Today, Calvin Kromer of Cary is a normal, active third grader, but his mother recalls a child who suffered such painful headaches he sometimes had to lie down for hours.
"It started early in first grade and it happened more frequently if he wasn't sleeping well or if he had to go from one activity to another without downtime," says his mother, Jeanine Kromer. The headaches typically progressed in intensity until Calvin was sick to his stomach, and then he would sleep for a while, she says.
During a regular pediatrician visit several years ago, Calvin's parents mentioned his symptoms and received a diagnosis of pediatric migraine. Now, thanks to a dose of ibuprofen whenever he feels the beginnings of a migraine, Calvin's life is no longer adversely affected by headaches.
Calvin's story resonates for many families with children battling migraine headaches. According to a Mayo Clinic Women's Health Source 1997 report, it is estimated that eight million children and adolescents suffer from migraine headaches each year, resulting in over one million lost school days.
Yet this childhood malady is often undiagnosed. Pediatric migraines may be treated as typical "under the weather" symptoms, particularly with young children who have difficulty articulating pain. Family members and doctors sometimes consider the headaches "passing phases of childhood or attention-getting behavior," writes Seymour Diamond, MD, author of the book Headache and Your Child: The Complete Guide to Understanding and Treating Migraine and other Headaches in Children and Adolescents (Fireside, 2001). Founder and director of the Diamond Headache Clinic in Chicago, the largest and oldest private headache clinic in the U.S., Diamond is author of over 300 scientific papers and more than 20 books on headache.
Do Kids Have Migraines?
Migraines are sometimes considered extremely rare, but an article in the March 2004 issue of Headache: The Journal of Head and Face Pain states that pediatric migraine occurs in 3 to 5 percent of young children and 18 percent of adolescents.
The exact causes of migraines are unknown, but experts believe they are genetically based. Research has shown that people with a parent who suffers from migraines have a 25 to 50 percent chance of inheriting the condition, while a child with two parents who suffer from migraines has a 70 percent chance of developing migraines.
Alisa Lancaster, a pediatrician at Cornerstone Pediatric and Adolescent Medicine in Cary, and a migraine sufferer herself, attests to the inherited component for migraines. "About 90 percent of children who have migraines will have at least one parent or grandparent with a history of migraine," she says.
Some migraines can be linked to certain triggers such as fatigue, physical stress, emotional stress, school stress, bright lights, weather changes, allergy season and certain foods or food additives. Food triggers can be difficult to identify, but some studies point to monosodium glutamate (MSG), red dyes and caffeine as potential culprits.
"I usually have the children and parents keep a headache diary to help them discover their trigger," says Lancaster. "Some kids will go to a birthday party and pig out on cake and ice cream, and then the next day they will have a migraine. If that happens repeatedly, then they have discovered the trigger."
Lancaster also says some children with "Type A" personalities experience stress that can initiate migraines if they are already predisposed. Kromer echoes those sentiments. A high achiever both academically and athletically, her son seems to be more susceptible to sensory overload than some children. He also requires 10 hours of sleep to function at his best.
What Is Migraine?
A migraine is an intense, pounding headache that may have associated symptoms such as nausea and vomiting. The headache starts around the eyes, the forehead, or at the sides of the head. Bright lights, loud noises and movement may intensify the pain, which can last from a few hours to a few days in serious cases.
A migraine occurs when overactive nerve cells send a message to the blood vessels, causing them to constrict and then expand. This action releases inflammatory substances that cause a painful pulsing headache.
Migraines, unlike other headaches, tend to intensify over several hours. "Sometimes a child will say the headache started in school and then by the time they get off the bus it is worse," says Lancaster. She notes that a headache that begins with severe pain most likely is related to a condition other than migraine.
Common symptoms may include nausea, vomiting, abdominal pain and dizzy spells. Children also may experience loss of appetite, diarrhea, constipation, hot flashes and cold hands and feet.
Older children and adults experience migraine pain typically on only one side of the head. Younger children, however, may experience pain on both sides of the head. Migraines are grouped into two categories: common, which is without an aura, or classic, which is with an aura. Aura symptoms may include blind spots, nausea, numbness, and vomiting, and usually occur 30 to 60 minutes before the acute headache.
Sometimes children will be irritable, fatigued, pale or depressed during the 24 hours prior to a migraine. Children and adults may also experience periods of elation, restlessness and wakefulness prior to a migraine.
Young children can be particularly difficult to diagnose. Lancaster once treated a preschooler who had abdominal migraine. These children initially mention vague complaints like stomach upset, but are actually experiencing a migraine.
"If you dig deep enough, you discover that the child actually has a headache with the abdominal pain. The headache is just not as intense as the abdominal pain. Young patients can be tough because they may not have classic symptoms," Lancaster says.
Prevention and Treatment of Pediatric Migraines
If your child suffers from frequent or severe headaches, a family physician can perform a complete evaluation, which may include patient history and tests such as CAT scans or MRIs to study the central nervous system. These tests produce cross sectional images of the brain that can reveal abnormal areas or problems that regular X-ray would not necessarily detect. You also may request a referral to a pediatric neurologist. Do not rule out the need for eyeglasses.
The best natural remedy for migraines is sleep. Many children experience relief from a few hours of rest. Other children need over-the counter or prescription medications, such as ibuprofen, sumatriptin nasal sprays and amitryptilene, all of which are used for adult migraine and, in reduced doses, for children. Ibuprofen has generally been found to be a more effective treatment for migraine than acetaminophen.
Aspirin should never be used to treat headaches in children under age 15 to reduce the risk of Reye's syndrome, a rare disorder children may contract when given aspirin while recovering from infections like chicken pox or flu.
In boys, migraine frequency may decrease with age. Adolescent girls, however, are three times more likely than boys, to experience migraine, because of hormone changes. Some adolescent girls with resistant headaches benefit from a low-dose birth control pill.
Parents should consider the possibility of migraine when a normal active child begins missing daily activities due to recurrent headaches or bouts of severe nausea.
The Kromer family knows all too well the severe, and often avoidable, impact of pediatric migraines. "I was just so grateful that he could be helped," says Kromer. "We were so worried at one point because we didn't know what it was."
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