Treatment and prevention plans are unique for younger people who experience
migraine headaches.
If you’ve ever experienced a migraine, you know it’s not your
average, run-of-the-mill headache. And a migraine is more than just a
“bad headache.” Migraines are in a headache class all their
own. They have specific clinical criteria. Migraine headache pain is often
described as throbbing or pulsating in nature. The headaches typically
last at least a few hours, but in extreme cases can last for a few days.
What’s worse, these headaches can be accompanied by light and sound
sensitivity, or nausea and vomiting in some people. Unfortunately, it
isn’t only adults who are prone to migraines. Kids and teens can
suffer from them too. The symptoms of migraine headaches in kids are very
similar to those experienced by adults. However, new research indicates
that the appropriate plan for treatment and prevention of migraine in
children may differ from the approach taken with adults.
Based on recent research performed by a multidisciplinary panel, and for
the first time since the early 2000s, the American Academy of Neurology
(AAN) has updated both its acute treatment guidelines for migraine in
children and adolescents, as well as its prevention protocol. It recommends
that treatment should center on early intervention and identification
of the best route to administer medication. For migraine prevention, the
academy recommends counseling on lifestyle factors that might increase
the risk of a migraine episode, as well as avoidance of migraine triggers
and the dangers of medication overuse.
For child and adolescent treatment, the AAN says evidence continues to
support the use of ibuprofen and acetaminophen for migraine pain relief
in young people. What the AAN also reports is high confidence in the use
of medications known as triptans. Triptans are used to treat acute moderate
or severe migraines – meaning they are designed to stop an episode
after it begins. Different than other typical pain-relievers, triptans
are designed to work through effects on the serotonin neurotransmitter
in the brain. When activated, serotonin helps to reduce inflammation and
constricts blood vessels – which helps to stop a migraine headache.
The AAN’s research also revealed that adolescents who received both
an oral and nasal spray type of triptan were more likely to be migraine-free
after two hours than those who had only received a placebo. The rationale
is that the nasal spray is absorbed more quickly and can get to work on
the migraine faster than if it were to be taken orally. Though there wasn’t
any evidence that acute treatments helped with migraine-associated nausea
and vomiting, some triptans did help with phonophobia (sensitivity to
sounds) and photophobia (sensitivity to bright lights) related to the
migraine episode.
Of course, one of the most critical questions on the minds of parents with
children who suffer from migraines is: How can we help stop a migraine
before it starts? In its research, the AAN determined that the majority
of medications studied failed to be superior to placebo. So, while there
may not currently be a recommended medication for migraine prevention
in children, the AAN does provide prevention recommendations in its new
guidelines. These recommendations comprise two general categories: lifestyle
modifications and trigger reductions.
Lifestyle Modifications – Chronic or frequent migraine headaches
are as different as the people who experience them, but they are associated
with certain lifestyle factors, especially in adolescents. These include
obesity/overweight, caffeine and alcohol use, lack of physical activity,
poor sleep hygiene, and tobacco use/exposure. If your child is affected
by any of these factors, improving or modifying them may help tremendously
in reducing the frequency of migraine episodes.
Trigger Reduction – Similar to lifestyle factors involved in chronic
migraines, migraine triggers can also vary from one child to the next.
Stress, altered eating patterns (skipping meals), weather changes, travel
(motion sickness), diet (foods with nitrates or MSG), and changes in a
routine can all be enough to trigger a migraine episode. For parents trying
to get to the bottom of what’s triggering their child’s migraines,
keeping a “migraine journal” can help. In the journal, you
can enter each migraine episode, its duration, and any triggers that may
have brought it on.
Though there is currently no cure for migraine headaches, much research
is being done to get to the bottom of what causes them and effective ways
to treat or eliminate them. When it comes to treatment for children and
adolescents, consult with your child’s pediatrician or a pediatric
neurologist to determine the best next steps. And of course, if there
are lifestyle modifications or trigger reductions you can help your child
make, give it a shot. You might be surprised how even the slightest alterations
can make a significant difference.
Sources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5885754/
https://www.medscape.com/viewarticle/917713
https://n.neurology.org/content/93/11/487
https://headaches.org/2007/11/19/facts-about-triptans/
https://n.neurology.org/content/93/11/500
https://my.clevelandclinic.org/health/diseases/9637-migraines-in-children-and-adolescents