Identifying the symptoms of juvenile migraines


By Lorna Collier

My son was only 7 when he came home from school one winter afternoon complaining of an upset stomach. Suddenly, he closed his right eye, clutched his forehead and began screaming in pain. Nothing I did for the next frantic half hour eased his agony. Finally, he vomited. An hour later, he was running around the house as if nothing had happened.

Although I didn't know it at the time, my son had just had his first migraine headache. He continued to have these episodes for the next year, during which time I feared brain cancer and other dreaded diseases. I never suspected migraines because, after all, kids don't get migraines, right?

Wrong. Migraines are relatively common in children, affecting four to ten percent of school-age kids. A migraine is a type of headache that usually is accompanied by severe pain, nausea, vomiting and sensitivity to light and sound. Experts believe that during a migraine attack, a spasm occurs in the arteries at the base of the brain. This spasm, along with a release of serotonin, reduces blood flow to the brain. Arteries in and around the brain then widen to meet the brain's energy and oxygen needs, causing the release of pain-producing chemicals.

It can be tricky to identify migraines in kids. Adults may have attacks that last a day or longer, building slowly in intensity. But kids are more likely to experience abrupt, intense attacks of pain, sometimes lasting less than an hour, says Merle Diamond, M.D., associate director at the Diamond Headache Clinic in Chicago.

Children with migraines also tend to experience stomach pains more often than do adults with migraines. In fact, some children have only stomach pain -- they do not experience head pain at all. Childre are less likely to see the "auras" that adult sufferers report.

"It's a real problem at the grade-school level," says Kenneth Lofland, Ph.D., director of the Headache Program at the Pain & Rehabiliation Clinic in Chicago. "They might go to the school nurse and report their symptoms, but even if the nurse knows about adult migraines, she might not understand it's a juvenile migraine."

Migraines tend to run in families. They can occur in children as young as 3 years old, but boys tend to begin having migraines at age 7 or 8, while girls start a couple of years later, shortly before beginning their periods. After puberty, girls are three to four times more likely than boys to suffer from migraines.

The causes of migraines are not fully understood, but certain common triggers have been identified. Estrogen seems to play a role in triggering migraines in females. Women tend to have migraines during ovultaion and their menstrual cycles, when their estrogen levels are high.

Stress also can set off a migraine attack. Diamond says that children's migraines are often triggered by schedules packed with too many activities. Other common triggers include foods with tyramine or nitrates, such as chocolate, cheese, nuts and hot dogs. Disrupted sleep and eating patterns can bring on migraines, as can overexertion or getting overheated.

If your child has recurring, severe headaches accompanied by nausea, see your pediatrician or family doctor. Before diagnosing juvenile migraines, the doctor will rule out other possible causes for the symptoms, such as a brain tumor or a thyroid disorder. If your child's symptoms are especially severe and persistent, you may be referred to a pediatric neurologist or other specialist for testing and treatment.

Once juvenile migraines are diagnosed, a variety of treatment options are available. The first step is to prevent or minimize attacks by eliminating or avoiding known triggers, says Diamond. The doctor may suggest that you keep a headache diary to track how your child's diet and other circumstances correlate with his headaches. A variety of medications also can help to prevent migraine attacks or stop them once they have begun.

Biofeedback and relaxation therapy have also been shown to be effective for treating children with migraines, says Lofland. These therapies usually require five to eight training sessions and practice at home, and are generally not used for children who are less than 7 years old.

My son is now 10 and we still have not figured out what triggers his migraines, except that they almost always occur late in the afternoon during late winter and early spring. His attacks are infrequent -- three to five a year. We keep a prescription medication (an Imitrex inhaler) at home and at school that usually stops the attacks within five minutes.

If we're lucky, he will outgrow the migraines: up to 60 percent of boys do, say some studies. Most girls with migraines, on the other hand, can expect to continue to suffer from them throughout most of their adult lives.

For more information about migraines, contact the American Council for Headache Education (ACHE), 609/423-0258 (www.achenet.org), or the National Headache Foundation, 800/843-2256 (www.headaches.org).

© Copyright 1999, Lorna Collier (appeared in Chicago Parent magazine, April 1999)


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