Believe it or not, as m any as two-thirds of children complain about headaches so severe they need to seek medical attention at some point during childhood.
Migraines in particular have a high prevalence, ranging from 2% to 11% in various population studies. While migraines and tension headaches together cause the majority of childhood headaches, some studies are suggesting there may be an increase in the incidence of childhood migraines. The reason for the increase escapes experts at this point. Dr. Andrew D. Hershey with the Cincinnati Children’s Headache Center in Cincinnati, Ohio, says that clinicians are limited by what he calls “the deficiency of scientific data on childhood migraines.”
A landmark study out of the University of Calgary, showing the important association between weather changes and headaches, caught the attention of the world media a few years ago. Is this association true for children? We do not know for certain, but the older the child, the more likely the association may be.
With the increasing number of soft drink machines at schools and the relentless consumption of caffeinated sodas, some children are experiencing a higher incidence of sleep disturbance. A recent article published in Pediatrics clearly showed significant changes in sleep patterns of teenagers as a result of consuming sodas with modest caffeine content. Since lifestyle issues play such an important role in predisposition toward migraines, I cannot help but wonder if there may be a connection between the higher incidence of migraines and the excessive consumption of caffeinated beverages. (In adults, we do not wonder about this connection - we know it exists.)
Most childhood migraine experts agree that to diagnose migraines there has to be a history of recurrent, paroxysmal headaches with headache-free intervals. Additionally, at least two of the following scenarios are required: an aura, nausea or vomiting, a family history of migraine in parents or a sibling, a throbbing headache located on one side of the head and pain relieved by sleep.
The International Headache Society has published criteria for the diagnosis of migraines in adults, and since then several revisions of the original criteria specifically for childhood migraines has been suggested. One such revision speculates that in children, migraines do not always occur on one side (unilaterally), therefore the absence of a unilateral headache means there is still a possibility of a migraine.
Not all children with a migraine experience pain and there is a condition known as the Alice in Wonderland Syndrome. This occurs when a child is sitting in the classroom and sees the teacher become larger and smaller or closer and further away. Motion sickness may be associated and there is often no associated headache.
Diagnosing migraines on the basis of pain may be tricky; younger children especially have a hard time explaining their symptoms verbally. In one study, 25% of children between the ages of 9 and 16 were unable to provide information about even one headache characteristic. Last year, in a study the first of its kind, clinicians explored the usefulness of children's drawings in the diagnosis of headaches. They found some startling information: children's headache drawings are a simple, inexpensive aid in the diagnosis of the headache type with a very high specificity, sensitivity and predictive value for migraines versus other headaches. For example, children with a migraine drew pictures of a hammer and a chisel pounding on one side of the head (nine-year-old); a baseball bat hammering away at the side of the skull (14-year-old); and a drum in the centre of the head illustrating pain throbbing "like a drum set in my brain" (10-year-old). Examples of the visual auras that often accompany migraine headaches included drawings of a 16-year-old girl showing light sensitivity by drawing a picture of a line crossing out the sun, and a 12-year-old showing a light bulb associated with sparkling dots. It is worth the effort to find this classic article from Pediatrics, March 2002, by doctors Carl E. Stafstrom, Kevin Rostasy and Anna Minster, especially if you are uncertain about the diagnosis of migraine in your own child.
If you are a woman with migraines, each of your children stand a 50% chance of having the disorder and migraines are more prevalent in females. If you are a man with migraines, your children stand a 25% chance of having the disorder.
Lack of sleep, skipping meals, a change in routine and a break in tension often precede migraines. In the end, prevention of migraines may be difficult, but possible.
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An informed parent is ... an empowered parent.