Youngsters and adults alike can be affected by migraines, a recurrent headache syndrome that causes extreme pain, nausea and vomiting.
The condition is believed to result from abnormalities in the brain chemical serotonin and a stretching of blood vessel walls going to the brain and scalp.
The age of migraine onset varies. In most cases, migraine first arises during early adolescence. The condition has also been known to strike for the first time in children and in adults in their early 20s.
There are two predominant forms of migraines: classic and common.
Classic migraine affects about one-quarter of migraine patients. It usually begins with a warning, or aura, during which spots are seen on one side of the visual field.
The aura disappears after a few minutes and is followed by a headache that usually develops on the side opposite the aura. Affected children are likely to become sensitive to light and noise, feel nauseated and vomit.
The other form, common migraine, has similar symptoms. The difference is that in common migraine, headache is not as one-sided and is not necessarily linked to an aura or vomiting.
The duration of migraines ranges from a few hours to a day or two. Once the migraine has ended, children generally feel fine and can resume their usual activities.
There are steps that parents can take to reduce the incidence and severity of their child’s migraine attacks. For example, they can ensure that the child gets enough sleep, eats properly and exercises.
For some children, a diet lower in tyramine, an amino acid found in some foods, and a precursor of serotonin, can decrease the frequency, duration and severity of the condition.
Doctors may recommend that children avoid eating one or more of the foods that contain tyramine. These include cheese and cheese products, grapes and grape products, bananas, apples and oranges.
For children with occasional migraines, sleeping off the headache in a darkened room with a cold cloth on the head can be an effective nonmedicinal treatment. Children who have severe headaches may require medication for relief.
The first step in medication is use of acetaminophen or a nonsteroidal anti-inflammatory such as ibuprofen. These medications tend to be more successful at preventing migraine from becoming severe rather than eliminating a migraine in progress. In order to be efective, they must be taken in the right amount and at the first sign of the headache.
Children who are not helped by these methods may require specific treatment for migraines. This treatment causes constriction of the dilated blood vessels.
Medications used for treatment differ in adults and children. Adults often use injectable medications such as sumatriptan at the first sign of a migraine attack.
Instead of injectable medications, children are often prescribed oral medications such as ergot, with or without caffeine. Also, preventive medications, such as Periactin, certain antidepressants in small doses and Inderal may be used. These three medications can sometimes reduce the number and decrease severity of attacks when they occur.
Dr. Irving Fish is Associate Professor of Clinical Neurology and Director of Pediatric Neurology at New York University School of Medicine.