Migraine headaches are fairly common in children, and pose a greater challenge because of the inability of children to describe the problem properly. Estimates suggest that between 5 to 10 percent of children may suffer from migraines. It is more common in girls, and in boys they are seen more frequently at the age of 10 to 12 years. In teenage girls it is often associated with menstrual cycle.
Migraine is an episodic and recurrent severe headache, pulsating in character, which is often associated with nausea and vomiting. A typical attack of migraine can last from one hour to three days, and can be debilitating enough to interfere with normal daily activities. Sometimes, an attack of migraine is preceded with vision disturbances like blurring, flashing lights, colored spots or even dizziness, symptoms referred to as 'aura' which occur a few minutes before the headache begins.
Migraine is believed to be caused by dilation of blood vessels in the brain because of deficiency of a chemical 'serotonin' which constricts them. This dilation causes the stimulation of nerves that carry the pain sensation, thereby leading to headache and other symptoms. However, recent researches have indicated a more complex causation involving genetic defects that affect different parts of brain. Incidentally, migraine often runs in families, and a history of family members having migraine should alert to the possibility of recurrent headache being migraine.
In children too, migraine produces severe symptoms, but its description may differ from child to child. Some typical descriptions are:
"I feel as if my heart is pounding in my head."
"I feel like being placed inside a big bass drum."
Many children, especially younger ones, are unable to clearly express their experience. Typically they will become very inactive, try to hide themselves alone, not be active at all or just go and lie down and sleep at unlikely hours of the day. The headache of migraine is relieved by sleep, and aggravated by sound and lights. A child having a migraine headache would usually not prefer to watch television.
Migraine headaches recur, and in extreme cases they can recur up to three times in a week. These headaches are precipitated by certain factors like loud sounds, bright lights, unusual exertion, sudden change in environment, lack of sleeping or change in sleeping habits and certain foods. Often it is possible to identify the factor that triggered migraine.
There is a long list of foods that can trigger migraine. These include canned or processed meat, including ham, herring, hot dogs, pepperoni and sausage, aged cheese, caffeine (in excess), chocolate, avocados, beans, brewer's yeast, including fresh yeast coffee cake, donuts and sourdough bread, cultured dairy products, such as buttermilk and sour cream, figs, foods containing monosodium glutamate (MSG), nuts, peanut butter, papaya, pickled, preserved or marinated foods, raisins, red plums, snow peas and soy sauce. However, whether these foods are really a trigger in the child needs to be ascertained by proper investigation of dietary habits and history.
In some children, migraine can also manifest in atypical forms like recurrent stomach pain, vertigo and cyclical vomiting. These cases may be difficult to diagnose unless there is a clear family history of migraine available.
Migraine is another of those diseases which can not be cured, but which can be managed by taking necessary precautions and appropriate treatment. The first step is to understand the precautions required by every patient of migraine, including a child. They should avoid excess of caffeine, ensure regular and adequate sleep for eight to 10 hours, avoid over-stressing and unaccustomed exertion and follow proper meal schedules. If any food has been seen to trigger headache, it should be avoided.
The second step in managing migraine is to educate the child, as well as the parents, about migraine, so that the attacks can be prevented, and when they do occur, they can be recognized at the earliest stage, and the treatment prescribed by the physician for this purpose is taken immediately. Early treatment can reduce the duration of migraine episode and minimize discomfort. Proper rest and avoiding further triggers during an episode also help in controlling it. It is also advisable to keep a diary of all headaches so that the pattern behind its occurrence is available for planning the appropriate treatment and dosage. There are medications available that reduce the frequency of migraine episodes but these may not be required in every child with migraine. In many children prevention and precautions alone bring sufficient relief.
Lastly, it is important to remember that not all headaches are migraine and that sometimes headaches can be a symptom of a more dangerous condition like brain tumor. Hence, all headaches in children need to be properly attended and appropriately investigated before they are labeled as migraine.