Migraine: a guide for families. Neurology Division of the IWK Health Centre

Transcription

1 Migraine: a guide for families Neurology Division of the IWK Health Centre IWK Neurology, Halifax, N.S. PL-0440 Last Update: 07/16 Next Review: July 2019

2 Sample Headache Diary Your Notes About the 24 Hours Before the Headache s Onset Date Stress Good or Bad Missed Meals Missed Sleep All New or Different Foods Eaten Other (for example: sunlight) Severity (Mild, Moderate, Severe)

3 Introduction: Parents are often surprised when told that their child has migraine headaches. The purpose of this pamphlet is to explain some facts about migraine: what causes it, how it can be treated, and how you can help your child with migraine. What is Migraine? Migraine headaches are a special type of recurrent headache. There is no specific test for migraine but there are several features which help distinguish migraine from other types of headache. 1.) The pain is often described as pounding or throbbing. This is different from the pain of stress or tension headaches which is usually a dull ache or a pressing, tight feeling around the head. 2.) Migraine headaches sometimes occur only on one side of the head, although more often in children they affect both sides. The side involved in the headache may change from one attack to another. 3.) Migraine may be accompanied by nausea, vomiting, loss of appetite, or stomach pain. The vomiting often occurs near the end of the attack. Children will often complain that sound or light bother them during the headache. 4.) Before the headache, there may be a warning sign known as an aura. There are many different types of aura, such as blurring of vision or spots before the eyes. Auras are more common in adults than in children. 5.) Migraine headaches are often relieved by a period of sleep. 6.) In many cases other family members also have migraine. 1.

4 Types of Migraine Different patterns of migraine have been described over the years. In children there are two main types which occur frequently. 1.) Migraine without aura or Common migraine often affects both sides of the head. 2.) Migraine with aura or Classic migraine is more likely to occur on one side of the head. Who Has Migraine? Migraine is more common than most people think. About 1 in 20 children and 1in10 adults have migraine. Migraine occurs in all ages. Even toddlers can have migraine, although it is often hard to diagnose at such an early age. Migraine occurs in both boys and girls. During childhood, more boys are affected but in adults, women are more often affected. How Often Does Migraine Happen? The frequency of migraine headaches varies greatly. In rare cases, children have clusters of headaches several times each day. Others are only bothered by their headaches once or twice a year. For most children, the frequency lies somewhere between these extremes with headaches occurring about once a month. The headaches may be short, lasting only an hour or so. On the other hand, sometimes they are very long and can drag on for more than two or three days. Typically a headache lasts 2 to 4 hours. 2.

5 Why Does Migraine Occur? It is currently believed that migraine occurs when trigger factors cause the release of special chemical substances which affect the brain and its blood vessels. How exactly this happens is not clear. The type of aura which occurs before a headache depends on which part of the brain is affected. There are many different types of auras. The most common are visual complaints including flashing lights, moving spots, zigzag lines, double vision or even a temporary loss of vision. Some children describe that objects look much bigger or much smaller than they should. Others experience dizziness or numbness and weakness. Before migraine without aura, the child may seem depressed or overexcited for a few hours before the headache begin. When the headache starts the child often looks pale and may have black circles under the eyes. The pain may start behind one eye or over one temple. Later, it may spread to other parts of the head. At this time exertion, movement, lights and loud noises may make the headache worse. Other Symptoms Children who suffer from migraine sometimes have associated problems at times when there is no headache. These include sleepwalking, breath-holding, recurrent abdominal pain, vomiting, travel sickness and fainting. Factors That May Trigger Migraine Many factors may bring on migraine headaches. Each of these trigger factors may be able to bring on a headache alone, but often a combination of factors leads to the onset of the headache. The importance of any trigger varies from one child to the next. 3.

6 Trigger Factors: 1.) Stress - which can be either good (excitement) or bad. 2.) Missed meals. 3.) Being overtired. 4.) Foods. 5.) Others - for example: sunlight, perfumes, hormonal changes, rainy weather. Prevention Of Migraine Unfortunately there is no simple cure for migraine. Your doctor will make the diagnosis from your child s story and symptoms, usually without any further tests. The next step is to try to prevent headaches and to treat the headache episodes as early as possible. Prevention is the most important part of coping with migraine. Each time your child has a migraine headache, it is important to try to identify significant events which may have caused it. These triggers can then be avoided in the future. The best method of identifying these triggers is to keep a headache diary of the 24 hour period before the headache onset. Therefore, as soon as your child has recovered from the headache and is feeling better, he or she should look back over the 24 hours before the headache and the diary should be filled in for each of the 5 factors. Regular sleep pattems and meals are helpful for the child with migraine. Wearing sunglasses or a hat will help those who are sensitive to bright sunlight. Emotional stress is a frequent cause of migraine and is often not so easy to deal with. In some children learning relaxation techniques, such as selfhypnosis, can also be very valuable. If a food seems to trigger migraine, it should obviously be avoided. 4.

