child migraine

9 May 2023

New Resource for Kids with Migraine (and their parents)

A new book, just published this year, provides another resource for young kids (ages 4-8) who are struggling with migraine.

Recently I enjoyed reading an article by Joanne McPhail, the author of a new children’s book, “Milly Has A Migraine”. Well, of course I don’t “enjoy” hearing about people’s migraine attacks! But there was a lot of insight in a short article. Here’s a bit of it – click the link for the rest.

I am not sure what was worse as a parent; watching them in pain and not being able to fix it, or watching their emotional struggles and not having a band-aid for that either. Having a lot of migraine attacks can be so difficult in so many ways. From people not understanding the whole-body experience of a migraine and wondering why you can’t just carry on with a headache; to people thinking you are exaggerating or making things up. Then there is just being forgotten about (out of sight, out of mind), left out and missing out. My kids were both sports kids, and I cannot tell you how much guilt we all had about practices and games missed. I will say that I probably didn’t help at those times, as I myself felt badly about them missing these things, and likely contributed unwittingly, to their stress. With a little distance, it’s easier to reflect on these things and reflect on what I could have done better.
Joanne McPhail

It is a challenge helping children with migraine, even if – or maybe especially if – depends on how you look at it – you have migraine yourself. And so I’m always interested in resources that will help parents and children alike in the journey. Milly Has A Migraine is one of these – another way to open up conversations with your child about migraine.

If you’re interested in the book, you can pick it up at Amazon here – Milly Has A Migraine. Purchasing through the link will also help the work of this website continue, helping kids and adults alike through the maze of migraine and headache information.

6 September 2022

New Resource for Children and Teens with Migraine

James Resources 0

The Migraine Trust has recently developed a new online resource for children and teens with migraine. They announced it along with their recent report, “Dismissed for too long: The impact of migraine on children & young people” (pdf).

The report highlighted the need for better communication and support for younger migraine patients. A visit to a good doctor is key, but children and teens also need support at home, school, work, and in the community in general. Many people don’t even realize that many children do experience migraine attacks, and that those attacks may or may not be different than an adult attack.

The new site is divided up by age group. Children and their parents can click around to learn how to communicate their symptoms to other people, how to find help at school, and how to help themselves deal with migraine attacks.

Each section is age-specific, not only in language but also in topics and specific health concerns. Older patients will be thinking about college and preparing for adulthood. Younger patients commonly experience abdominal migraine, so you’ll see information about “tummy aches“.

To check out the new resource, go right to Help for children and young people with migraine.

15 June 2020

Does Migraine Affect Sleep in Children and Adolescents?

James Discoveries & Stats 0

We often discuss the links between sleep and migraine here. But studies are mostly focused on adults – what about children and adolescents?

A recent study published in the Journal of Medicine and Life has confirmed what we already suspected – there is a strong link between sleep problems and migraine.

Children and sleep - how well are they sleeping?

In this small study, researchers chose 18 patients with migraine, and a control group of 16. Each patient was evaluated and underwent a sleep test. So this is a general sleep test, not a test to see how well patients slept when they were actually having a migraine attack. So the question is, how well do migraine patients sleep during a regular night?

In this study, researchers found that children and teens with migraine did tend to have less deep sleep and more light sleep. They had more “arousals” during the night. And it took them longer to fall asleep.

These indicators could be a sign of a sleep disorder. And researchers did note that the numbers were more likely to indicate sleep disorders in the children with migraine.

Studying migraine in children is an extremely complex issue. It can have very different symptoms in children compared to adults, and those symptoms can change quickly. Because this is a time of growth and development, diagnosis and treatment can be challenging, but it is also all the more important. Both migraine and sleep disorders can have a major impact on normal growth and learning.

Parents and doctors need to pay special attention not only to “headaches”, but to other symptoms, and to sleep and sleepiness during the day. Diagnosing a sleep disorder can be a major step forward in treating migraine early. And although this was a small preliminary study, it does confirm what other studies are telling us, and hopefully will lead to a quicker diagnosis of sleep problems in children who are experiencing migraine symptoms (which often include stomach pain and nausea in children).

Read a summary of the findings of this study here: Researchers Investigate Relationship Between Sleep Disorders, Migraine in Children

Full study: The Role of Polysomnography in Identifying Sleep Disorders in Children with Migraine

8 May 2020

Which Medications are most recommended for Children and Teens with Migraine?

James Discoveries & Stats, Medications 0

These specific recommendations come from the American Academy of Neurology and the American Headache Society. A helpful summary was published at Practical Pain Management.

As with many such studies, the recommendations come from the level of “confidence” that we have based on the results of clinical trials. For example, as we’ll see under “preventatives”, amitriptyline (Elavil) is “high confidence” as a preventative, but propranolol (Inderol) is “low confidence”. That doesn’t necessarily mean that amitriptyline is amazing and the best or that propranolol is useless. It does mean that our data for propranolol is a lot more limited – although so far it looks quite promising.

