Friday, June 12, 2015


Headaches are very common in children and adolescents. In one study, 56% of boys and 74% of girls between the ages of 12 and 17 reported having had a headache within the past month. By age 15, 5% of all children and adolescents have had migraines and 15% have had tension headaches. Does your child tend to head off to a quiet, dark room when there is too much going on? It could be migraines.
While headaches are more common in children once they reach 9 or 10, some children as young as 2-3 can articulate that their head hurts.

Migraines, tension and cluster are called primary headaches because they are neurological disorders not caused by an underlying medical condition. There is no specific medical test for migraines, so diagnosis is usually based on symptoms. Some of the classic symptoms include:

*A moderate to severe throbbing pain for 24-72 hours. Often this is on one side of the head. (for those of you who enjoy knowing its etymology,  the word migraine comes from the Greek hemicranios, meaning half a head.)
*nausea (they may or may not actually vomit)
*Sensitivity to light, noise or odor

Roughly 15-20% of migraine sufferers experience visual disturbances about 15 minutes before the headache sets in. This is known as an aura.

The drawing up at the bottom was drawn by one of my favorite people, Rachel, when she was seven years old  in an attempt to describe to her doctor what an aura felt like.

Migraines don't always manifest as headaches. Some children also have abdominal migraines. If your child is having frequent tummy aches and or complaints about nausea, ask them if they have any visual symptoms.

Migraines have a big genetic component. There is often a strong family history. A pediatric neurologist at UCSF says, "If you're having trouble finding the family history, the paternal grandmother is often the link.  Because migraine genes are expressed more often in women than in men, dad might pass on the genes to a child without knowing it."
There are also current studies to see if there is a connection between colic in a baby and migraines later on.  

Secondary headaches result from another medical condition. These conditions can range from a relatively harmless illness like sinusitis or the flu to more serious conditions. Strep throat is often accompanied by a headache. Simple cold/allergies are also common culprits. As miserable as these headaches are, most parents and practitioners are less concerned if there is an obvious cause like a virus.

Mystery headaches are somewhat more alarming. A red flag that you should contact a doctor about a headache would be one:

*    that wakes the patient out of a deep sleep
*    appears suddenly and is more severe and different from past headaches
*    comes along with weakness or numbness or tingling
*    makes it difficult to think or remember things
*    follows  a recent head injury (within 2 weeks)

Headaches that are associated with vomiting are also worth checking out (if the entire family has the flu and is having similar symptoms, I am much less concerned.)

If there is a headache that is coming more than once a week or with any kind of frequency that has you alarmed,  it is worth getting checked out. It is always worth starting with  your primary doctor, but they may want to do a referral to a headache specialist.

The first step is for the  neurologist to make sure that there isn't something serious going on. Once the scary stuff has been ruled out, they can be an essential part of your team helping to manage chronic headaches moving forward. Headache specialists can help you identify the triggers and explore many non-medical options. The folks at UCSF are on the cutting edge of managing migraines. They are exploring things like CoQ10 and Riboflavin rather than jumping to medication options (you need to see them to discuss dosages.) In fact they are currently looking for teens for a study seeing if melatonin might play an important role in treatment. If you have a teen 12-17 who might be interested in taking part in this check out this link:

The patient will need to only go in for one visit. The rest of the data will be gathered remotely. The participants will also be given a Fitbit that they get to keep!

If your child is having headaches, start keeping a journal to see if you can identify the causes. The information that will be most useful to the doctor is the frequency of the headaches and the tracking of the treatment. What did you try? Did it help?

As you think of other things to add to the journal look at this list of some common triggers and see if any obvious one come to mind:

*Irregular sleep habits
*Skipping breakfast
*Not getting regular exercise
*Change in weather
*Foods with additives/nitrates
*Red wine (hey this info is for you grown ups too)
*Hormone fluctuations
*Recent stress
*Lighting changes e.g., bright fluorescent
*screaming baby? 

My daughter Lauren had very frequent headaches. Our cousin Avi lovingly nagged and nagged her to see if a gluten free diet would help. He was relentless. She finally gave in and agreed to give it a shot. To her delight (and horror) it made a huge difference. She has been gluten free (and headache free) for years. When she gets an accidental exposure to gluten the headaches come roaring back. There is no ignoring the connection.

I get migraines when I drink a certain type of red wines. A glass of Syrah will trigger a headache that knocks me flat. Every step ricochets from my feet up through my head. Not fun. My learning curve on this was almost comical. I couldn't imagine that I was really reacting to only one type of wine and it took about 3 or 4 miserable experiences until I stopped all experiments and simply don't drink any Syrah.

If you or your child are suffering from headaches be a sleuth!

There was a recent study that showed in some cases regular exercise was just as effective as medication in preventing and reducing headaches.  

Some people have also had success with alternative therapies such as gentle chiropractics and or acupuncture.  

I will close with some last words of wisdom from the wonderful Dr Gelfand

*    Get regular sleep
*    Stay well hydrated with non caffeinated beverages
*    DON'T skip breakfast
*    Get regular exercise.
*    Chocolate is innocent!! It is no longer on the list of frequent triggers,  

I was very fortunate that Dr Amy Gelfand allowed me to "pick her brain" so to speak about this important topic. Dr. Gelfand is a child neurologist at the UCSF Headache Center. She specializes in diagnosing and treating children who suffer from a variety of headache disorders, as well as children with childhood periodic syndromes such as abdominal migraine that are felt to be precursors to migraine headache later in life.

September 2015 check out this blog from Dr Gelfand

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