Coping with Migraines and Chronic Headaches in School
| Staff Writers
Symptoms, Diagnosis, Treatment, and Prevention for Children, Teens and Young Adults
It can be upsetting to see your child in pain with migraine but, unfortunately, it’s not that unusual. According to the American Migraine Foundation (AMF), migraine is a common and frequently disabling condition reported in 12 percent of the population, with between four and 10 percent of children experiencing migraine. Symptoms vary, with some specifically affecting children. These symptoms are often painful and difficult to cope with, and they can have an impact on a child’s academic performance. This guide can help students and their parents understand and manage migraine without sacrificing performance in school.
What is a migraine?
When a person has a really bad headache, that person may say “I have a migraine,” but that may not necessarily be the case. Migraine is a complex neurological disorder caused by brain changes, especially to the surface of the brain, including inflammation, dilation of blood vessels and, as a result, an alteration of blood flow.
The Migraine Research Foundation indicates that migraine attacks involve not only severe and even throbbing head pain — which can last anywhere from four to 72 hours — but it may also be accompanied by other symptoms that could cause impairment, such as visual disturbance or nausea. An attack can be frightening and debilitating — in some cases, a person may be unable to do anything but lie still in a dark room and wait for it to pass.
Scientists still don’t know what causes migraine attacks. It’s believed to be a genetic condition — the AMF reports that about 70 percent of children with migraine have immediate family members who have migraine attacks. But the disorder isn’t wholly predetermined by genetics — environmental factors can also play a role. And sufferers of migraine may be stigmatized by people who expect them to push through it and get over it, because it’s “just a headache,” which may add to a person’s suffering, particularly children.
Though there may be subtle warning signs that begin hours or even a day or two before the onset of a migraine attack, it can also happen very quickly and without much warning. While there is no cure for migraine, there are ways to help your child minimize attacks and manage their health to help stave off some attacks before they ever start.
Types of Migraines and Headaches
Though migraine often includes a severe headache, migraine and headache are not the same thing. A variety of headache and migraine types may be typically found in sufferers. The following is a list of the basic types of each and their distinguishing characteristics.
Migraine with Aura A migraine with aura is seen in about one quarter of migraines. Because a migraine involves changes in the nervous system, it’s often accompanied by what’s called an aura, which is usually a visual disturbance but can also be a sensory or motor disturbance. The Mayo Clinic explains a visual aura as being “like an electrical or chemical wave that moves across the visual cortex of your brain.” This means a sufferer may temporarily lose normal visual function and see sickle- or C-shaped objects or zigzag lines. Some people see bright flashes or experience partial loss of vision. In other cases, a sensory aura may include a numb or tingling feeling in one limb, speech or language problems or facial weakness. An aura typically lasts 10 to 30 minutes and usually precedes the migraine attack but may also occur at the same time, and in this type of attack, the symptoms and pain tend to set in more slowly, acting as a warning sign before the pain appears.
Migraine without Aura Known also as the “common migraine,” a migraine without aura is the most frequently seen type of migraine, affecting 70-90 percent of sufferers, according to The Migraine Trust. Migraines with and without aura often are very similar, with attacks lasting from a few hours to several days, light and sound sensitivity, blurred vision, pain that’s usually on one side of the head, nausea, vomiting and stiffness in the neck and shoulders. However, in migraine without aura, the onset is typically faster and patients usually experience more frequent attacks.
Migraine without Head Pain You may be surprised to learn that not all migraine attacks include head pain. In this type, sometimes called a silent migraine, sufferers have all the usual symptoms — such as an aura, constipation or diarrhea, tiredness, stiffness in the neck or shoulders, nausea and sensory disturbances — but without the head pain. The pattern may vary from person to person, but even without the pain, an attack can be distressing and disabling.
Hemiplegic Migraine The AMF says this very rare type of migraine can be frightening, especially to first-time sufferers, because a person will experience weakness on one side of the body (called hemiplegia), along with a migraine headache attack. The weakness is a kind of aura and may be accompanied by other auras such as visual disturbances. Hemiplegic migraines may run in the family or happen to an isolated individual. Diagnosing one can be difficult, since it often resembles a stroke or seizure, so anyone experiencing these symptoms should see a doctor immediately and get a full neurological workup.
Retinal Migraine Also rare, a retinal (sometimes called ocular) migraine is usually accompanied by other migraine symptoms and includes repeated bouts of visual disturbance in just one eye, usually within one hour before the headache pain sets in. The person may see twinkling lights (called scintillations), experience areas of decreased or lost vision or even, in very rare cases, temporary blindness in one eye. Because there are no diagnostic tests to confirm retinal migraine, according to the AMF, sufferers should be assessed by their doctors to be sure of the underlying cause.
