Children & Migraine
Unfortunately, many children suffer from migraine – it’s often helpful for them to understand that others are suffering too.
CHILDHOOD MIGRAINE
As adults, migraineurs usually develop coping mechanisms to manage their migraines and have the capacity to organize their lives and routines to fit around its occurrence. They can learn to detect possible triggers and search out the most suitable medications. Usually they are given a clear diagnosis from their doctor that they are indeed suffering migraine, which gives a name to their condition.
It is not quite so easy for youngsters who have headaches because they are not in the same position to have control over what happens to them or a full understanding of the ways of dealing with it until they are older.
Whenever migraine is mentioned, the first thought is of severe head pain only. It should be remembered that migraine is a condition where headache is just one of its symptoms.
Migraine can affect children and diagnosis is often difficult because their symptoms can so often be mistaken for something else. In the early childhood years they can experience a form of migraine that might include visual disturbance, nausea and characteristically abdominal pain. There may be no headache and their stomach pains and vomiting can be attributed to other conditions. It is therefore difficult to make an association with migraine initially.
It is believed that a person is born with a predisposition to migraine. It all begins with whatever triggers that flashpoint, the action of the blood vessels to the brain as they initially constrict and then relax in response to some internal chemical stimuli. It is this process that is occurring when a child develops their first symptoms even if they are not experiencing a headache at that time.
When they are very young children may not have the vocabulary to describe just what they are experiencing and parents recognize only that they have a child who is unwell.
Any sudden onset of head pain or lethargy needs to be addressed immediately to rule out serious complaints such as meningitis and medical advice should always be sought. When tests dismiss this as a possibility, but headaches and associated symptoms begin to recur on a regular basis, a pattern may emerge, but it can often take a long time to have a child’s condition identified.
Children may be of an age to ask questions such as “why have I got a headache in my tummy?” or “what are those squiggly worms in front of my eyes?” when they first experience visual disturbance, which gives a clue to the mystery.
Childhood Migraine or Abdominal Migraine as it is often referred to has been recognized and well documented for some time but many people are unaware that the condition exists at all. Some migraineurs on learning about it are often surprised to find that they can identify with earlier experiences when they were young, never previously making the connection with their later migraines as adults. Bilious attacks and fainting spells were possibly the forerunners of their migraine condition. In the past the connection would not have been made and it can be easily understood why other plausible diagnoses were given for these ailments.
Adults can suffer a form of abdominal migraine but it is children who appear to have this as part of their condition from the onset.
Children can also develop the serious forms of adult migraine and become extremely ill requiring hospitalization but this is not so common and luckily most do not encounter severe migraine until the onset of puberty. Boys appear to suffer more in the early years but usually outgrow it as they reach their teens. With girls, migraine can continue, begin across this time or worsen when they start menstruation. Some like those who suffer eczema and asthma as children can find the condition disappears completely. Attacks tend to become less frequent after the age of seven according to some reports. Also it is possible to have isolated attacks of migraine at any age with it occurring once or twice a year or maybe only once or twice in a lifetime.
Parents, relatives or teachers need to be astute, recognizing early symptoms and being very sympathetic to the needs of a child suffering migraine. Like adult migraine there are warning signals that herald an attack. Often the child’s behaviour gives rise to the suspicion that they may be exaggerating or trying to avoid some activity when they display signs of restlessness, becoming irritable or hyperactive. Alternatively they may become pale and listless with the need to withdraw from contact with others. They can be over-sensitive to light, noise or smells.
Early intervention is important to both manage the condition and to reassure the child who can become distressed. Parents or caregivers can often detect in advance when an attack is going to happen because of changes to the child’s appearance and behaviour. Preceding a headache a reported 20-30% of children will experience aura symptoms lasting between 20-60 minutes. These may include flashing lights, zigzag lines or blurring of vision. It is important to start treatment as early as possible. When the onset of symptoms occur it is advisable to remove the child to a quiet darkened area where they won’t be disturbed. They then can be given a mild analgesic like aspirin or paracetamol dissolved in a sweetened drink. This will help to relieve the pain and counteract blood sugar levels that may be low. Sleeping off the pain can then be the best remedy. The application of ice or hot water packs, whichever is preferred and elevating the child’s head is beneficial. If the child is vomiting it is advised to avoid all foods and allow only a little liquid at regular intervals. Children’s migraines can last from 2 to 48 hours.
It is important to ensure that a child is not disadvantaged at school or within their peer group. Co-operation between teachers and other children and their parents can be of immense value to a family coping with the problem of their child’s migraine attacks.
Parents are advised too keep a diary and to record the times their children are unwell and anything significant that has occurred around that time. All possible triggers should be investigated and checks made to establish any pattern that could be contributing to a child’s headaches. This might include activities, unusual pressures or diet. For children it could involve problems at school with other children, teachers or schoolwork. At home there may be family pressures or some imagined worry that is concerning the child. Often they have worries about the condition itself especially if it means missing activities or being seen to cause problems to others.
Food triggers could be contributing in some way and it is not always overeating, junk food or fizzy drinks to blame, often it is the good healthy foods that are at fault. Citrus fruit, nuts, vegemite, milk, cheese and even fish may all be triggers. It should be noted it does not always follow that something the child has consumed prior to a headache is the cause, it is more likely something they have eaten in the 8-24 hour prior to the attack. It is also recognized by the experts that there is a period called the pro-donal stage in which they believe migraine starts to form up to 3 days before a headache appears. This applies to all migraine sufferers
Dehydration and missed meals can be definite triggers and the time period between the consumption of food and liquids is especially important for young children. No more than 4 hours maximum is advised. Other factors that can encourage attacks are similar to adults such as travel, exposure to flickering lights like computers, lack of sleep or oversleeping (especially at weekends) and excessive physical activity.
With careful and thoughtful management by parents children can be guided through the worst aspects of their migraine attacks and as they get older, learn to recognize what they need to do to best help themselves.
Migraine is generally considered an adult complaint by most people and it is not realized just how many children from infancy through to their late teenage years suffer this debilitating condition. Although some adult medications can be given in mild doses for children, many of the migraine medications are contra-indicated for those under the age of 18.
It is important that all migraineurs know about childhood migraine so that they can help to educate others. It does not always follow that families with a history of migraine are necessarily aware that their children could be exhibiting signs of the condition at what to them seems an inappropriate age. Inherited conditions can sometimes jump a generation so it is wise to always keep a careful watch on younger family members for warning signs.
