| Headaches in Children |
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By: Alexander Mauskop, M.D., Director , New York Headache Center The problem of headaches in children has been neglected by both parents and pediatricians alike. While they may not be as prevalent as in adults, headaches in children are quite frequent and deserve more attention than they have received. Many adult migraine sufferers report having attacks for as long as they can remember , and children even as young as 2 years of age have been known to suffer from headaches. The distribution of headaches between girls and boys is even until puberty when girls begin to have more headaches than boys. Among the reasons for a parent's inattention to a child's headache is reluctance to accept the child's complaint as real or severe enough to warrant a visit to the doctor. Even if parents themselves suffer from headaches they are still doubtful, thinking that the child may be mimicking the parent's complaint to get attention, or to avoid school or a household chore. Occasionally parents think that diagnosis of migraine will stigmatize their child and will interfere with a future career. Unfortunately, very often no medical attention is sought for a child with headaches. The active treatment of headaches in childhood is very important since it has been reported that chronic severe migraine headaches can sometimes cause permanent disabilities. Diagnosis Once the child is brought to a physician, he or she will usually make sure that no other serious condition is the cause of the headaches. Post-concussion, tension and migraine headaches are by far the most common types in children as well as adults. Headaches during upper respiratory viral infections and other childhood diseases usually stop when the illness is over. Meningitis is a very serious condition which always should be suspected in a child with a new onset of headaches and associated fever, neck stiffness and sometimes lethargy or confusion. Like adults, brain tumors and bleeding into the brain are not common causes of headaches. Seizures in children can occasionally manifest themselves only by headaches. Such presentation is even more unusual in adults. Emotional distress and overexertion are the two most common migraine precipitating factors in children. However, studies indicate that neither children nor adults with migraines are under more stress than people without migraines. Certain foods are well known to precipitate migraine at any age. Treatment The treatment of childhood headaches is very similar to that of adults. Dietary changes that are suggested to the parents are often difficult to implement in children. These include avoidance of hot dogs, pizza, chocolate and other tyramine containing foods. Many medications used to treat headaches in adults have not been tested for safety in children. Abortive treatment with ergot preparations such as ergotamine and preventive therapy with beta blockers such as propranolol (Inderal) have been successfully used in children. Acupuncture is an effective alternative to treatment with medication. The treatment of choice, however, is biofeedback with or without other types of relaxation training. Long-term results of biofeedback treatment both in children and adults are very impressive- up to 80-90% of patients are still improved 5 years after the treatment. Most physicians, myself included, become very suspicious and doubtful when any therapy claims such a high success rate. Only after experiencing such excellent results were we convinced of the high effectiveness of biofeedback. Children learn biofeedback technique very quickly. Many will stop having headaches after only 2 or 3 sessions. Children as young as 3 years of age can be trained to control their headaches using temperature feedback. Each session is 30-60 minutes long and the frequency of the treatment is 1-2 per week. The average number of sessions is 6-10 for adults and fewer for children. The treatment consists of learning, among other things, to increase the temperature of the body by watching it being constantly displayed on a computer screen. Relaxation training is part of the treatment process which must be done under the supervision of experienced staff. In summary, headache in children is a serious but often underrated condition that may respond dramatically to biofeedback therapy. |