Chronic Migraine According to the AMF, frequent migraine may not necessarily be chronic. Chronic migraine involves 15 or more headache days per month — in other words, the sufferer experiences migraine or headache for at least half of every month. Only about one percent of the population suffers from chronic migraine. To receive a diagnosis, sufferers must keep careful track of their migraine experiences in a daily diary and be carefully examined by their doctors.
Tension According to Mark Green, MD, director of the Center for Headache and Pain Medicine and professor of neurology and anesthesiology at the Icahn School of Medicine at Mount Sinai in New York, tension headaches are by far the most common type of headache, and they tend to be mild enough for sufferers to treat them with over the counter pain relievers and continue throughout their days. They’re typically brought on by tension or stress and affect only the head, without any accompanying dizziness, nausea or sensory disturbance.
Sinus Many people complain of sinus headache, which often includes facial pain and pressure, as well as nasal and sinus congestion. Interestingly, the AMF says the vast majority (90 percent) of self-diagnosed sinus headaches are actually migraine attacks. A true sinus headache is rare and usually a secondary symptom of a viral or bacterial sinus infection that is characterized by nasal discharge that is discolored, decreased sense of smell and fever.
Cluster This rare type of headache is said to affect men three times as often as women. It’s said to be the most painful of all headaches and is frequently confused with migraine, although its severe headaches on one side of the head, accompanying stuffy or runny nose, red or teary eyes and sense of restlessness or agitation usually distinguish it from migraine. It tends to recur in a series, or cluster, that may last for weeks or even months. Sufferers describe the pain as being like something boring into the head or like a hot poker in the eye. Severe pain attacks may last anywhere from 15 to 180 minutes, occurring on average twice a day over a period of four to six weeks and then disappearing for up to one year.
What Are the Symptoms of Migraine?
One of the distinguishing factors of migraine is that an attack occurs in distinct phases, each of which can be recognized by its unique set of symptoms. Understanding the phases and accompanying symptoms can help parents and students to manage this disorder. Here are the four phases and the symptoms commonly seen in each.
This phase may be thought of as the pre-headache phase. Most people experience a prodrome, but it may not always happen before every single attack. It may last a few hours or even a few days. This is the phase in which the sufferer can take steps to try to minimize the oncoming attack’s severity, such as taking medication, relaxing or meditating.
Symptoms may include:
Changes in mood
Sensitivity to light and sound (though this is less frequent in children)
Constipation or diarrhea
Muscle stiffness, especially in the neck and shoulders
Cravings for certain foods
Among children, scientific research has found that fatigue, mood change and neck stiffness were the most common prodrome symptoms.
As described in the previous section, about one-fourth of migraine attacks include auras, which typically precede the headache phase by about five minutes to an hour and involve visual or other sensory disturbances. The minority of children’s migraines include auras.
Symptoms may include:
Appearance of geometric patterns, shimmering or twinkling lights or blind spots
Speech or language disturbance
Feelings of numbness in the face or arm
This is the most recognizable stage of migraine, as it’s the most painful and debilitating. It also tends to last the longest. In this phase, adults usually get pain on one side of the head, whereas children characteristically experience pain on both sides. Pain may be described as throbbing, drilling, burning or like an icepick in the head. Sometimes the pain is more severe for some headaches than for others.
In addition to head pain, symptoms of this phase for adults and children include:
Sensitivity to light, sound or smells
Neck pain and stiffness
Sometimes called the “migraine hangover,” the postdrome is the final phase, which is experienced by about 80 percent of migraine sufferers. This phase can be debilitating as well, but it typically doesn’t involve headache pain. In this phase, the person is left feeling weakened, exhausted and overly sensitive to stimuli, so it’s best that students in this phase only engage in relaxing activities and drink plenty of water.
Symptoms may include:
Sensitivity to light, sound or smells
5 Common Migraine Symptoms for Children, Teens and Young Adults
It’s important to note that children may experience migraine symptoms that are different from those of adults.
Pain: Children experience steady pain on both sides of the head, which often wraps around the forehead above the eyes, whereas with adults the pain tends to be more prevalent on one side of the head.
Sleepiness: While migraine may cause insomnia in adults, children are likely to be very sleepy and go right to sleep.
Vomiting and abdominal pain: While both children and adults tend to experience nausea, children are more likely to have vomiting and abdominal pain, or cramping, that centers around the belly button. In fact, many children experience abdominal migraines, without headache. Some children experience cyclical vomiting, in which the episodes are regular and predictable, occurring several weeks apart.
