Migraine, what a pain! (Pedcast)

Welcome to the pediatric blog I call DocSmo.com.  I am Dr. Paul Smolen, founder and curator of this blog dedicated to parents and children.  We go beyond the office and give parents a little more depth in their understanding of pediatric health topics.  From diapers to the degree, we talk about it here.  Thank you for joining me today. The only thing better than the kids in pediatrics, are their parents.  I love bringing information to help parents. Today we are going to talk about a topic that is very close to my life experience, since I am a sufferer, of migraines… an incredibly common pediatric disorder. Believe it or not, most parents don’t recognize this headache in their children when they first begin. Well, we don’t want that to happen to informed, sophisticated DocSmo listeners so here we go.   Lets start with what is migraine?  It is a syndrome meaning a constellation of symptoms that follow a typical pattern.  Usually, a migrainer as they are called will first start feeling weak and very tired, possibly preceded by vision changes called a “visual aura”.  If you have never had one of these think of this as what the world looks like if you were looking through the air coming off a very hot road in the summer… it scintillates, it dances and distorts everything. That’s what an aura typically looks like but they can vary from person to person.  Next usually comes a throbbing headache, often focused around the eye or neck which steadily increases in intensity, a crescendo so to speak for you music lovers.  Often this head pain is more intense on one side of the head. Many migrainers get associated symptoms such as sweating, nausea, light and noise sensitivity, and vomiting as part of the mix. These headaches can be brief or last for days.  In between these “spells”, the child is completely normal.  So remember, fatigue with or without an aura followed by a crescendo type headache, often more intense on one side of the head and not responsive to rest or common pain meds is probably a migraine if the child is perfectly normal in between these spells.  If rest and mild analgesics help, this was probably just “I’m tired” headache.   So what causes migraine?  No one really knows but usually close relatives will have similar headaches so there is certainly genetics to this.  They might not call it migraine but maybe “sick headaches”, “menstrual headaches” or “sinus attacks”, but if they follow this pattern, they are likely migraine.  Estrogen and testosterone have a lot to do with these headaches so for children who have this tendency, that means onset most often in middle school.  Migrainers usually have triggers, whether that be stress, noise, bad smells, dehydration, missing a meal, certain foods, or in my case, calculus class in college.  If you are a sufferer, you often think you have a brain tumor.  I did.  What actually happens in the brain is not definitely known but the large nerve in a child’s face called the trigeminal nerve seems to be involved and cause real physical swelling and inflammation around the brain. That’s why the earlier the treatment is started, the better it works.  Stop the swelling and inflammation and the headache subsides. That also explains why acetaminophen usually doesn’t work… it doesn’t reduce inflammation like aspirins.   If your child has been examined and diagnosed with migraine, here is a useful approach I have learned and used over the years. I think it is vital to HAVE A PLAN LAID OUT BEFOREHAND, before the headache comes.  Here is what I recommend if your child starts to get sick at school with a headache you think is migraine:   -Should a headache start at school, have your child go to the school office and ask to take a usual headache reliever that reduces inflammation like Ibuprofen or Naproxen.  Make sure you supply the school with whichever you want. -Have your child be allowed to be in a quite place for 30 minutes after taking their medicine.  Make sure your they rate their pain on a 1-10 scale before they lay down.… if the headache starts getting better…muscle tension and fatigue was likely the culprit.  Time to go back to class.   -If things don’t get better and they are rating their headache as the same or worse, time for stronger medicine.  I go right to what is called the triptans… these are specifically designed meds for migraine. You can also leave a few of these in the nurses station for use because time is of the essence… the sooner the better. Two that are approved by the FDA for children, Axert or almotriptan and Maxalt or rizatriptan.  Maxalt tablets are available in a generic tablet and are very cheap… this is what I start Maxalt.  If a child cannot swallow a tablet or has a lot of nausea with their headaches, I go for the Maxalt melting tabs  (ODT’s)( currently much more expensive).  If a child gets to this stage, time to call Mom or Dad and go home.   -Pay attention to what triggered the migraine and file that information away for future use.  I have found personally, that ibuprofen, naproxen, or Motrin migraine, taken at times when I think I might be migraine prone, can prevent migrainous headaches.  I think this is only for frequent migraine suffers which hopefully no one in your family will ever be.   So remember, that migraine is episodic, escalating, severe, often localized pain in the head and associated with other symptoms like nausea, vomiting, noise and light sensitivity.  Most often they are incapacitating. If you think your child suffers from these, provide your child’s school with a written plan, some ibuprofen or naproxen, and a few triptan tabs.  See if that strategy doesn’t can’t work for you.  I hope it does.   As always, thanks for making me one of your trusted healthcare sources of information.  I will always try and bring you relevant, practical information that you can use with your children.  Your comments are welcome at my blog, or on facebook or itunes.   www.docsmo.com https://www.docsmo.com/docsmo-videos/     This is Doc Smo, hoping every parent has an advanced degree, in how to keep their children pain free.  Until next time.

2 Comments

  1. DocSmo says:

    Wendy wrote on Facebook: “I enjoyed this topic as it is near and dear to my heart, having a child that suffers from migraines. Thanks for encouraging parents to have a plan and to provide necessary medications at school. It certainly benefits the child and helps out the school nurse!”

  2. Kelly says:

    Wendy wrote on Facebook;

    “I wanted to tell you how much I enjoyed the migraine pedscast. I’m a pediatric nurse practitioner in Houston, I find your advice simple for the layperson as well as professionals. My friend’s 8 year old seems to have developed migraines and I was able to give her your advice, however due to his age and some of the symptoms were blurred vision, extreme pain behind the eye- he does respond to OTCs Ibprofen- since he isn’t a patient of mine, plus the familial hx negative for headaches or migraine -I did recommend a pedi neurologist.”

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