How common are migraines in children?

73.9 percent of seventh graders complain of primary headaches. The most common forms are migraines and tension-type headaches. Almost 50% of those affected report symptoms of migraine - this is significantly more than previous studies suggested. 78.7 percent of children with tension headaches and 62.1 percent of those affected with symptoms typical of migraines have not yet been to the doctor for this reason. 33.8% of those affected by tension headaches and even 40.9% of children and adolescents with migraines take headache medication without a doctor's recommendation.

How do I know if my child's headaches need treatment?

If headaches occur again in children, a doctor should always be consulted, who will then make a precise diagnosis of the type of headache. This precise diagnosis is a prerequisite for further treatment of the headache. However, headaches should be treated by a doctor even if the previous treatment concept 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 a headache occurs that is suddenly completely different than before, you should urgently see a doctor. This also applies if symptoms such as neck pain, neck stiffness, fever, chills, joint pain, neuropsychological disorders or increasing fatigue exist.

How can you tell the difference between a tension headache or a migraine?

Migraine is a paroxysmal disorder that can occur anywhere from 4 hours to 3 days. In children, migraine attacks can also occur more briefly, lasting only 2-3 hours. Headaches most often begin in the morning after waking up. They usually subside by late morning. This sometimes gives the impression that the child wants to avoid going to school. However, this is a typical course that is caused by an energy deficit in the nerve cells in the early morning. The headache has a pulsating, throbbing character. The pain intensity is very strong. The pain can occur on one side. Normal activity is severely hindered or even made impossible. Accompanying symptoms include nausea, vomiting, and hypersensitivity to noise and light. The migraine attacks can be initiated by neurological symptoms, the so-called aura. The most common visual disturbances are zigzag lines, flickering, speech disorders, abnormal sensations or even paralysis.

Tension-type headache is a bilateral dull, pressing headache. The pain intensity is mild to moderate. The duration is 30 minutes up to 7 days. Normal activity is hindered, but not impossible. There may be hypersensitivity to noise or light, but nausea or vomiting typically does not occur. Tension-type headaches can also occur chronically on more than 15 days per month.

Headaches can be varied, even combined. The most common types are migraines and tension-type headaches. Especially with migraine sufferers, over half of affected patients also experience tension headaches. In addition, other types of headaches can also exist, such as headaches caused by high blood pressure or medication overuse headaches. It is therefore very important to work out the various diagnoses very specifically and then take targeted action against them in therapy.

What are the causes?

Today we differentiate between 367 different main headache diagnoses. There is no such thing as a “headache” or “a” stomach ache. The precise differentiation of the pain mechanisms and the conditions that maintain the pain is therefore of central importance. In the case of the most common headaches, migraines and tension-type headaches as well as medication overuse headaches, the mechanisms are now very well known, and it is therefore possible to specifically intervene in the pain mechanisms.

Migraine pain is caused by a so-called neurogenic inflammation in the blood vessels of the meninges. Certain nerve messengers are released there, which cause local inflammation. This leads to increased sensitivity to pain in the vascular membranes, so every shock, every movement, every pulsation and throbbing hurts. The triggering of the excessive release of these inflammatory substances occurs through activation of certain nerve nuclei in the brain stem. This is a result of excessive regulation due to energy deficits due to increased energy turnover in the nerve cells. There are now 38 known risk genes for migraines. These lead to an amplification and release of the neurotransmitters discussed in the nervous system. This means that migraine therapy must intervene in this process in a complex manner in order to stabilize the headache. Headaches can be severely disabling illnesses that have underlying biological mechanisms.

According to current understanding, tension-type headaches are caused by exhaustion of the central pain processing system in the brain. The body's own pain regulation system is exhausted due to the excessive use of pain stimuli, pain mechanisms can no longer be adequately regulated and this leads to an initially episodic overstress and, if there is a lack of regeneration, to a chronic overstrain with the corresponding pain episodes and even to permanent pain.

The development of headaches due to medication overuse is explained by painkiller-related exhaustion of the body's own pain defense system. Due to the frequent pain attacks and the excessive consumption of acute painkillers, the body's own pain defense system is increasingly weakened and more and more headache episodes occur, up to a permanent headache at the end of the development.

What are the treatment options for children?

  • Information: Information, knowledge and behavioral health measures are the most important pillars of therapy, especially for children. Headache therapy in children should not be limited to the treatment of symptoms and critical illnesses. Rather, therapy must focus on maintaining and restoring mental and physical balance, strengthening organ functions and preventing possible disease mechanisms.
  • Avoiding stress: An important trigger for migraine attacks in children is physical overexertion and stress. Such factors can always be at work when, for example, children sleep too long or too short. Irregular going to bed and waking up should be avoided in children with migraines.
  • Nutrition: A sudden change in diet and eating behavior should also be avoided. This includes, for example, a hasty breakfast or even skipping breakfast before school because of lying in bed for too long.
  • Environment: But external factors that you have difficulty influencing yourself can also cause physical stress. These include high humidity in humid weather, extreme heat, sudden weather changes, poor air conditions due to poorly ventilated rooms, strong smells, suddenly changed lighting conditions, noise or drafts. Headaches in children can also be triggered by external pressure, such as hairbands, tight headbands, hats or swimming goggles.
  • Sports: Excessive sports activities can also lead to migraine attacks. If possible, children should choose sports that do not require a very rapid change in physical activity. Ideally, swimming, running, cycling or other endurance sports are suitable for this.
  • An irregular life, tension, fears, stress and psychological overload are the main potent triggers for migraine attacks in children.
  • Digital media and TV: Frequent television with often aggressive and stressful content, computer games, spending a long time on the Game Boy, upbeat music and many appointments in the schedule are often everyday life for children. All of these can trigger migraine attacks. Children with migraines are particularly sensitive to intense smells and these should be avoided.
  • Light: Constantly changing lighting conditions should also be avoided. This also includes the – often well-intentioned – desk placed in front of a window. The constant adaptation to the light and dark situation is a permanent stress factor for the nervous system and can trigger migraine attacks. If children suffer from migraine attacks particularly frequently at school, you should check where the child sits at school and pay attention to whether unfavorable changing lighting conditions can be identified as a trigger. Moving the child can then reduce the problem. In young people, flickering lights in discos combined with noise can also be a potent migraine trigger.
  • If severe pain occurs, even accompanied by severe nausea or vomiting, drug therapy should be initiated. However, before using a specific preparation, a doctor should be consulted and the necessary medical examinations should be carried out. Due to the high number of headache days per month, preventative drug therapy may also be necessary. This should also be clarified during a medical examination.

 Is the disease less serious in children than in adults?

Serious consequences can occur at any age. Children and young people in particular can no longer participate in a regular life due to headaches, have to drop out of school and their lives get out of hand.

What prevention options are there?

Our current scientific analysis has shown that almost three quarters of children and young people complain about headaches at school, but only 30 percent know the correct diagnosis for their symptoms. 37.5 of those affected take headache medication without a doctor's prescription. Knowledge and information are the best medicine. We have therefore initiated the hat campaign. Children and young people should be made their own headache experts.

The cartoon character Beanie has a headache and goes to the doctor. He has lots of tips on what you can do to prevent headaches from occurring in the first place. With humor and charm, the sympathetic figure “Mütz” 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 prevent headaches? But the comic also motivates headache-free readers to get smart and take precautions. The project is aimed at children and young people between the ages of 9 and 16 and their families.

The “Hat Campaign – Childhood without Headaches” provides free teaching materials for headache prevention to seventh graders. 21 health insurance companies are supporting the project nationwide as part of their statutory prevention mandate. The results of the accompanying scientific survey show high case numbers and inadequate care for children and adolescents affected by headaches. With a new comic film, the initiators are creating an offer that provides students with contemporary information about the development and treatment of headaches. For further information see https://schreinklinik.de/2016/09/30/mutze-hat-den-kopfschrei-satt-der-comicfilm-zur-aktion-mutze-gegen-migrane-und-kopfschrei-in-der-schule /

-What is the prognosis for acute migraine in a child?

Today there are over 367 main diagnoses of headaches. The most common types of headaches include migraines and tension-type headaches. Migraines are based on a genetic predisposition; today there are 38 risk genes and 44 different gene variants known that increase the likelihood of migraines. Basically, these genetic foundations remain present throughout life.

Migraines usually mean that you are particularly reactive for several decades of your life. Anything too fast, anything too sudden, anything too many and anything too impulsive can trigger migraine attacks. This requires an adapted lifestyle. The dream that there is some way to stop the migraines and switch off and then be able to live as you want without restrictions is not productive. Migraine is a serious illness that must be treated intensively and sustainably through knowledge, information, behavioral measures and, if necessary, medication. This is comparable to sunburn: you can actively protect yourself from it, but the sensitivity to it remains. On the other hand, there are also symptomatic headaches that can be stopped completely by treating the underlying disease. This is not the case with so-called primary headaches, which are independent illnesses.

You can find the detailed interview on:

http://www.spiegel.de/plus/neurologe-im-interview-wie-sie-migraene-fähr-schon-im-kindesalter-erkennen-a-cdbeaa1e-cb47-4414-8f5f-c8c850a5b8c1