Shorter duration: The duration of the headache stage is typically shorter for children, Green says. For adults, this stage usually lasts four to 72 hours, but for children it’s more like two to 48 hours.
Less frequency: Migraine episodes tend to occur less frequently in children than in adults.
Common Migraine Triggers for Children, Teens, and Young Adults
Though no one knows exactly what causes migraine or brings about an attack, research has uncovered some typical triggers that tend to be associated with attacks. According to Green, these include:
Before the onset of puberty and menstruation in girls, it’s less common to see migraine in girls than boys. Once menstruation begins, this ratio flips, Green says. As girls grow into women, their likelihood of experiencing migraine grows to a ratio of 3:1 over men. And the beginning of a girl’s monthly period can be a trigger for an attack.
Inconsistent eating patterns.
“Humans are meant to be grazers, not to sit down and have big meals,” Green says, explaining that children should eat small meals throughout the day. “Skipping a meal can become a migraine trigger.”
The AMF says that about a third of migraine sufferers cited dehydration as one of their triggers.
Green suggests that some foods such as MSG, artificial sweeteners, nitrites found in processed meats like hot dogs and fermented foods, which may include foods such as yogurt or sauerkraut, can be triggers for some.
“Stress and anxiety can be an important migraine trigger,” Green says, adding that even the relaxation after a period of high stress can be a potent trigger.
Inconsistent sleep pattern.
“Things should be regular in a migraineur,” Green says. Sleeping too little or too long, or not observing a regular sleep schedule, can trigger an attack.
In some cases, patients experience attacks following the use of medications, such as those used for depression or blood pressure.
How to Recognize Migraines in Children and Teens
When it comes to recognizing migraines in children, there are certain characteristics parents can watch for:
Onset How an incident begins can be a clear give away. A migraine in a child will come on very quickly. The head pain is also a distinguishing factor. Nausea and vomiting typically don’t accompany other types of headaches, so this can be a hallmark of migraine. Children in particular are likely to vomit or complain of abdominal pain. “One thing that I’ve always found very helpful in distinguishing a migraine in a child is that children get very tired during a migraine,” Green says. “Most people do, but it will make a child very sleepy, so that should make you very suspicious.” Children, he says, will often go to sleep in the throes of a migraine, and that this usually is the best possible treatment. This is not usually the case in adults, he adds.
Dizziness or vertigo These may also be signals of migraine, and in certain cases of basilar migraine, babies may actually fall over or become unconscious, though this is extremely rare.
Decline in academic performance A child experiencing frequent migraine attacks may have a decline in academic performance and miss school. Social involvement and participation in sports may suffer as well. But Green says that in children, the onset of an attack is often at the end of a school day, which may have been triggered by an inconsistent sleep or eating schedule or stress.
Sudden tiredness “If a kid comes home from school once a month looking kind of pale and maybe is complaining of a stomach ache, maybe is nauseated, wants to go to sleep and then wakes up an hour later looking great, we’re pretty suspicious that’s migraine,” Green says.
If it’s rare for your child to get a headache at all or the symptoms don’t seem to take the shape of those described above, it may not be necessary to visit the doctor. Take careful note of the symptoms, and have your child assessed by a doctor if the headaches are recurring and/or long-lasting. And take the headache seriously, especially in a young child.
“When a child develops an aggressive headache, we worry about them even more than we might in adults because, while serious headaches in children aren’t very common, children have a higher chance of developing brain tumors in the back parts of their brains, or other developmental abnormalities, which can present in headache,” Green says.
Visiting a doctor not only can put your mind at ease by ruling out something more dangerous, but it may provide solutions for minimizing the severity of attacks or preventing future ones.
How to Treat Migraines in Children and Teens
Addressing migraines in children and teens may include a combination of medications and behaviors that can help minimize or stop an attack, or even ward them off before they start. However, consult with your child’s doctor before trying or administering any of the treatments discussed below.
Symptomatic medication Symptomatic medication treats the symptoms associated with the migraine headache or related symptoms such as nausea and vomiting. These are usually available over the counter. According to Green, these may include treatments that aren’t specifically for migraine, such as acetaminophen or ibuprofen. Aspirin may be acceptable only for children age 14 or older and should never be given to children, says Green. “There is a term out there called ‘baby aspirin,’ but this is a very dangerous term, because it makes parents think you can give aspirin to a baby. But if you do that, they run the risk of a terrible disease called Reye’s Syndrome,” warns Green. Some prescription medications, such as Phenergan and Thorazine, may provide a stronger level of symptomatic relief. Consult with your child’s doctor for more information.
