Headache is prevalent in children and young people. By the age of 7, at least 50% of all children will have experienced a headache of one sort or another!
A recent British study showed that 20% of children with chronic headaches are associated with poor quality of life, greater than those with diabetes or asthma. However, most children with chronic headaches never get to see a neurologist.
Our brain cells speak to one another with chemicals, such as serotonin, generating electrical signals. Headaches arise as a result of chemical disturbances triggering excitable brain cells and, therefore, malfunctioning brain cells.
What Are the Types of Headaches?
In general, headaches can be divided into Primary or Secondary.
‘Primary headaches” appear to occur on their own, whereas, ‘Secondary headaches occur due to another condition.
There are many types of ‘Primary headaches’ and ‘Secondary headaches’. The following are the common types:
| Primary Headaches | Secondary Headaches |
|---|---|
|
|
What are the Headache RED flags?
If your child’s headaches or symptoms are unusual for him or her, or the symptoms are unexplained or persistent, you should seek medical advice as soon as possible.
These are the RED flags:
| Under 5 years old | 5 - 11 years old | >12 years old |
|---|---|---|
|
Persistent or recurrent vomiting |
Persistent or recurrent headache |
Persistent or recurrent headache |
|
Poor balance or coordination |
Persistent or recurrent vomiting |
Persistent or recurrent vomiting |
|
Abnormal eye movements |
Poor balance or coordination |
Poor balance or coordination |
|
Behavioural change or lethargy |
Abnormal eye movements |
Abnormal eye movements |
|
Seizures |
Double or blurred vision |
Double or blurred vision |
|
Abnormal head posture, stiff neck, or head tilting |
Behavioural change or lethargy |
Behavioural change or lethargy |
|
|
Seizures |
Seizures |
|
|
Abnormal head posture, stiff neck, or head tilting |
Delayed puberty or slow growth |
Any child needing urgent medical attention, should be taken to the nearest emergency department or hospital.
What is Migraine?
The commonest primary headache in children is ‘Migraine without aura’. The warning signs before a migraine attack are called ‘aura’ (such as visual disturbance, strange smells or taste, or unsteadiness).
Children with Migraine without aura are likely to have headaches on both sides of their heads, and the duration of the attacks is usually shorter.
Figure from “Patterns of Cerebral Integration Indicated by the Scotomas of Migraine,” by K. S. Lashley, 1941, Archives of Neurology and Psychiatry, 46(2), pp. 333–334.
What Causes Migraine?
The exact cause of Migraine can vary and may not always be known. However, several factors or triggers can contribute to the development of Migraine:
1. Genetic factors:
Migraines may run in families. A specific migraines called Hemiplegic Migraine is now linked to genetic mutations in CACNA1A, ATP1A2 and SCN1A genes.
2. Triggers
Migraine attacks may be brought on by dietary triggers (such as caffeine, alcohol, cheese, chocolate, and citrus food), and lifestyle factors (such as stress, fatigue, poor sleep, prolonged screen time, and irregular meals).
What Are The Common Co-Occurring Conditions?
Children who suffer from chronic headache disorders or Migraine may experience various co-occurring conditions that can affect their overall health and wellbeing.
Numerous studies have shown that Migraine can have a significant impact on an individual’s quality of life. Migraine can disrupt an individual’s ability to perform daily activities, both physically and emotionally, and also affect their social life. Even during symptom-free periods, quality of life can be negatively affected as people try to restrict daily activities to prevent another migraine attack.
Anxiety is the most common mental health issue that is linked to Migraine. In fact, individuals who suffer from Migraine are twice as likely to experience anxiety disorder compared to depressive disorders. Recent studies showed that the incidence of anxiety in people with Migraine is four times higher than those without Migraine.
How to diagnose Migraine?
Diagnosing Migraine and other headache disorders in children involves a thorough evaluation by a paediatric neurologist, which will include a detailed medical history, physical examination, and neurological evaluation.
During your appointment, Dr Yeo will want to know as much as possible about what had happened to your child during the headache attacks.
It will help Dr Yeo by providing the following information:
- Diary of your child’s headache (onset time, duration, warning symptoms, and description of the headache, triggers, aggravating or relieving factors)
- Any other symptoms that occur during the attack, such as nausea/ vomiting, sensitivity to light, or even seizures.
