Migraine Awareness Day

Although my specialty in Neurology is epilepsy, I still practice a good deal of general Neurology. This means that I have a large group of patients I follow that suffer from migraines and other headache types. June is National Migraine and Headache Awareness month and June 21 is Migraine Awareness day.

In honor of this, I wanted to write a little bit about migraines and headaches as they are very common disorders that affect children. About 10% of school-aged children suffer from migraine, and up to 28% of adolescents between 15-19 years are affected by it (Migraine Research Foundation). Patients with these disorders can experience a lot of morbidity, including missing school, ER visits, and missing out on preferred activities.

How do we diagnose a migraine? We ask a lot of questions! When did it start, where is the pain, how does it feel, how long does it last, what makes it better or worse, do you have other symptoms like nausea, vomiting, light, or noise sensitivities?

Migraine headaches are characterized by lasting a long time (4-72 hours, can be shorter in children), can be unilateral or bilateral (the latter is more common in children), have a pulsating quality, pain is moderate to severe, physical activity make it worse, and they can be accompanied by other symptoms like nausea, vomiting, light, or noise sensitivity.

Diagnosing migraines can be more complicated in children since the history can be tough to obtain and children may experience symptoms a little bit different. It is not uncommon for the child to be more tired, cranky, complain of vision changes, or even be dizzy.

If you suspect your child is suffering from any type of headache, please discuss this with your pediatrician for further management and see if further consultation with a Pediatric Neurologist is warranted.

In the mean time, the first step in headache management is to keep a detailed headache diary in order to identify triggers and to follow a few healthy habits.

Common triggers include dehydration, poor sleep, and low blood sugar. They are also some foods that can trigger migraines, such as those containing MSG, nitrates, and tyramine. Foods like strong cheese, chocolate, and hot dogs are some examples but unfortunately, many foods can be a headache trigger.

These are all the things I recommend to my patients and their families:

1. Drink lots of water!
2. Get appropriate sleep depending on age group and develop good sleep hygiene, such as avoiding naps and screen time before bed time
3. Don’t skip meals and eat every 3 hours
4. Try to eat healthy protein with most of your meals
5. Avoid any food you have discovered to be a trigger (I don’t like food restricting children, so I would not recommend cutting out all foods that are listed as triggers without talking to a physician)
6. Exercise daily
7. Stress and untreated mood disorders like depression and anxiety can be big triggers of migraines, particularly in those patients with frequent headaches; addressing these issues can be very helpful in headache management.

If your child needs medication, please talk to your pediatrician about using ibuprofen or acetaminophen. These medications should not be used daily for headache management as they have side effects and can lead to medication overuse management. If they are not helping or they are being used very frequently, a consultation with a Pediatric Neurologist is needed.

On June 21, I wore shades to bring awareness and support to the 1 billion people worldwide that live with migraines.