How common are migraines in children?
73.9 percent of seventh graders complain of primary headaches. The most common forms are migraine and tension-type headaches. Nearly 50% of those affected report migraine symptoms – significantly more than previous studies suggested. 78.7 percent of children with tension headaches and 62.1 percent of those with migraine-like symptoms have not yet consulted a doctor. 33.8% of those with tension headaches and even 40.9% of children and adolescents with migraines take headache medication without a doctor's prescription.
How can I tell if my child's headaches require treatment?
If children experience new headaches, a doctor should always be consulted to make a precise diagnosis of the type of headache. This accurate diagnosis is essential for further treatment. Headaches should also be treated by a doctor if the previous treatment approach is no longer effective. An examination is also necessary if new symptoms appear, the headaches become more frequent, the pattern of occurrence changes, or if there are unusual accompanying symptoms. If headaches suddenly occur that are completely different from previous ones, a doctor should be consulted immediately. This also applies if symptoms such as neck pain, neck stiffness, fever, chills, joint pain, neuropsychological disorders, or increasing fatigue are present.
How can you tell the difference between tension headaches and migraines?
Migraine is a recurrent condition that can last from 4 hours to 3 days. In children, migraine attacks can be shorter, lasting only 2-3 hours. Headaches most often begin in the morning after waking up and usually subside by late morning. This can sometimes give the impression that the child is trying to skip school. However, this is a typical pattern caused by an energy deficit in the nerve cells in the early morning. The headaches are throbbing and intense. The pain is very severe and can be one-sided. Normal activities are severely impaired or even impossible. Accompanying symptoms include nausea, vomiting, and sensitivity to light and sound. Migraine attacks can be preceded by neurological symptoms known as an aura. The most common symptoms are visual disturbances such as zigzag lines or flashing lights, speech difficulties, paresthesia, or even paralysis.
Tension-type headache is a dull, pressing headache on both sides of the head. The pain intensity is mild to moderate. It lasts from 30 minutes to 7 days. While it may hinder normal activities, it does not make them impossible. Increased sensitivity to noise or light may be present, but nausea or vomiting are not typical. Tension-type headache can also occur chronically, on more than 15 days per month.
Headaches can manifest in various ways, including combinations. The most common types are migraine and tension-type headaches. In fact, over half of migraine patients also experience tension headaches. Other headache types can also be present, such as headaches associated with high blood pressure or medication overuse headache. Therefore, it is crucial to identify the specific diagnoses and then tailor the treatment accordingly.
What are the causes?
Today we distinguish 367 different primary headache diagnoses. There is no single "headache," just as there is no single "stomachache." Therefore, the precise differentiation of pain mechanisms and the conditions that maintain the pain is of central importance. In the most common headaches—migraine, tension-type headache, and medication-overuse headache—the mechanisms are now very well understood, allowing for specific interventions into these pain mechanisms.
Migraine pain arises from a so-called neurogenic inflammation of the blood vessels lining the meninges. Certain neurotransmitters are released there, causing local inflammation. This leads to increased pain sensitivity in the blood vessel membranes; therefore, every jolt, every movement, every throbbing and pounding is painful. The trigger for the excessive release of these inflammatory substances is the activation of specific nerve nuclei in the brainstem. This is a consequence of over-regulation due to energy deficits resulting from increased energy expenditure in the nerve cells. Currently, 38 risk genes for migraine are known. These lead to an increase and release of the aforementioned neurotransmitters in the nervous system. It follows that migraine therapy must intervene comprehensively in this process to stabilize the headache. Headaches can be severely debilitating conditions with underlying biological mechanisms.
According to current understanding, tension-type headaches are caused by an exhaustion of the central pain processing system in the brain. The body's own pain regulation system is exhausted by excessive strain from pain stimuli; pain mechanisms can no longer be adequately regulated, leading initially to episodic and, if regeneration is insufficient, chronic overuse with corresponding pain episodes, ultimately resulting in persistent pain.
The development of headaches due to medication overuse is explained by a depletion of the body's own pain defense system caused by painkillers. Frequent pain attacks and excessive intake of acute painkillers increasingly weaken the body's own pain defense system, leading to more frequent headache episodes and ultimately to chronic headaches.
What are the treatment options for children?
- Information: Especially in children, information, knowledge, and behavioral medicine measures are the most important pillars of therapy. Headache therapy in children should not be limited to treating symptoms and critical illnesses. Rather, therapy must focus on maintaining and restoring the mental and physical balance, strengthening organ functions, and preventing potential disease mechanisms.
- Avoiding stress: A major trigger for migraine attacks in children is physical overexertion and stress. These factors can always be at play when children, for example, sleep too long or too short. Irregular bedtimes and wake-up times should be avoided in children with migraines.
