child headache

16 February 2017

Concussion: What Kind of Rest is Needed?

A large study is questioning some of the common wisdom regarding treatment of concussion in children.

We’ve talked a lot in the past about concussion (which is a brain injury), especially related to sports injuries. Concussion needs to be taken seriously – it could result in ongoing symptoms. Recent recommendations include being very cautious of activities that could result in another concussion, and getting sufficient rest after the injury.

In particular, cognitive rest. That is, avoiding (for example) reading, homework, and video games. (For more, see the 2014 study Effect of Cognitive Activity Level on Duration of Post-Concussion Symptoms)

But while getting rest and avoiding activity with a risk of concussion seems to be the best, does that mean that the child or teen should lie in bed all day? Apparently not.

A study involving 3063 children and teens (up to the age of 18) compared patients who returned to physical activity (within 7 days) with those who were restricted to more “conservative” rest. The question – which group was experiencing more postconcussive symptoms at 28 days?

Postconcussive Symptoms in Children and Youth As you can see from the chart, those who went back to physical activity within 7 days were significantly less likely to have the unwanted symptoms.

Depending on who you talk to, there seem to be two dangers. First, keeping your child away from any physical activity seems to be a danger. Activity is all the more critical to growing children and teens – it can play an important part in their recovery. But the other danger remains – not taking the concussion seriously, and putting the child right back into the sport that caused the injury in the first place.

A slow and cautious return to low-risk physical activity, with limited brain-work for a while, seems to be the best advice.

For more on the study, see the abstract: Association Between Early Participation in Physical Activity Following Acute Concussion and Persistent Postconcussive Symptoms in Children and Adolescents. Also see Early return to physical activity after concussion may reduce post-concussive symptoms at the New York Headache Clinic.

7 February 2014

Patent foramen ovale closure – for children?

James Discoveries & Stats, Treatments 0

Patent foramen ovale closure is still being used as a treatment for migraine and other headaches in children. But is it worth the risk?

Patent foramen ovale (PFO) closure is the closing of a common “hole in the heart” that once was hoped to be a great new migraine treatment. So far, however, the surgery has not lived up to the original hype. Trials have failed to put this anywhere close to the top of the list when it comes to migraine treatment.

In spite of the general let-down, the treatment is still being used, even among children.

It has been estimated that one in four people have PFO, but most people have no symptoms at all. But in some people this does seem to contribute to migraine.

Pediatric Neurology recently published a study from the USA on PFO treatment for children in general. Children with both migraine and non-migraine headache usually reported an improvement after the surgery.

So far so good. However, the researchers have some concerns, and rightly so.

First, this study was not designed to see how effective PFO closure was in patients, and so it had a number of shortcomings which we won’t get into here. But there are some things that would be helpful to know. For example, did these patients have other symptoms besides headache or migraine that prompted them to see a cardiologist (in most cases, the procedure was recommended by a cardiologist)? If so, could it be that treating other conditions are actually helping with migraine symptoms?

Researchers are also concerned about long term effects of this surgery (it’s a generally safe surgery, but it’s still surgery), and the cost. If there are less-invasive treatments that work just as well or better, doctors should be cautious about recommending PFO closure.

This study highlights the need for further well-designed studies of PFO closure for migraine and headache. For example, I would like to see further study into type of migraine or headache vs type of PFO.

We’re still getting mixed answers about how helpful it is, and we need to be especially cautious before we recommend it for children.

For more information:

Should we give up on the PFO Closure Solution?
In Children, the PFO Solution Studied (a previous study)
Clinical Practice, Resource Utilization, and Outcomes of Device Closure of Patent Foramen Ovale in Pediatrics. (abstract of the above mentioned study)

28 November 2012

Child with Headaches? Glasses not the Solution.

James Discoveries & Stats, Tips 1

Your child is getting frequent headaches? Especially while they’re working on homework? Looks like they need eye glasses – right?

Actually, probably not.

Earlier this month, a study was presented at the 116th Annual Meeting of the American Academy of Ophthalmology. The records of 158 children were reviewed who had come to the ophthalmologist because they had frequent headaches.

All the children were given an eye exam.

Most of the children did not have problems with eyesight (problems that had not already been corrected – some did wear glasses). About 14% said that they had headaches when doing homework and other visual tasks. But a need for vision correction was not the primary cause of the headaches – in ANY of the cases!

Researchers noted that for most of these children the headaches did lessen over time – but getting dealing with vision problems did not mean they were any more likely to resolve.

The take-away? If your child is having frequent headaches, it’s very unlikely that vision problems are the issue. Of course, your child should have regular check ups for eyesight. But don’t wait for new glasses to deal with headache problems.

If your child has frequent headaches, it’s not normal. Take your child to a doctor right away. If your doctor brushes it off as nothing, seriously consider a specialist. The earlier you can catch headache problems, and treat them, teh better.

via Children’s Headaches Rarely Indicate a Need for Eyeglasses, Study Finds

27 July 2012

Attention Problems in Children with Headache?

James Discoveries & Stats 0

Could some attention problems in children actually be related to headache or migraine?

Studies in the past have indicated that visual response times may slow in patients with migraine. The way we respond to visual stimuli is one way that attention disorders are found and diagnosed. So – is it possible that attention disorders, particularly in children, could be related to migraine and headache?

Could headache change the way children pay attention?

Researchers in Italy set out to find the answer. In a study reported on in November by the American Headache Society, 62 children with headache and/or migraine were taken alongside with 52 children without headache or migraine.

The children had three headache types: migraine with aura, migraine without aura, and tension-type headache.

The children were tested. Interestingly, there was a difference between the patients and the controls, but there was no difference between children with migraine or tension type headache.

So the answer at this point seems to be yes – children with tension-type headache or migraine do have more problems with attention than children without these conditions.

In their conclusion, researchers wrote: Our results confirm the presence of an association between attentional problems and headache that may impact academic learning and daily activities on the long term.

The research reminds us again that it’s important to treat children with migraine and tension type headache. These things truly impact all of life, and not just the moment when the child is having a headache.

It’s very easy for parents and care givers to say,"It’s only a headache, and it’s only once in a while." But headache should never be considered normal, and should always be taken seriously. Doing so can avoid many problems in the future.

Incidentally, the researchers rightly noted another hint that this study gives us. The children had the same results, even in different conditions – hinting again that there may be a very similar physiological basis for both migraine and tension-type headache. For more on this idea, don’t miss Major shift in Migraine Thought? (part 1).

Here are some tips for dealing with child headache.

23 March 2011

A Smile on a 7 year old Migraineur…

James Resources, Website news 0

One of the winners of the book for children entitled My Secret, Jill, was kind enough to send me pictures of her 7 year old migraineur! I won’t give any more information (to protect the innocent), but I think the smile says it all. She was pretty excited to get a book about migraine – almost like it was written just for her (and it kind of was, right?)!

If you have a child with migraine, or another type of chronic pain, this is just the book to get! Find out more right here. I’ll bet there are some birthdays coming up… 🙂