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Daily Dose

Teens & Headaches Go Together

I just read an interesting study about teenagers with headaches. About one to two percent of adolescents have chronic daily headaches, defined as greater than 15 headache days per month for greater than three months.

Once school begins, teens stress levels increase with each week of school, and with that come more complaints of chronic headaches. It is not unusual for me to see several teens a week who complain that they have headaches every day. Despite these persistent headaches, the majority of adolescents continue to participate in their school activities, sleep well once they fall asleep and spend their weekends doing whatever it is that teens all do. I see very few teens who look like they are in “severe” pain, although they state that their head is “killing” them while they chatter away about where it hurts, and how often it hurts etc. It is quite reassuring to watch their faces and expressions as they go into detail about their headaches. In these cases it is important to obtain a good history to rule out any underlying pathology, as well as to inquire about family history of migraines. In this study the authors followed adolescents ages 12 – 14 years who met criteria for chronic daily headaches. They followed the group after both one and two years, and then again after eight years. The results showed that after one year 40 percent of adolescents still complained of chronic headaches. After two years, only 25 percent reported headaches. After eight years, only 12 percent reported chronic headaches. Most participants reported substantial or some improvement in headache intensity and frequency during the eight-year follow-up. The most significant predictor for ongoing problems with headaches was onset of chronic headaches before the age of 13 years. For the most part 75 percent of adolescents with chronic daily headaches improved over the eight-year period, which is quite reassuring. This study just seemed to confirm that teens and headaches go together. If a good history and physical exam is performed and there seem to be no underlying problems that contribute to their headaches, it is best to discuss the natural history of chronic headaches. I think it is important to spend time with adolescents to explore ways to alleviate stress as a trigger for chronic daily headaches. Basic changes in lifestyle such as healthy eating, regular exercise, and a good night’s sleep will often help reduce headaches. Relaxation techniques and cognitive behavioral therapy may also be utilized. At least we know that the headaches reduce with time, maybe just a maturational process, like many things! That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Kids And Headaches

1:30 to read

A recent study suggests teens and chronic headaches go together. This interesting study revealed about 1-2% of adolescents have chronic daily headaches, defined as more than 15 headache days per month for greater than 3 months.

When school begins, teens stress levels increase with each week of school, and with that come more complaints of  chronic headaches.  It is not unusual for me to see several teens a  week  who complain that they have headaches every day. Despite these persistent headaches, the majority of se adolescents continue to participate in their school activities, sleep well once they fall asleep and spend their weekends doing whatever it is that teens all do. I see very few teens who look like they are in “severe” pain, although they state that their head is “killing” them while they chatter away about where it hurts, and how often it hurts etc. It is quite reassuring to watch their faces and expressions as they go into detail about their headaches.  In these cases it is important to obtain a good history to rule out any underlying pathology, as well as to inquire about family history of migraines. In this study, the authors followed adolescents ages 12–14 years who met criteria for chronic daily headaches. They followed the group after both 1 and 2 years, and then again after 8 years. The results showed that after 1 year, 40% of adolescents still complained of chronic headaches.

After 2 years, only 25% reported headaches.  After 8 years, only 12% reported chronic headaches. Most participants reported substantial or some improvement in headache intensity and frequency during the 8 year follow-up. The most significant predictor for ongoing problems with headaches was onset of chronic headaches before the age of 13 years.  For the most part 75% of adolescents with chronic daily headaches improved over the 8 year period which is quite reassuring. This study just seemed to confirm that teens and headaches go together.  If a good history and physical exam is performed and there seem to be no underlying problems that contribute to their headaches, it is best to discuss the natural history of chronic headaches.

I think it is important to spend time with adolescents to explore ways to alleviate stress as a trigger for chronic daily headaches. Basic changes in lifestyle such as healthy eating, regular exercise, and a good night’s sleep will often help reduce headaches.  Relaxation techniques and cognitive behavioral therapy may also be utilized. At least we know that the headaches reduce with time, maybe just a maturational process, like many things!

That's your daily dose for today.  We'll chat again tomorrow! Send your question or comment to Dr. Sue! Send your question or comment to Dr. Sue!

