Maybe because it is now officially Christmas season and, for me at least, Christmas always makes me think of childhood, my own childhood, that of my children and the present children (grandsons included) around me.
I think I can generalize and say that all human ailments seem worse when they afflict children and there is no exception for headache disorders. I was fortunate that only one of my children suffered from migraines and that was only for a few years.
There are two notorious headache syndromes that are especially horrendous for children and their families and that is New Daily Persistent Headache (NDPH) and either Status or Chronic Migraine. The only difference between status and chronic types of migraine is that the status form is measured in days of headache and chronic in weeks, months or years. The two major syndromes, NDPH and Chronic Migraine, are not the same but do overlap.
It is horrible for a parent to watch a child suffer, miss school and loose friends because they are in bed with a headache every day. Good headache care for adults is seriously lacking but it is even far worse for children.
We are one of the few headache clinics that do see children with headache disorders. I know of many other headache specialists that would like to work with children but it is very complicated from a psycho-social standpoint, so they opt-out. Parents, while well-meaning, can be over-bearing when their child is not responding to treatment, which is often the case. I, as a parent, understand that distress. Parents should also understand that headache disorders are hard to treat and if their frustration caused them to attack the headache specialist, who is trying their best to help them, then soon there will be no headache specialist to see children.
The scientific journal of the American Headache Society, simply called Headache, devoted their November/December issue, which came out yesterday, to children. I am glad to see that. At our International Headache Congress in Spain last May, we devoted our mornings to children with headache disorders.
I want to summarize a few things I got from reading the recent Headache issue. For the sake of brevity, I will put these in bullet statements.
- There are four cyclic syndromes in early childhood that are forms of migraine, and later evolve into migraine. These include; abdominal migraine, cyclic vomiting syndrome (with no headache), infant colic, benign paroxysmal torticollis and benign paroxysmal vertigo.
- When a child falls into daily severe headaches, either Status Migraine or NDPH, early and aggressive (IV infusions) have the best results in preventing the headaches from becoming chronic. There is often a delay in doing the IV treatments because of either provider, and more often, parent resistance.
Cognitive Behavioral Therapy (CBT) is very helpful for children in decreasing the pain experience and improving their quality of life. It is more complicated adding a CBT program. This is due to several factors including the lack of pediatric providers for CBT, sometimes lack of insurance coverage and the patient’s concern about the stigma of taking their child to a mental health professional.
- I will mention one more and that is the problem of the transition period for children. While there are some resources for younger (before age 16) children with headaches and a little more for adults (over age 21) there is a gap between 17-21 where the care is very spotty. This age group has some of the worst access to good headache care.
Sorry once more I had to type as fast as I could without proof-reading. I will be back to fix mistakes.
J. Michael Jones, MPAS-C