Before even getting to medication, the article (Ask the PharmD: What are the recommendations for preventing and treating pediatric migraine?) quite rightly points to lifestyle changes. We could add to that other treatments, including biofeedback and certain supplements. It’s tempting to look at the most recommended medications and think that these are the most recommended treatments – that’s not the case. With children, as with adults, there are some excellent treatments that you’ll probably want to try before any regular medications (especially preventative medications).

So let’s start with abortive medications – which drugs are most recommended to stop a migraine attack once it’s started? Remember, this is different with every child, but at this point the most recommended include triptans – but not any triptan. Most recommended are zolmitriptan, and then sumitriptan. Also the combination of sumitriptan and naproxen. However, these are only recommended for ages 12 and up (many medications simply haven’t been adequately studied in younger children).

Ibuprofen is also recommended, and is the #1 choice for younger children (6 months and older).

Sumitriptan/noproxen and zolmitriptan were also recommended for the related symptoms of photophobia and phonophobia – that is, sensitivity to light and noise.

If the symptoms are serious and frequent, and other medications haven’t worked sufficiently, preventatives may be tried.

For preventatives, as mentioned earlier, amitriptyline was the “high confidence” choice, with topiramate sneaking in under “moderate confidence”. These were only listed for ages 10-17.

Remember, preventatives should be far down the list of things to try. Steady doses of medication and their side effects are not to be rushed into. Check this article for other reasons to be less than optimistic about preventatives for children: New Study Questions Preventative Migraine Drugs for Kids

Remember, these recommendations do not automatically mean that they’re the best choice for you or your child. If other medication has been tried but these have not, it’s probably a good place to start. But it will be worth the trouble to investigate other non-drug treatments, many of which have been very helpful for children and teens.

For more details, take a look at the article at Practical Pain Management, especially the last section.

2 May 2019

New Approaches to “Aggressive” Migraine Treatment

James Medications, Treatments 0

Migraine symptoms are sometimes “endured” for months or years without serious focus on treatment. Many people are being told that migraine is “normal” and that they just have to “put up with it” and “take an aspirin” (not that aspirin is always a bad idea).

Aggressive Migraine Treatment at the Hospital — Aggressive migraine treatment often requires hospitalization…

There are other patients who have tried many treatments, and are still, or now, experiencing several headaches a week, or almost constant migraine symptoms. And so “aggressive” treatments are finally tried.

One such aggressive treatment is used for children and teens as well as adults who haven’t responded to many of the most effective drug or even surgical treatments. It’s intravenous dihydroergotamine (DHE) therapy.

This is a serious, aggressive therapy because it generally involves hospitalization. Patients are given DHE every few hours (perhaps 3 times a day).

Results of this kind of treatment have been quite positive. Not only are many patients much better or even headache free at the end of the treatment, the improvement is often sustained for many months afterwards. (A couple of quick examples – see Repetitive intravenous dihydroergotamine as therapy for intractable migraine. and Inpatient treatment of status migraine with dihydroergotamine in children and adolescents.)

In spite of the positive results, one of the biggest drawbacks to this treatment is that full hospitalization is very expensive.

But trying to take the treatment to the next level, some specialists in Kansas City are using what they call the “Comprehensive Aggressive Migraine Protocol”, or CAMP. This is a 5 day treatment protocol for 11-18 year old patients. CAMP aims to make two major improvements:

This is “outpatient” treatment, so full hospitalization is not required.
Instead of full focus on DHE, the DHE treatment is combined with other treatments, such as massage therapy, relaxation training, and aromatherapy.

This type of treatment may not only save money, but also save on the extra stress of full hospitalization, as well as the possible stress of having the full focus on the intravenous DHE treatments. Also , it helps the patents take control of their condition by learning techniques that they can use at home in the months ahead. Finally, it brings a number of treatments together, which could mean better long-term success.

CAMP was the focus of a recent study, and here are the results

On average, headache intensity declined by 58% over 5 days of treatment (P<.01). Headache frequency decreased by a mean of 1.5 days per week (p=.01) through 3-month follow-up, with a 27% reduction in the proportion of patients reporting a continuous headache (p<.01). There also was an average reduction of 76% in school days missed per month (p<.01) and significant reductions in indices of healthcare utilization (healthcare provider calls and ED visits) (p<.01).
Enhancing outpatient infusion with interdisciplinary care to manage refractory pediatric migraine: Preliminary outcomes from “CAMP” (the Comprehensive Aggressive Migraine Protocol) (P3.10-016)

One statistic alone – the 76% decrease in missed school days – should get our attention. That’s pretty significant.

Sometimes migraine does require “aggressive” treatment. This study reminds us that there are times when we should consciously take time out of “normal life” to really focus on serious treatment, because the benefits for ourselves and those we love in the months and years ahead can be very significant.

Aggressive treatment may take many forms, and one way specialists can help is by giving options to migraine patients – protocols of well-researched and carefully planned treatments, that can break the cycle of migraine symptoms.

Learn more about Dr. Jennifer Bikel, the study’s lead author, here. Read more about DHE treatment in general here.