Abortive therapy Instead of treating the symptoms, abortive therapies are meant to stop the migraine attack process. If administered right at the onset of an attack, they may minimize or even stop the pain, sensory issues and other associated symptoms. In some cases, patients may need to have a doctor administer the medications intravenously. Unfortunately, as Green points out, pharmaceutical companies rarely do clinical trials on “the extremes of life,” meaning patients under 18 or over 65. As a result, most abortive treatments aren’t approved for use in children and adolescents, with the exception of some in the Triptans class of drugs, which require a prescription. It may be difficult to give a pill to a child, but some Triptans may come in nasal sprays. When it comes to non-medication treatments, Green suggests that caffeine can help; in fact, some migraine medications include caffeine because it can make them more effective.
Preventative therapy Preventative treatments are used to keep migraine attacks from happening. Taken daily, they may reduce the frequency, duration, and severity of migraine attacks. And they are typically an entirely different class of drug than abortive therapies. In other words, giving your child a preventative medication after an attack has begun will do nothing to stop it. The AMF says that amitriptyline or topiramate may be effective preventive treatments for children who experience frequent headaches.
Relaxation Of course, nothing is better at stopping a migraine attack in younger children than sleep, Green says. “Have them lie in a cool, dark room, propped up on a pillow, and try and have them go to sleep and keep it quiet. And if they can do that, it may terminate migraine very successfully.” And because lack of sleep, an irregular schedule and stress can all be triggers of migraine, regular relaxation is an important function of migraine management.
Migraine Management and Prevention
For a child or adolescent, living with migraine can be distressing and frustrating. The best thing parents can do is maintain an open dialogue with their kids — find a common language that helps young children to communicate, keep the focus on their needs and make the process of finding solutions a joint effort.
Use cold packs. During a migraine headache, a cold pack can be very soothing to a child experiencing severe head pain.
Keep a migraine diary. Work with your child to keep careful track of their day-to-day activities, such as diet, level of stress, variances in schedule, sleep patterns, symptoms, etc. This may help you and your child’s doctor to determine triggers and/or the frequency of attacks as well as develop a more effective treatment plan.
Keep to a consistent sleep schedule. Go to sleep and wake up at the same time every day, even on weekends.
Maintain a regular, healthy eating plan. Because migraineurs need regularity, a consistent pattern of eating frequent, small meals throughout the day can help to prevent attacks. And because some processed foods, such as those containing artificial sweeteners or nitrites, may be migraine triggers, children should be kept to a healthy diet that’s full of vegetables, fruits and whole grains. Talk to your doctor for specific diet options to try.
Make sure your child gets exercise. “Regular exercise is good for any kind of pain problem, including migraine,” Green says.
Be sure your child stays hydrated. Because dehydration may be a trigger, encourage your child to drink water throughout the day and, if necessary, talk to your child’s teacher about getting breaks in class to do this. This is even more important in hot weather.
Use caffeine — but don’t overuse it. Green says that although caffeine can be helpful in treating migraine, overuse can lead to a caffeine-withdrawal headache, which can be a trigger for a migraine attack for some. Getting the same amount at the same time each day can help prevent this, and for non-caffeine users, adding caffeine, such as a Coca-Cola, to a symptomatic treatment may help ease symptoms.
Manage stress. Help your child manage stress and find outlets for it, including regular time to relax and unwind. Sports and play can be great stress relievers for kids.
Try therapy. Cognitive behavioral therapy and biofeedback have been shown to relieve symptoms and help prevent attacks by teaching the child to manage their own symptoms. Cognitive behavioral therapy can help a child psychologically reframe the thinking surrounding migraine in order to cope with attacks. And, according to the AMF, biofeedback uses an instrument that monitors a bodily response, such as muscle tension or skin temperature, as the person tries to modify that response. Some of these instruments are designed for children, and the practice of biofeedback can be helpful to a child or teen in learning how to manage symptoms and pain.
Consider non-medical remedies. Aromatherapy, physical therapy, and acupuncture have been shown to be effective in relieving the effects of migraine without side effects. And for nausea, children and teens may try drinking ginger ale, lemon-lime sodas, peppermint and ginger teas, or eating crackers or peppermints, all of which can help to soothe an upset stomach.
Parents should also be aware that migraine is statistically associated with other problems, like depression, Green says. “Be aware that if you have someone with migraine, they may be at higher risk than the rest of the general population of having depression. That may have to be treated in addition.”
And remember that frequent, recurring migraine pain is not normal, even though it may be a common trait in your family. Stay in touch with your child’s doctor, particularly if you or another member of the immediate family is already a migraine sufferer, which may predispose your child to the condition. Your doctor can help address symptoms or patterns, identify triggers and prevent attacks.
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