physical and psychological well-being to counteract pain states. They may
also carry out Cognitive Behaviour Therapy helping the sense of control over
pain, reducing the fear of pain, enhancing function, increasing feelings of
hopefulness and resourcefulness, and improving mood.
In Summary, headaches in children are under-diagnosed entities which need
careful monitoring and treatment to avoid long-term morbidity and improving
the child’s psycho-social well being. A multidisciplinary approach including
Pediatric Neurologist, Paediatrician and Child Psychologist should be
undertaken wherever possible.
Dr. Aman PS Sohal is a U.K trained Consultant Pediatric Neurologist with dual
training in Pediatric Neurology and Neuro-physiology. He moved to the U.A.E
in 2015 after working at Birmingham Children’s Hospital UK for a few years.
He is Co-founder and Clinical Director of Neuropedia Children’s Neuroscience
Center, Dubai where he is currently based.
Courtesy: Asian Lite Media
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