How to care for a child with migraine headache?

Migraine is a severe form of headache that affects a person periodically and repeatedly. Migraine headaches in children are similar to those of adults in signs and symptoms, and treatment. Familial tendency is the most common cause of migraines in children. About 10% of children get migraine headaches. Though migraine headaches are considered benign, they bring about a lot of hassle in day to day life activities. They are one of the leading cause of sick leave at schools.

The classic migraine attack can be divided into three phases in children. They are: the aura, the headache, and the recovery phase.

The aura phase occurs 30 minutes before the actual headache where the child will experience visual disturbance (light flashes), nausea, sensitivity to bright lights, loud noises, and strong odors. The child may complain of dizziness and tingling sensation over the face and hands. Some children talk irrelevantly due to mild confusion and loss of attention. The child may look pale and tired.

Aura is followed by the headache phase. Here, the child suffers a severe throbbing headache and will search for a dark room to rest. The headache is usually one sided over the temple and is profound around the eyes. It is relieved by vomiting.

The recovery phase is a period of exhaustion with associated muscle aches in the neck and scalp. The child tends to sleep longer during this post headache phase.

Boys and girls are equally affected during childhood. The girls continue to have migraine attacks after menarche but the episodes decreases in boys.

The diagnosis is made with the help of a detailed history, physical examination, fundoscopic examination of the eyes and the neurologic function tests. A familial history and a unilateral, pulsating, and throbbing on and off headache supports the diagnosis of migraine. On physical examination, the child may look pale and ill, have dark circle under the eyes, and be irritable. Symptoms like photophobia, abdominal cramps, diarrhea, sweating, and swelling will be noticed during an actual attack of migraine.

CT scans and opthalmic examination should be taken for children to rule out the presence of tumor or any other problem (if any). The management is divided into symptomatic and preventive approach. Pain relief is the first goal in symptomatic approach and it is done with analgesics, abortives and prophylactics. Identifying and avoiding is the next step to put an end to the migraine headache. The triggers are usually milk products like cheese, chocolates, nuts, preservatives and caffeine. Avoiding stress and illness also prevents the child from having an episode of migraine headache. Preventive drugs are propranolol, antidepressants, barbiturates, and tranquilizers, but they are avoided for children.

The child must be brought for follow up check ups if the child is treated with any medication. The child should be monitored for side effects periodically, and any adverse effect must be reported to the doctor immediately. Keeping a record of the circumstances surrounding the attack (like activities, food, and feelings) will definitely help to identify and prevent the migraine attacks.