- Nutrition: Sudden changes in diet and eating habits should also be avoided. This includes, for example, eating breakfast in a hurry or even skipping breakfast before school due to lying in bed too long.
- Environment: External factors, which are difficult to control, can also cause physical stress. These include high humidity in muggy weather, extreme heat, sudden weather changes, poor air quality due to poorly ventilated rooms, strong odors, sudden changes in lighting, noise, or drafts. Headaches in children can also be triggered by external pressure, such as from hairbands, tight headbands, hats, or swimming goggles.
- Exercise: Excessive physical activity can also trigger migraine attacks. Children should ideally choose sports that don't require rapid changes in physical activity. Swimming, running, cycling, or other endurance sports are ideal.
- An irregular lifestyle, tension, anxiety, stress and mental overload are major potent triggers for migraine attacks in children.
- Digital media and TV: Frequent television viewing, often involving aggressive and stressful content, computer games, prolonged use of Game Boys, upbeat music, and packed schedules are commonplace for children. All of these can trigger migraine attacks. Children with migraines are particularly sensitive to strong smells, which should be avoided.
- Light: Constantly changing light conditions should also be avoided. This includes the – often well-intentioned – placement of a desk in front of a window. The constant adjustment to the light-dark situation is a persistent stress factor for the nervous system and can trigger migraine attacks. If children frequently experience migraine attacks at school, their seating arrangement should be examined to see if potentially unfavorable, changing light conditions can be identified as a trigger. Moving the child can then reduce the problem. For teenagers, flickering lights in nightclubs combined with noise can also be a potent migraine trigger.
- If severe pain occurs, even accompanied by severe nausea or vomiting, medication should be used to treat the attack. However, before using any specific medication, a doctor should be consulted and the necessary medical examinations should be carried out. It may also be necessary to take preventative medication due to the high number of headache days per month. This, too, should be clarified during a medical examination.
Is the disease less severe in children than in adults?
Severe cases can occur at any age. Children and adolescents, in particular, may be unable to participate in a regular life due to headaches, may have to drop out of school, and their lives may spiral out of control.
What prevention options are available?
Our latest scientific analysis has shown that nearly three-quarters of children and teenagers complain of headaches at school, but only 30 percent know the correct diagnosis for their symptoms. 37.5 percent of those affected take headache medication without a doctor's prescription. Knowledge and information are the best medicine. That's why we initiated the "Mütze" (Cap) campaign. We want to empower children and teenagers to become their own headache experts.
The comic character Mütze has a headache and goes to the doctor. The doctor has lots of tips on how to prevent headaches from occurring in the first place. With wit and charm, the endearing character Mütze takes young people on a journey of discovery: Where do headaches come from? What role do medications play? What does "prevention" mean, and who can help avoid headaches? But the comic also motivates readers without headaches to learn more and take preventative measures. The project is aimed at children and young people between the ages of 9 and 16, as well as their families.
The "Action Hat – Childhood Without Headaches" provides seventh-grade students with free teaching materials on headache prevention. Twenty-one health insurance companies support the project nationwide as part of their statutory prevention mandate. The results of the accompanying scientific survey demonstrate high rates of headaches and inadequate care for children and adolescents. With a new animated film, the initiators have created a resource that provides students with up-to-date information about the causes and treatment of headaches. Further information can be found at https://schmerzklinik.de/2016/09/30/mutze-hat-den-kopfschmerz-satt-der-comicfilm-zur-aktion-mutze-gegen-migrane-und-kopfschmerzen-in-der-schule/
What is the prognosis for an acute migraine attack in a child?
Today, over 367 main diagnoses of headaches are distinguished. The most common types of headache include migraine and tension-type headache. Migraine is based on a genetic predisposition; currently, 38 risk genes and 44 different gene variants are known to increase the likelihood of developing migraines. These genetic predispositions generally remain present throughout life.
Migraines typically mean being plagued by this heightened reactivity for several decades of life. Anything too fast, too sudden, too many, or too impulsive can trigger migraine attacks. This necessitates an adapted lifestyle. The dream that there's some way to simply switch off migraines and live life to the fullest is unrealistic. Migraines are a serious condition that requires intensive, long-term treatment through knowledge, information, behavioral adjustments, and, if necessary, medication. This is comparable to sunburn: you can actively protect yourself, but the sensitivity to it remains. On the other hand, there are also symptomatic headaches that are completely stopped by treating the underlying condition. This is not the case with so-called primary headaches, which are independent diseases.
You can find the full interview at:
A very good overview with the important information that sensitivity lasts a lifetime and you can “only” turn the adjusting screws. I only really realized it today.