MIGRAINE IN CHILDREN

MIGRAINE IN CHILDREN

What is migraine?

Migraine refers to a condition where the sufferer gets repeated headaches.

What are the other symptoms of migraine?

People may have nausea or vomiting associated with headaches. They also do not like noise or light during the headache episodes. Some children with migraine may not have headache and they may present with only repeated abdominal pain. 

Do children suffer from migraine?

Yes, children do suffer from migraine. 10-25% of children may suffer from migraines. Before puberty, migraine is more common in boys. After puberty, it becomes more common in girls.

What is the earliest age when migraine can affect children?

Migraine has been reported in children as early as 18 months old. About half of the children with migraine have their first attack before the age of 12 years.

What is the cause of migraine in children?

In most cases, there is a combination of genetic and environmental factors. Children with one parent with migraine has 50% chance of getting it, whereas children whose both parents have migraine have 75% chance of getting migraine. Most children with migraine have at least one close family member suffering from it.

How does migraine affect children’s quality of life?

Migraine in children can be as disabling as in adults. Children with migraine miss school twice as often as compared to those without migraine. They also suffer from anxiety, depression, and mood swings, and may not be able to focus in studies. They may also not enjoy sports and other recreational activities.

How is the diagnosis of migraine confirmed in children?

In most cases, the patient’s history and clinical examination are enough to make a diagnosis of migraine. However, in some cases, a brain scan may be needed to exclude other causes.

How is migraine treated in children?

Migraine can be effectively treated in children with medications.

For acute severe headaches, helpful medicines include paracetamol, ibuprofen and triptans (such as sumatriptan, zolmitriptan and rizatriptan).

To prevent headache episodes in future (migraine prophylaxis), propranolol, Flunarizine, topiramate or valproic acid may be used.

What measures can the children take to reduce the headache episodes?

1. Sleep adequately,

2. Eat food on time,

3. Avoid stress,

4. Certain triggers such as cakes, chocolates, Chinese food, too much TV/phone use, can be avoided/reduced. 

DR SUDHIR KUMAR MD DM

Senior Consultant Neurologist

Apollo Hospitals, Hyderabad

04023607777

drsudhirkumar@yahoo.com

https://www.facebook.com/bestneurologist

FREQUENTLY ASKED QUESTIONS ABOUT HEADACHE

FREQUENTLY ASKED QUESTIONS ABOUT HEADACHES

Headache is a common disorder. A large number of people suffer from headaches. Migraine and tension headaches are the commonest causes of headaches. They are not life-threatening, however, they cause significant disability, as pain impairs the quality of life. In some cases, headaches can be caused by serious causes, such as brain tumor, brain hemorrhage, brain fever, etc. 

The current interview focuses on the common causes of headache. How should we diagnose migraine? It can be diagnosed based on symptoms in most cases. When should one consult a doctor for headache? When should one do a brain scan? How do we treat headaches? To get answers to these and other questions, please watch this interview. The link of the youtube video with the interview is:

https://youtu.be/VgBvamY5kS0

Feel free to post your comments or ask any queries.


Dr Sudhir Kumar MD DM (Neurology)
Senior Consultant Neurologist,
Apollo Hospitals, Hyderabad
04023607777
drsudhirkumar@yahoo.com
https://www.facebook.com/bestneurologist/

SUMMER HEAT AND NEUROLOGICAL PROBLEMS

SUMMER HEAT AND NEUROLOGICAL PROBLEMS

Summer is here and temperatures are starting to rise. Summer has its share of fun, with lots of delicious mangoes and frequent trips to ice cream joints. However, it also brings with it, its share of problems. Here, I would discuss the neurological problems that may get worse with summer heat.

1. Migraine- Migraine is a condition characterized by frequent episodes of headaches, associated with nausea or vomiting. Headaches in migraine patients are triggered or exacerbated with a number of factors, heat being one of them. It is common to have severe headache with every outing in the scorching sun. So, it is better to avoid going out during the hottest parts of day- 12 noon to 3 pm. Also, one can use umbrella to avoid direct sunlight.

2. Multiple sclerosis (MS)- MS is a disease that affects central nervous system (brain, spinal cord and optic nerves). In this disease, there is damage to the myelin sheath, the covering of the nerves. The symptoms in MS patients get worse with increased heat, as after exposure to summer heat, hot water baths, strenuous exercises, etc. The symptoms noted are blurred vision, fatigue, weakness and cognitive dysfunction. So, patients with MS should avoid heat exposure.

3. Heat stroke- Heat stroke occurs if body temperature rises to abnormally high levels on exposure to heat for prolonged duration. Generally, our body tries to regulate temperature with sweating, increased thirst, etc when exposed to heat. However, these mechanisms may fail when exposed to high temperatures for prolonged periods. Symptoms of heat stroke include high temperature, headache, nausea, weakness, muscle cramps, confusion, and in severe cases, unconsciousness and coma may also occur.

4. Brain stroke- Exposure to heat can lead to dehydration, thereby, increasing the chances of a brain stroke. Brain stroke may lead to paralysis due to blockage of blood supply to a part of brain.

