Headaches are one of the most common pain disorders in childhood which negatively affect the child’s and the family’s quality of life. They are under recognized and undertreated mainly because children experience headaches differently than adults. Headache criteria are based on adult symptoms, so most young children are not recognized as having headaches because they don’t fulfill adult criteria.
Children who experience pain often become sensitized to pain. The nervous system actually interprets signals inappropriately. An example of this is when the brain interprets a feeling of pressure as pain. The signals are saddled over to the pain pathway instead of travelling up to the brain and being registered as soft touch, deep pressure, hot, cold, tingling and so forth. The other change that happens in the brain is that the threshold for what is felt as pain is lowered; therefore less of a signal is required before the child feels pain. This is a concern because without an appropriate understanding of the cause of pain, a correct diagnosis and an early intervention, the child has a higher likelihood of becoming an adult with chronic pain
Infants can have headaches following complications around or during delivery. A long, difficult or fast delivery and particularly one where the infant is pulled or pushed out are reasons why an infant can have a headache and be irritable. An acute cesarean section where the baby has descended in the canal and is pulled back up is traumatic for the head and neck. We understand an infant has a headache based on the history around delivery and their behavior. Holding their heads, scratching their face, pulling their hair and/or holding their eyes shut are common signs of a headache in an infant. Infants with difficulty feeding and sleeping may have a headache. Toddlers display headaches by head banging, holding their heads, turning away from light and/or seeking a quiet and dark room.
Pre-schoolers may have headaches of short duration which are usually experienced above the eyes. The quality is mostly pressing or tightening and they may cause problems with sleep. Among boys, behavioral disorders may be a sign of or a precursor to headaches. In this age group headaches may not be the primary symptom, instead the child may experience vegetative symptoms. The child may have episodes of pallor and sweating, abdominal pain, vomiting and/or vertigo. This age group is particularly difficult to diagnose due to issues with communication.
School age children may still have short episodes of headaches which increase with increasing age. Headaches are often experienced like a band around the head or at the temples. By puberty headaches behave more like those we recognize in adults and are more easily classified and diagnosed. It is most common to get a first headache in adolescence, but headaches starting at a younger age are not uncommon. Risk factors for headaches in adolescence are chronic stress, physical inactivity, pain in the shoulders and neck, smoking, drinking alcohol, and coffee consumption.
The most common types of headaches are migraine headache, tension-type headache (spännings huvudvärk) and cervicogenic headache ( huvudvärk som härstämmer från nacken).
Migraine headache is due to a neurovascular reaction caused by inflammation and vasodilation. It is hereditary and frequently coexists with asthma and atopic disease. It is primarily due to a chemical trigger, but stress and mechanical dysfunction of the neck can initiate and exacerbate it. This headache is classically experienced on one side of the head, though it may change place during an episode or from episode to episode. It is accompanied by nausea, vomiting, sensitivity to light and sound. Children with headache who vomit usually have migraine headaches. This headache becomes worse when you strain yourself, it is a pulsating headache which is relieved by sleep. This headache is relieved by a class of medications called triptans. Other common medications like paracetamol and ibuprofen do not completely relieve the headache.
Migraine headaches are the most common cause of severe recurrent headaches in children. The quality of life for these children and their families is compromised, with children often home not only with headaches but other sicknesses. It affects their social life and academic performance. Risk factors for developing a migraine headache are complications during pregnancy, prematurity, intracranial bleeding in childhood, meningitis and food allergy.
In younger children precursors to migraine include childhood periodic syndromes. These are primarily recurring episodes of vertigo, vomiting, abdominal pain. Studies are currently investigating whether colic is an early manifestation of migraine in some children. In older children some common symptoms of migraine include sensitivity to smells, dizziness, balance disturbances, anxiety and depression. Sleep disturbances are common with migraine headaches, including nightmares, snoring, grinding teeth and sleep talking. Poor sleep patterns are related to the onset and chronicity in migraine headaches. Other triggers for migraine headaches are fatigue, infection, stress, hormones, missing meals and bright flashing lights. Foods which can trigger a migraine include dairy products, citrus fruits, nitrites, food dyes and additives and artificial sweeteners. Other offending chemicals include allergenic proteins (cross allergens)LINK, sulfites, histamine, MSG and asthma medicine.
Nutraceuticals are vitamins, minerals and herbs used to treat health problems. Research has shown effectiveness of certain products for the treatment of migraine headaches in children. These include D vitamin, riboflavin, magnesium, coenzyme Q10, feverfew and butterbur.
A prior injury to the neck or mechanical problems with the neck can initiate or exacerbate a migraine headache. In these headache sufferers, chiropractic treatment of the neck reduced the frequency, intensity and duration of the headache as well as decreased the intake of headache medication. This highlights the importance of ergonomics for children and adults who are prone to headaches.
Look for coming articles on tension-type headaches, cervicogenic headaches and ergonomics for children and adults.
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