and tension type headaches
are the most commonly seen primary headaches in children and adolescents. Migraines tend to have an inherited component so often times there is a history among family members. About 10 percent of children and adolescents suffer from migraines. They are generally more severe than tension type headaches and usually occur with nausea and vomiting. Tension headaches are more common, but usually less disruptive unless they are very frequent. Stress, poor sleep, dehydration, and other issues such as depression and anxiety all can influence headaches. It is important to make the correct diagnosis regarding type of headache to start a treatment plan. Sometimes brain imaging studies such as MRI
are recommended to rule out other types of headaches as a secondary symptom of another neurologic condition.
Patients being evaluated in our comprehensive Headache Clinic are typically seen by a physician and/or pediatric nurse practitioner specializing in headache management. Depending on the child’s age and family interest, they may also be seen by a clinical psychologist with special expertise in cognitive behavioral therapy and biofeedback/relaxation therapy related to headache treatment. Making the correct diagnosis is important. Therefore, we ask families to bring a headache diary to their appointments detailing frequency of the headaches, and other associated factors such as nausea and vomiting with the headache, a need for sleep associated with the headache and how headaches response to the medications taken acutely for the headaches.
The first line of treatment is evaluating lifestyle issues such as good sleep hygiene, adequate hydration, minimizing caffeine use, regular meals, and exercise. Stressors such as school issues that may impact headaches are discussed. Presence of depression and anxiety can also make headaches worse. Non-pharmacologic therapies such as biofeedback and relaxation therapy with our psychologist may be very helpful for the age-appropriate child (generally 8 years of age and older).
Medications, either over the counter or prescription, may be recommended to use acutely when the child has a headache. Depending on the frequency and the disability (how disruptive the headaches are), a preventive therapy may be indicated. Some naturalistic therapies have had some success, such as magnesium, riboflavin, or butterbur. At other times a prescription medication may be suggested. With any of these preventive therapies, it may take 8-10 weeks to notice a significant change in headache frequency, so it is important to be patient with treatment plans. On some occasions, we offer clinical research studies in which patients/families may participate if interested.
The Headache Clinic accepts referrals from primary care physicians and pediatric specialists from the United States and internationally. To make a referral, there are three options: