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

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