5. Epilepsy- Heat can be a trigger for seizures. Some people experience an increase in seizure frequency during summer months. In children below the age of six, febrile seizures are common, where they get seizures during an episode of high fever. Also in adults, high fever can trigger an episode of seizure. There is a special type of epilepsy, where the person gets a seizure after taking hot water bath; this type of epilepsy is referred to as “hot water epilepsy”.  The increase in seizure frequency may be due to loss of anti-epileptic medications through too much sweating or perspiration in hot weather.

Strategies to beat the summer heat:

• Stay indoors as much as possible, especially during the hotter parts of day,
• Use umbrella to avoid direct sunlight exposure,
• Stand in shade,
• Use AC or fan, when indoors,
• Drink plenty of water and juices to keep yourself well hydrated.

DR.  SUDHIR KUMAR MD (Medicine) DM (Neurology)

Senior Consultant Neurologist,

Apollo Hospitals, Hyderabad, India.

Email: drsudhirkumar@yahoo.com

Appointments: 0091-40-23607777/60601066

MANAGEMENT OF MIGRAINE HEADACHES

Management of Migraine Headaches

There are two steps involved in ensuring the best outcomes for a patient with migraine:

1. Correct diagnosis, and 
2. Correct treatment.

Diagnosis of Migraine Headaches

Migraine is a common condition, affecting about 15% of women and 5% of men. Often, no tests are required for diagnosing migraine. Despite this, there is a significant delay in diagnosis of migraine in many cases. The correct diagnosis depends on the clinical features. Therefore, a good history, as given by the patient, is often sufficient for the diagnosis of migraine. The details can be read on my earlier post in May 2011

http://bestneurodoctor.blogspot.in/2011/05/how-to-diagnose-migraine.html

Treatment of Migraine Headaches

Starting appropriate treatment is equally important.

Many patients come to me telling that there is no treatment available for migraine or it can not be cured or I have to suffer with these headaches whole life and so on. So, they never take any treatment. Obviously, it is totally incorrect. There are excellent treatments available for treating migraine, and more than 95% of patients get better with proper treatment. You can read about these treatments later on in this post.

There is another group of patients who take only pain-killers, as and when they get headaches. This approach is not correct and may be harmful too, on account of three reasons:

1. Taking a pain-killer may help in reducing one episode of headache, however, it does not prevent the recurrence of headaches in future.
2. Pain-killers may cause side effects such as gastric ulcers, acidity, liver damage and kidney damage, if used for long.
3. Taking more than 15 tablets of pain-killers per month may actually worsen the headaches, a condition called as analgesic-abuse or analgesic-overuse headaches.

On account of the above, it is advised to restrict the use of pain-killers to as low as as possible.

Medical treatment of Migraine

1. If a person has only one or two episodes of headaches per month, then, there is no need of any preventive medications. Use of analgesics may be justified in these cases, as and when they get headaches. Common drugs in this category include-

• Paracetamol,
• Disprin,
• Zandu balm or tiger balm (very popular in India)
• Ibuprofen,
• Diclofenac,
• Vasograin,
• Rizatriptan,
• Sumatriptan

Any of the above can be used at the time of severe headaches. Some people also have vomiting, then ondansetron or domperidone tablets may be used.

2. Preventive therapy of migraine-

If a patient gets more than two episodes of headaches per month, then, it is important to start preventive medications (on daily basis) so that the headache frequency and severity can be minimised (or stopped).
Common drugs in this category include:

• Flunarizine
• Beta blockers such as propranolol,
• Topiramate,
• Divalproex sodium

In some cases, a combination of two medicines may be required.

Patients, who do not show adequate improvement with above, can be treated with botox injections. More details on this can be read in my previous post (October 2012)

http://bestneurodoctor.blogspot.in/2012/10/botox-treatment-for-migraine.html

I hope this article provides a little help to those with migraine. If you have any further queries, please mail me.

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad
Phone: 0091-40-23607777/60601066
email: drsudhirkumar@yahoo.com

How to diagnose migraine?

How is MIGRAINE DIAGNOSED?

Introduction

Migraine is the commonest cause of headache in the world, affecting about 15% of all women and 5% of all men. It affects younger people, affecting their education or employment. It is important to make an early and accurate diagnosis of migraine so that the best treatment can be started early.

Diagnosis of migraine is based on clinical signs and symptoms and usually no investigations are necessary.

Following features are suggestive of a migraine:

1. Headache- classically on one side of the head, but it may occur on both sides, it is described as pulsatile or throbbing type. Headache episodes last for more than 4 hours, and upto 72 hours.
2. Nausea (a feeling of vomiting) or vomiting
3. Photophobia or phonophobia- headache gets worse on exposure to bright light or noise.

Following features may not be suggestive of migraine and in these cases, one should consult a neurologist (a brain scan may be necessary):

1. Most severe headache of the lifetime,
2. Early morning headaches,
3. Drowsiness along with headache,
4. Weakness of one side of body,
5. Occurrence of fits or convulsions.

If you notice any of the above symptoms, please contact your neurologist or family doctor.

Dr Sudhir Kumar MD (Internal Medicine) DM (Neurology)
Senior Consultant Neurologist
Apollo Hospitals, Hyderabad, India
Phone: 0091-40-23607777/60601066
Email: drsudhirkumar@yahoo.com