- Your child’s drawing/ picture depicting his/ her headache attack (if possible)
Depending on your medical history and clinical evaluation, Dr Yeo may suggest the following tests to exclude other causes of headache:
- Magnetic Resonance Imaging (MRI) of the brain: These are detailed pictures of the brain to evaluate the structure of your child’s brain.
- Computed tomography (CT) of the head: This is a special x-ray equipment to assess head injuries, severe headaches, dizziness, and other brain issues.
- Genetic testing may be offered to identify underlying genetic factors.
How do we treat Migraine or other headache disorders?
After the headache diagnosis is confirmed, your paediatric neurologist or Dr Yeo will formulate a personalised treatment plan with you and your child. This process will take into account all aspects of your child’s lifestyle/ circumstances and help you and your child understand his/ her condition.
Considering all aspects, Dr Yeo will guide you and your child in finding the right treatment strategy:
Lifestyle Modification
Understanding the root cause or triggers of your child’s headache is crucial to ensuring its effective management. Understanding the triggers can help you choose the right treatment.
Lifestyle modification can improve Migraine and co-occurring conditions, such as anxiety and stress. These may include good sleep hygiene, regular exercise/ physical activities, appropriate support at school, and identifying and avoiding triggers and psychological stressors.
Pharmacological Modulation
There are two important types of medications:
1. Reliever or Attack Treatment – These are used at the beginning of or during a headache attack. For example, simple analgesia (e.g. paracetamol, ibuprofen), sumatriptan or indomethacin.
2. Preventive Treatment – These are to be taken on a daily basis to prevent headache attacks. For example, propranolol, flunarizine, topiramate, amitriptyline, botulinum toxin therapy, or greater occipital nerve block injections.
Both reliever and preventive medications work by modulating or stabilising the abnormal electrical signals of the brain cells or pain receptors.
Considering all aspects, Dr Yeo will guide you and your child in finding the right medications. Dr Yeo will discuss which medications have been found to work well, or not, for your child’s particular headache disorders, and also the pros and cons of each medication or other treatment options.
Complementary Treatments
Complementary treatments may be used alongside specific headache pharmacological modulation. There is limited evidence to show that most complementary treatments are effective in preventing headaches, but they may certainly improve general wellbeing and other co-occurring conditions.
Topical Remedies
‘White TigerBalm’ and ‘Axe Brand Universal Oil’ contain Peppermint, which has a cooling effect on the skin. Research has shown that it can reduce muscle contraction mediated by pain receptors and also increase blood flow to the scalp. It has been shown to be as effective as Paracetamol in relieving episodic tension-type headaches.
Herbal medicines and Supplements
Herbal medicines contain active ingredients made from plant parts or extracts. Some herbal medicines can have adverse effects or interact with other medications.
‘Magnesium’ plays an important and varied role in our brain and body. Research shows that it may be effective as a preventive treatment for Migraines. Common side effects are upset tummy or diarrhoea.
‘Riboflavin (Vitamin B2)’ is an essential function in the energy metabolism of our body and brain cells. Evidence has shown that it may be effective as a preventive treatment for Migraine. It is generally well tolerated.
‘Co-enzyme Q10’ has an important function in the energy metabolism of our body and brain cells. It may be effective in preventing Migraines and is well tolerated.
‘Feverfew’ is a type of herbal medicine that contains MIG-99, which is an active feverfew extract. This extract has anti-inflammatory and smooth muscle relaxant properties that might be helpful in treating migraines. Several research studies have been conducted on the effectiveness of feverfew in treating migraines, but the optimal dosage has not yet been clearly identified.
Acupuncture
Acupuncture involves the insertion of fine needles at specific locations of the body for therapeutic purposes. There is some evidence to show that acupuncture can help prevent migraine.
Psychological Therapy
Psychological therapy or specific therapy such as biofeedback are also proven to improve headache disorders and co-occurring conditions such as anxiety, stress, mood and sleep disorders.
Mindfulness and Yoga
Mindfulness is a form of meditation which involves paying attention to the present moment, including your thoughts, feeling and surroundings. This helps to improve mental wellbeing.
Yoga is an active form of meditation, focusing on movement and breathing exercises.
If you have any further questions, you can schedule an appointment today with Dr Yeo.
Dr Yeo recommends keeping a headache diary to track the nature of your child’s headaches.
Download the Paediatric & Neurology Clinic’s Headache Diary form by clicking here.
