Headaches are common among children and young people. By the age of 7, at least 50% of all children will have experienced some form of headache.
A recent British study revealed that 20% of children with chronic headaches experience a poorer quality of life, even more so than those with diabetes or asthma. However, most of these children never consult a paediatric neurologist.
Our brain cells communicate with each other using neurotransmitters, such as serotonin, which generate electrical signals. Headaches occur when there are chemical disturbances that trigger overactive brain cells, leading to malfunctioning brain activity.
Types of Headaches
Headaches can be classified as either primary or secondary.
Primary headaches occur independently and are not caused by any other underlying conditions. In contrast, secondary headaches arise as a result of other health issues.
There are various types of both primary and secondary headaches. Below are some of the most common types:
| Primary Headaches | Secondary Headaches |
|---|---|
|
|
What are the Headache RED flags?
If your child is experiencing headaches or symptoms that seem unusual, or if these symptoms are unexplained or persist over time, it is crucial to seek medical advice promptly. Taking action now can lead to better outcomes and ensure your child’s well-being.
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 |
What is Migraine?
The most common primary headache in children is known as ‘Migraine without aura.’ The warning signs that occur before a migraine attack are referred to as ‘aura.’ These may include visual disturbances (e.g. zig-zag lines, visual field defect or even blindness), unusual smells or tastes, or feelings of unsteadiness.
Children experiencing migraine without aura tend to have headaches that affect both sides of their heads, and the duration of these attacks is generally shorter.
The spatial and temporal progression of visual aura during a migraine attack can be illustrated with drawings. In the below illustrations, the symbol “X” represents the fixation point, while the numbers indicate the time in minutes during which the aura is experienced. The migraine aura gradually expands across the visual field and is characterized by zig-zag lines at the leading edge, along with an inner bean-shaped area of vision loss (scotoma).
What Causes Migraine?
The exact cause of migraines can vary and is not always known. However, several factors and triggers may contribute to the onset of migraines:
1. Lifestyle Triggers
Migraine attacks can be triggered by certain dietary factors, such as caffeine, cheese, chocolate, citrus fruits, and alcohol. Additionally, lifestyle factors like stress, fatigue, poor sleep, excessive screen-time, and irregular meal patterns can also contribute to the development of migraines.
2. Genetics
Migraines often run in families. A specific type of migraine, known as Familial Hemiplegic Migraine, has been linked to genetic mutations in the CACNA1A, ATP1A2, and SCN1A genes.
What Are The Common Co-Occurring Conditions?
Children who suffer from chronic headache disorders, such as migraines, may experience various co-occurring conditions that can impact their overall health and well-being.
Numerous studies have demonstrated that migraines can significantly affect an individual’s quality of life. They can disrupt a person’s ability to perform daily activities, both physically and emotionally, and may also harm their social life. Even during symptom-free periods, the quality of life can be negatively affected as individuals often restrict their daily activities in an effort to prevent another migraine attack.
Anxiety is the most prevalent mental health issue associated with migraines. In fact, individuals who suffer from migraines are twice as likely to experience an anxiety disorder compared to those with depressive disorders. Recent studies indicate that the incidence of anxiety among people with migraines is four times higher than in those without migraines.
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 confirming the diagnosis, Dr Yeo will collaborate closely with you and your child to develop a personalised treatment plan. This comprehensive approach will address every facet of your child’s situation, ensuring both of you gain a clear understanding of the condition.
With a deep commitment to your child’s well-being, Dr Yeo will empower you to explore the most effective treatment strategies.
Lifestyle Changes
Recognising the root causes or triggers of your child’s headaches is vital for their effective management. By understanding these triggers, you can make informed decisions about the treatments that will work best.
Implementing lifestyle changes can significantly reduce migraines and related issues, such as anxiety and stress. Prioritising good sleep hygiene, increasing regular physical activity, ensuring appropriate support at school, and actively identifying and avoiding specific triggers are crucial steps in helping your child thrive. Taking these proactive measures empowers you to create a supportive environment for your child’s well-being.
Medications
There are two important types of medications:
1. Reliever
These medications are crucial for use at the onset or during a headache attack. Effective options include simple analgesics like paracetamol and ibuprofen, as well as targeted treatments.
2. Preventer
To truly reduce the frequency and severity of headache attacks, preventive medications are taken daily. Proven options include nutritional therapy, flunarizine, pharmacomodulation therapy, and specific monoclonal antibody therapy for migraine, e.g. Ajovy (fremanezumab).
Both reliever and preventive medications work by stabilising or modulating the abnormal electrical signals within brain cells and pain receptors, addressing the root cause of headache pain.
Dr Yeo is dedicated to guiding you and your child in identifying the most effective medications tailored to your child’s headache disorders. He will provide a thorough discussion of which treatments have shown success and those that may not be beneficial, along with a detailed examination of the pros and cons of each medication and alternative treatment options. With his expertise, you can confidently navigate the pathway to effective headache treatment.
Complementary Treatments
Complementary treatments can be valuable additions to specific headache medications. While evidence supporting their effectiveness in preventing headaches is limited, these treatments can enhance overall wellbeing and provide relief from accompanying conditions.
Topical Remedies
‘White Tiger Balm’ and ‘Axe Brand Universal Oil’ contain peppermint, which has a cooling effect on the skin. Recent European clinical studies have shown that peppermint can reduce muscle contractions mediated by pain receptors and increase blood flow to the scalp. It has also been found to be as effective as paracetamol in relieving episodic tension-type headaches.
Herbal Medicines and Supplements
Herbal medicines are made from active ingredients derived from plant parts or extracts. While some herbal remedies can be beneficial, they may also have adverse effects or interact with other medications.
‘Feverfew’ is a type of herbal medicine that contains MIG-99, an active extract of feverfew. This extract has anti-inflammatory and smooth muscle relaxant properties, which could be beneficial in treating migraines. Although several studies have investigated the effectiveness of feverfew for this purpose, the optimal dosage has not yet been clearly established.
‘Magnesium’ plays an important and diverse role in our brain and body. Research indicates that it may be effective as a preventive treatment for migraines. However, magnesium overdosage can cause upset stomach and diarrhoea.
‘Riboflavin (Vitamin B2)’ is essential for energy metabolism in our body and brain cells. Evidence suggests that it may be effective in preventing migraines and is generally well tolerated.
‘Coenzyme Q10’ also plays a crucial role in energy metabolism for our body and brain cells. It may help prevent migraines and is well tolerated by most individuals.
Acupuncture
Acupuncture involves the insertion of fine needles at specific locations of the body for therapeutic purposes. The UK National Institute for Health and Care Excellence (NICE) recommends considering acupuncture as a treatment option for migraines.
Psychological Therapy
Psychological therapy and specific treatments, such as biofeedback, have been shown to improve headache disorders and related issues, including anxiety, stress, mood, and sleep disorders. 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.
Dr Yeo recommends keeping a headache diary to track the nature of your child’s headaches.
If you have any further questions, you can schedule an appointment today with Dr Yeo.