7 Treatment Of Migraine If the onset of a headache is recognized, the most important step is to start treatment early. The headache can usually be treated successfully if simple medications are given before it becomes severe. Once the headache is well under way, then it is usually too late to stop the headache and it will have to run its course. It is important, therefore, for both the child and parents to learn to recognize the beginning of a migraine headache. If there is an obvious aura or if the child is old enough to describe the symptoms, this is easy. In a young child, however, the only clues may be a pallor or paleness or changes in behaviour. The person should rest in a quiet darkened room. They should avoid stimulation like bright lights, loud noises, TV and excitement, all of which may make the headache worse. Simple pain killers like acetaminophen (Tylenol), if given in the correct dose for the patient s age, are usually strong enough. They usually only work well if given very early in the course of the headache. If your child is usually in school when the headache begins, arrangements can be made with the teacher to give medication at the onset of a headache. Very rarely are other medications required. If vomiting is very severe, a medication usually given as a suppository may be necessary. It is very unusual for children to require daily medication. It is important for parents to be sympathetic and understanding, while remaining calm and relaxed during the headache. 5.

8 Migraine Headaches And Diet Among children with migraine, only 1 in 20 will find that foods tend to bring on their headaches. For the other 19 out of 20, foods are not a factor. When food is important it is most likely to be among the following: These foods are the most commonly associated with migraine and some people can avoid their headaches if they are eliminated from their diet. smoked meats, pizza, kippered or pickled herring nuts foods containing MSG (Chinese foods) foods containing nitrates (hot dogs) Other foods may be involved for individual children. What About The Future? It is difficult to predict for each individual child what the future of their migraine headaches will be. Overall about 7 out of 10 children with migraine will continue to have migraine when they are adults. It is therefore important to find out how to manage your child s headaches early in their course. 6.

9 For More Information The Neurology Service IWK Health Centre 5850/5980 University Avenue PO Box 9700 Halifax, NS B3K 6R8 (902) IWK website: Consumer and Patient Health Information Section (CAPHIS) of the Medical Library Association - Top 100 Websites You Can Trust. This is a list of links to 100 different quality health websites reviewed by the Medical Libraries Association. FamilyDoctor.Org - This website is by The American Academy of Family Physicians. It has a list of conditions from A-Z, linking to full-text pamphlets. Le gouvernement de la Nouveau-Brunswick Publications et services de santé en langue française. Des sujets divers: particuliers et familles; traitement des dépendances et de santé mentale; votre santé. KidsHealth.Org - This is by Nemours health experts. It has fact sheets for parents, children, teens. Mayo Clinic - Patient pamphlets and symptomchecker from the medical experts of the Mayo Clinic. Medline Plus Database - There are over 750 topics such as conditions; diseases; nutrition; medications. 7.

10 Headache Diary 1) Keep record only when a headache has occurred. 2) When the headache is relieved, complete the diary for the 24 hour period prior to the onset of the headache. 3) Stress can be good or bad. An example of good stress would be a birthday party or a school dance. An example of bad stress would be problems at school or disagreements at home. 4) Food - Record any unusual or different foods eaten during the 24 hour prior to the onset of the headache. 5) Other - This includes anything specific noticed about the prior 24 hours, for example: bright sunlight, unusual exercise, etc. 6) Severity: Mild - does not interfere with normal activities Moderate - uncomfortable - may choose quiet activities Severe - feels unwell - must go to bed (in a dark, quiet room) 8.

11 Sample Headache Diary Your Notes About the 24 Hours Before the Headache s Onset Date Stress Good or Bad Missed Meals Missed Sleep All New or Different Foods Eaten Other (for example: sunlight) Severity (Mild, Moderate, Severe)

12 Notes: All IWK patient / family pamphlets translations are completed by certified translators. Translations are of original English versions. All IWK patient / family pamphlets are for informational purposes only. They are reviewed by the authoring IWK department every 3 years. Ask a health care professional, such as a physician, for medical advice. IWK pamphlets are available online at IWK Neurology, Halifax, N.S. PL-0440 Last Update: 07/16 Next Review: July 2019