Newsletters

Healthy Child Spring/Summer 2004

Headaches During Childhood and Throughout Life

by MARILYN A. KUBICHEK, M.D., F.A.A.P.
Attending Neurologist

Headaches are a very common childhood complaint that can continue to be a lifelong issue. Frequently, these events are rare and usually self resolve.

However, some children do experience frequent, recurrent, and severe episodes that may require intervention.

Mechanism
The brain itself is insensitive to pain. Structures associated with the brain that
are pain-sensitive include some of the large blood vessels, the scalp, sinuses, teeth, face, eyes and ears.

Very often the nerves that control these areas also supply the cerebral blood vessels and the tissue that surrounds the brain. As a result, pain from these extra cerebral sources is perceived by the body as headaches.

TYPES OF HEADACHES

Migraine
This type of headache is the result of a sensitivity of the blood vessels that culminates with a narrowing and/or dilation of the arteries that supply the brain. It can occur at any age and in either sex. Usually, there is a positive family history.

The paroxysmal events are separated by pain-free periods. The pain is usually unilateral, but can switch sides, is throbbing in nature, with nausea and occasional vomiting. Some people have a warning or “aura” prior to the headache. They can also have visual disturbances, such as blurry vision, sparkles, lights, colors or have an area of visual loss called a “scotoma.”

These events can occur at any time of day. They can be very brief or last for days. Precipitating factors include certain foods, dehydration, skipping meals, stress, changes in the weather, illness (especially with fever, hormonal changes) and lack of sleep.

Some children experience a migraine variant that can consist of periodic complaints of abdominal pain, vomiting or dizziness that can occur with or without a headache. A family history may be present for migraine and these patients can respond to migraine therapies. They can also go on to develop migraine headaches later in life.

Cluster headaches
This form of headache is more common in males. It usually does not occur prior to age 10. The event consists of a onesided headache that is localized to the area surrounding the eye. Patients can also experience eye redness, tearing, and nasal congestion.

The attacks are usually short, lasting 30 minutes to one hour and occur in clusters for 1-3 days over a 6-12 week period. They will then resolve with remissions lasting years. They typically do not respond to the standard therapies for migraine headaches.

Muscle tension headaches
These occur as a result of contraction of the muscles of the scalp and neck. This is a very common form of headache in adolescents and adults. The patient usually describes a “band”or pressurelike sensation. On physical exam, the muscles may be tender and spasm can be appreciated. These headaches do not typically interfere with the patient’s activities. They also respond well to acetaminophen or ibuprofen.

Posttraumatic headaches
These can occur after some form of a concussion or head trauma. This can be as simple as heading the ball during soccer practice to a severe injury after a car accident. They can last days to months depending on the severity of the initial trauma. They can also self resolve. Other associated symptoms include sleep problems, behavioral changes and changes in school performance with memory and concentration problems.

Headaches with Depression
A symptom of childhood depression can be chronic headaches. This can be associated by school problems, mood disorders, weight loss or gain, sleep problems and social withdrawal.

Traction Headaches
This category encompasses the more severe causes for headaches such as a brain tumor, a collection of blood or infected fluid, such as an abscess, or an elevation in intracranial pressure. These headaches can occur at any time. However, they are usually more chronic and progressive in nature. They can be exacerbated by coughing or sneezing and usually have associated vomiting. The patient will also not seem like themselves, even between attacks. Other physical signs can include weakness, double vision, changes in balance or gait and personality changes.

Evaluation of Headaches
A history regarding the frequency, nature, severity, triggers, associated symptoms and family history is very important in determining the headache type and appropriate evaluation and treatment. The patient may be asked to keep a diary regarding these symptoms. Very often a headache patient can experience different types of headaches.

Blood testing, EEG and neuroimaging, which may consist of a CT scan or MRI of the brain, may also be performed as part of the diagnostic process in addition to the physical examination.

Treatment of Headaches
The goal of headache management is to relieve the symptoms, allowing the patient to participate in their usual activities at a normal level and decrease the frequency and severity of attacks as well as preventing further episoids.

Abortive Therapy
Over-the-counter drugs, such as Advil and Tylenol, may be used. Prescription analgesics include Lorcet and Fioricet. Triptans, such as Imitrex, and DHEA products such as Migrinal are also prescribed. It is important to use these early in a headache, at the appropriate dose, and not to overuse these medications. Misuse can actually lead to a worsening or rebound headache.

Prophylactic Medications
These are medication used to block the neurochemical cascade that creates the headaches. They are used for a period of time to interrupt the headache cycle when the events are too frequent and/or severe. These can include antidepressants, anticonvulsants, beta blockers, calcium channel blockers and vitamin supplements.

Lifestyle Issues
Good heath habits impact headache sufferers. Daily exercise, adequate rest, stress management, hydration and diet all play a major role in preventative measures that can aid the headache patient.

Diet
Diet is probably the single best way to tackle common headache triggers. These are not food allergies. The body reacts to chemicals in the food, which then triggers a headache. By identifying your trigger and simply eliminating the food, you can significantly decrease or eliminate your headaches.

Headache management is a combination of stress management, good eating habits, and appropriate sleep patterns along with drug therapy. Eliminate the triggers you can. Perform 30 minutes of aerobic exercise at least three times a week and be aware of hormonal influences and environmental factors.

Today we have many lifestyle, dietary, and pharmacological options that can aid the headache patient toward a pain free life.

For a referral to a neurologist, please call the Saint Barnabas Physician Referral Service at 1-888-724-7123.

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