Daily Dose

Treating Migraines in Children

What is the best way to treat a migraine in children?So, we have discussed migraines and looked at how to diagnose in the pediatric population. Now it’s time to decide how to treat the headache. Just like diagnosing the headaches, it is important to individualize treatment for each child, with the goal being fast relief, no rebound or re-occurrence, with minimal or no side effects to the medications.

When I see a patient who has a history compatible with migraines, I not only have the child and parents keep a headache log, but I spend a lot of time discussing early treatment of the headache. One of the first things you learn in medical school about treating pain is “get ahead of the pain”.  This means that you need to be aware of your symptoms and begin therapy earlier than later, as pain that has gone on for some time is much harder to treat.  I find that one of the best ways to explain this to a parent and also an older child is to talk about surgery. When you have a surgical procedure, the anesthesiologist does not wait for you to “wake up” and tell him that it hurts, they have already given you pain medication to “keep ahead of the pain” before they wake you up. If you have ever had surgery you know this to be true. The same pain principles apply to treating headaches, especially migraines. At the first sign of a migraine, with or without an aura, I usually prescribe an ibuprofen (Motrin, Advil) product.  In studies, ibuprofen was more effective for headache relief than acetaminophen. I use a “generous” (10mg/kg/dose) dose and repeat it once in 3 -4 hours if the headache has not resolved. You do not want to use ibuprofen more often than several times a week or you may find that your child actually gets rebound or overuse headaches.  Ibuprofen is available in liquid, chewable and pill form so can be used in a young child with suspected migraines.  I also like to use naprosyn (Aleve) in older children who can swallow pills.  It too is a non-steroidal anti-inflammatory  and is available over the counter. The most frequently used medications for childhood migraines are called triptans.  This class of drugs has been around for more than a decade now, but they are not FDA approved for use in children and adolescents because of the difficulty in designing a study (this is true of many different medications.)  Regardless, they are frequently used to treat childhood migraines with good results, tolerability and a good safety profile. There are many different drugs, with names like Imitrex, Zomig, Maxalt, Frova, and the newest drug Treximet (a combination of a triptan and a non steroidal drug), and all have a similar safety profile. Once a child has “failed” therapy with an over the counter non-steroidal drug, I typically use these drugs as “rescue” medications.  Just like many other medications, each person seems to respond differently, so it may be a bit of trying different medications to see which one works “best” for each migraine sufferer. When a patient seems to find the best triptan, it is important to start the medication at the earliest onset of a migraine. I also try to help adolescents distinguish between “different” types of headaches, so that they are not using this class of drugs too frequently (max 3 headaches a week).  Not every headache is a migraine! If these medications do not relieve the headaches within 48-72 hours more aggressive therapies need to be used, and preventative treatments and strategies should be considered.  There are many studies underway looking at the combined effects of biofeedback therapy and cognitive behavioral therapy in combination with medications. These are discussions that each parent/child should have with their own physician as it relates to their headache frequency and pain level. That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Parents Need To Take Concussions Seriously

Dr. Sue explains why parents need to take concussion seriously. They are a brain injury.I have blogged previously about the latest recommendations concerning concussions and restrictions on activity after sustaining a  concussion. This subject has been in the news a great deal lately, not only within the medical community, but also within the NFL and other major sports groups.

