Migraine disorder can be manifested by headaches, stomach
aches, or, in a young child, irritability and vomiting. There is no doubt that children of
all ages do suffer from migraines, but the diagnosis is notoriously difficult to confirm
in the youngest groups due to the child's inability to give an accurate and detailed
enough history. In older patients, we can usually be sure due to the presence of an
"aura" prior to the headache, a normal neurologic exam, and a lack of findings
suggesting other diagnoses. There is also commonly a family history of migraine.
There are generally two approaches to managing migraines. The
first is based upon intervention, i.e. treating the headache when it occurs. The second
approach is preventive, i.e. giving something all the time trying to prevent headaches
from occurring in the first place.
The first step is to choose between these two approaches.
That choice generally should based on the frequency of the migraines. If this is something
that only occurs occasionally (once every few months), of course there is no point in
taking medication all the time. On the other hand, if someone is experiencing headaches
more than several times per week, chronic medication would be justified. It is debatable
exactly where to draw the boundary between these two approaches.
Intervention therapies are traditionally based upon
either narcotics or non narcotic pain killers. Other treatment options exist in this
category, however: Ergot containing compounds are generally considered not safe under age
nine or ten years, but can be very good for teenagers. Sumatriptan (Imitrex) is a newer
medicine which can be very effective, and safe for ages over 6 years, and which comes in
oral, nasal spray, and injectable forms. Non pharmacologic approaches to intervention
therapy would start with simple rest. They would also include techniques such as
biofeedback, self hypnosis, meditation techniques, yoga, and massage. Of course, many of
these would be difficult to teach a 3 year old as well..
Preventive therapies include the following:
A. Periactin is an anti histamine which, for reasons we do
not understand also has anti migraine properties. It can have the side effect of
drowsiness, however. Because this medication has been used for both allergies and to
stimulate appetite in young children for many years, however, it is often the preventive
drug we start with in young children because we have so much experience with it and know
it to be safe.
B. Tricyclic antidepressants are also effective when given
for migraine prevention. Once again, because we have plenty of experience using this kind
of medication for other purposes in children, Pediatricians are fairly comfortable
prescribed this for migraine as well. Usually, a lower dose than would be used for
depression is effective, although at times EKG monitoring and/or blood tests are necessary
to monitor this medication.
C. Inderal is a medication commonly used in adults to control
blood pressure. A secondary use in both adults and children is migraine prevention. This
can be very effective, but we rarely use this approach before age 7 to 8 - only because we
have little experience using this drug for any reason in younger children.
D. A number of
life style changes and/or
dietary maneuvers
can also help migraine. These include getting more sleep, avoiding caffeine, chocolate, or
cheese, or reducing stress at home or at school. |
