74% of girls and 52% of boys have headaches at age 17, according to a Finnish study of 6,262 twins. At age 11, 60% of girls and 59% of boys had headaches at least once a month. The prevalence of weekly headaches increase d in girls from 16% to 25% between ages 11 and 14. Headaches in kids is a major problem, but unfortunately it does not receive proper attention. Sometimes parents do not believe that their child has a headache or if they do, they are reluctant to take the child to a doctor because they don’t want to resort to prescription medications. Fortunately, many non-drug approaches are very effective in kids. Regular sleep schedule (very hard to enforce in teenagers), regular meals, frequent aerobic exercise, biofeedback or meditation, and supplements can be very effective. Several studies have shown that kids with headaches are often deficient in magnesium, riboflavin (vitamin B2), and Co-enzyme Q10 (CoQ10). If a child still has headaches, a medications may also be appropriate.
Read MoreGood news for adolescents with chronic daily headaches (CDH) was reported by Taiwanese researchers followed 122 kids, aged 12 to 14 who were diagnosed with this condition. A year later 40% still had CDH, and after 2 years, 25% had symptoms of CDH. They followed 103 of the original 122 for 8 years and found that only 12% still had daily headaches with 10 out of 12 diagnosed as having chronic migraines. This is what we see in practice, but now we have good evidence and can be more certain when we tell our adolescent patients and their parents that they will “grow out” of their headaches. Another piece of good news was that most kids were not actively treated and headaches improved on their own. However, it may take months or years for headaches to improve and we should not just sit and wait while the child suffers. Active treatment includes sleep hygiene, regular exercise, avoiding dietary triggers, biofeedback or relaxation training, magnesium, CoQ10 and other supplements, possibly acupuncture, Botox injections and medications.
Read MoreTreating migraines in adolescents presents some unique challenges. Besides difficulties, such as getting them to bed before midnight and getting them to improve their diets, we face the problem of not having any FDA-approved drugs to treat migraine attacks. And it is not for lack of trying on the part of makers of triptans, which are drugs that work miracles for many adult headache sufferers. The problem has been proving to the FDA that these drugs work in kids. Because children tend to have shorter attacks, by the time we try to assess the efficacy of a particular drug two and four hours after the pill is taken, the headache is gone even if the pill was a placebo. Many studies have shown that the triptans are safe and effective (as was observed in kids who have longer duration of attacks). Many, but far from all headache specialists use triptans, such as Imitrex and Maxalt in adolescents. A study just published in Headache proved that Axert, another drug in the triptan family and that was tested in 866 children, is effective in children 15 to 17 years of age. The bottom line is that triptans can be safely used in kids who suffer from severe migraine headaches. I am often asked by other physicians, what is the youngest age I would prescribe a triptan? Because of a shortage of pediatric neurologists I feel compelled to see children as young as 10 and this is the youngest age at which I will prescribe triptans.
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