There is more and more data to show that concussions in and of themselves are dangerous, but that repetitive concussions may cause even greater damage to the brain, especially to the still developing brain of young athletes. I just saw an eleven year old boy who is a soccer play, actually, he is the goalie. He was at school, just playing around in the gym, when he sustained a concussion after running into another child head on and falling backwards.  The boy remembered falling, but shortly thereafter he became disoriented, could not take a test due to the fact that his memory was impaired, and subsequently vomited. His concerned parents brought him to my office to be evaluated.  By the time I saw him he was feeling better, and he had a normal neurological exam. Based upon the history of his injury he was diagnosed with a concussion.  Because of this he and his parents were advised that he not participate in sports for a minimum of a week.  Of course, as it would turn out,  his school soccer team was supposed to be in the State championship game in 48 hours.  Their team was 92 -0.  After much discussion and a conversation with his coach the parents we all agreed that he would not play. The following day, I received an email from his father who felt that his son was doing well and was “back to normal”.   He had been re-thinking the issue of his son not playing and wanted me to reconsider my instructions for his son not to play. He even noted that he himself had played college soccer and had often played after suffering a concussion.  He felt that if his son played (if he was absolutely needed to secure a win) and did not do “headers” that he would be okay. What was he thinking?  I don’t really think he was thinking about anything other than his son’s team winning a State championship. He seemed to have tunnel vision, and could not see that there would be many more soccer games in his son’s future, but another concussion could cause long term problems for his son.  So, I stood by my recommendation, for which his mother “thanked me”.  His team played the game and of course they lost. I felt terribly for their loss, but at the same time, knew that medically this was the appropriate decision. So many times, we as parents get so “wrapped up” in our children’s lives, whether it be in sports, academics or even having the “best” birthday party, that we lose sight of the “big picture”.  I see the” big picture” as trying to make the best decisions for our children, given the best information that we have to help make that decision. Many of those decisions may not be easy, but we as parents know they are right.  Whether that is keeping your child from playing a soccer game after suffering a concussion, or taking away a teen’s cell phone and computer privileges after they have been drinking under age.  There are so many of these difficult decisions and we all hope to make them correctly. This patients family did, and I am proud of them! That's your daily dose for today.  We'll chat again tomorrow! Send your question or comment to Dr. Sue!

Daily Dose

Childhood Headaches

A child complaining of headaches also causes a lot of parental concern, as we often jump to the worst conclusions.Headaches are a very common complaint during childhood. A child complaining of headaches also causes a lot of parental concern, as we often jump to the worst conclusions (something about human nature?). The prevalence of any type of headache ranges from 37

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Your Child

Vitamin Deficiencies Linked to Kid’s Migraines

1:30

Those that have migraines say the pain is like nothing else - an intense throbbing or pulsing sensation in the head that can bring you to your knees.

The reason people get migraines is still a mystery, but a new study says scientists and doctors may want to add vitamin deficiency as a possible cause.

The study, presented at the 58th Annual Scientific Meeting of the American Headache Society, suggests that doctors treating patients with migraines may want to screen for vitamin D, riboflavin (B-2) and coenzyme Q10 deficiencies.

For the study, researchers at Cincinnati Children’s looked at existing data on 7,691 young patients who were migraine sufferers and their records of blood tests for baseline levels of vitamin D, riboflavin, coenzyme Q10 and folate. Of the study participants, 15 percent were found to have riboflavin levels below the standard reference range. A significant number of patients—30 percent—had coenzyme Q10 levels at the low end of the standard reference range. Significantly lower vitamin D was seen in nearly 70 percent of the patients.

The researchers also found that patients with chronic migraines were more likely to have coenzyme Q10 deficiencies than patients who had episodic migraines. Girls and young women were more likely than boys and young men to have coenzyme Q10 deficiencies at baseline. Boys and young men were more likely to have vitamin D deficiency, but the reasons behind these trends need further investigation.

Hershey says the study adds to an ongoing observation that a significant number of people with migraines have lower levels of these vitamins. However, this trend is not seen in all patients across the board.

Scientists have looked at the link between vitamin deficiencies and migraines before, but research has been inconsistent. This study shows an association, but does not prove that vitamin deficiencies cause migraines.

In general, taking these vitamin supplements at recommended doses probably can’t hurt, but much more research is needed to determine whether vitamins alone could help stop migraines. One challenge researchers face is that vitamin supplements are often an intervention used in addition to medications and other experimental therapies. It’s therefore difficult to determine whether improvements in the condition can be explained for reasons other than supplement use.

If your child suffers from migraines, you may want to ask your doctor to screen him or her for vitamin D, Coenzyme Q10 and riboflavin levels. You can then discuss adding supplements if the results show your child is deficient in any of these vitamins.

Story source: Jessica Firger, http://www.newsweek.com/vitamin-deficiency-causes-chronic-migraines-469227

 

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