EBHSG - FEBRUARY 1997 MEETING NOTES

TOPIC: "CHILDREN’S HEADACHES"

Majeed Al-Mateen, M.D., a pediatric neurologist at Childrens Hospital Oakland, spoke at the February 11, 1997 meeting of the East Bay Headache Support Group. The meeting was held in the Ball Auditorium at John Muir Medical Center from 7:30 to 9:00 PM, and approximately 35 people attended.

Dr. Al-Mateen’s topic was "Headaches in Children and Adolescents—Evaluation and Management." He sees children in his practice who range in age from birth to eighteen years, and even some in their early 20’s. The parents of his headache patients always come in with lots of questions, including:

"Does my child have a brain tumor?"

"Shouldn’t we do a brain scan?"

"What’s causing the headaches.?"

Dr. Al-Mateen passed out a summary of the points he would cover in his talk (which is attached) and then proceeded to go through them.

Item 3--Indications for Brain Imaging. Dr. Al-Mateen said that a child may experience vomiting with his headaches, which tends to occur in the morning upon waking. If a child has persistent headaches for more than three to six months, and other symptoms do not appear in that time, then the headaches are probably not serious (i.e., not caused by a tumor).

Item 5--Migraine Headaches. He said that he has seen patients as young as two years old with migraines. The migraines can cause ocular abnomalities, such as visual disturbance, losing vision, double vision, but is it hard to get a very young child to describe his symptoms accurately, thus making it harder for the physician to make an accurate diagnosis.

One type of migraine is Opthalmoplegia, which causes a drooping of the eyelid.

Dr. Al-Mateen mentioned there is a neurocutaneous skin disease related to the brain, where the patients have coffee-colored spots on the skin, and can have brain tumors.

Dr. Al-Mateen does a complete neurological exam and takes the history of each of his young patients, but most kids with headaches don’t require brain imaging.

Item 4--What Causes Headaches? It depends on the pattern of the headaches.

Pattern Possible Cause

Acute Meningoencephalitis

Acute recurrent Migraine

Chronic progressive Tumor

Chronic non-progressive Tension-type

Mixed Migraine and tension

The International Headache Society has identified certain criteria they use to diagnose migraine. Some are:

• Five or more attacks.

• Headache lasts from four hours to seventy-two hours in adults, and from two hours to forty-eight hours in kids.

• Throbbing or unilateral (on one side of the head).

• Headache has to interrupt normal activity.

• Headache is triggered by movement.

• Accompanied by photophobia or phonophobia (exposure to light or sound causes the headache to get worse).

• Nausea or vomiting.

Item 7--Abortive Treatment for Migraine. Dr. Al-Mateen said that in his experience acetaminophen and ibuprofen seem to work with kids’ headaches, and of the two, ibuprofen is the best. He also tries a combination of the two medicines. Treatment must start at the first sign of a headache, and adequate doses must be given. Also, after trying acetominophen and ibuprofen, he prescribes Midrin, which includes a tranquilizing medicine. Then Imitrex is tried. Imitrex was approved for adults only, but the doctors at Childrens Hospital have injected kids as young as eight years old with no ill effects, and Imitrex has been quite successful in getting rid of the headache.

People tend to have a life-long predisposition to migraine, but 48% stop having these headaches after childhood. Of the children under twelve years of age who suffer from migraines, most are boys, whereas after twelve years, the majority switches to females.

Item 8--Preventive Treatment. Keep sleep patterns regular--even on weekends. Eat regular meals (always have a snack available for your child). Don’t skip breakfast. Try relaxation techniques and biofeedback. Try to get the child to avoid headache triggers. Many children complain of more headaches in hot weather. Dr. Al-Mateen said it is mostly the change in weather that triggers the headaches, not the heat.

Item 10--Preventive Treatment (Pharmacological Treatment). Try using preventive drugs if the child experiences more than four attacks per month, or if the child has to miss school because of his headaches. Also, if the child can’t cope with his attacks, or if Sumatriptan or other abortive drugs have failed, preventive drugs may be helpful.

Drugs used for the prevention of headaches in children:

• Periactin--originally a drug to stimulate appetites.

• Inderal--a beta blocker.

• Elavil--for children over twelve years with tension-type headaches (or a transformed migraine--continuous--doesn’t go away).

• Depakote--originally for seizure and mood disorders.

Dr. Al-Mateen said that Childrens Hospital has a pain management clinic, and kids with chronic headaches can be referred to it. Using a multidisciplinary approach is the best thing.

Item 13--Mixed Headache Profile. Transformed Migraine is where the primary headache is a migraine, but it hasn’t been treated successfully and it is transformed into a chronic headache.

Questions and Answers.

At the conclusion of his talk, questions were asked from the audience. Dr. Al-Mateen was asked about cyclic vomiting. He talked about migraine equivalents, which don’t affect the head, but the patient experiences abdominal pain and/or vomiting.

He suggested that the child (or parent) keep a headache calendar so patterns can be detected.

Migraine is a systemic disorder. It doesn’t affect just the head. The child shuts down, looks pale, wants to sleep.

Dr. Al-Mateen was asked if he has ever found that getting glasses has corrected a headache condition. He said it was rare, but visual acuity can trigger headaches.

Rebound headaches were discussed. The patient should consider another approach to the problem of his headaches. Try non-pharmacological approaches first.

The child has to be motivated to use relaxation techniques (especially the middle-school aged child).

The notes provided above were taken by an EBHSG volunteer and have not been reviewed by the speaker for accuracy. If you have any questions regarding the notes, please contact the EBHSG.

The intention of the East Bay Headache Support Group is to provide information and resources. It does not provide medical advice, which should be obtained directly from a physician