Chronic Headaches of Children Treated at Cedars-Sinai

Media Contact: Sandra Van
Telephone: 1-800-396-1002
E-mail: [email protected]

CLINIC AT CEDARS-SINAI MEDICAL CENTER SPECIALIZES IN TREATING CHRONIC HEADACHES OF CHILDREN

LOS ANGELES (March 31, 1999) -- Shortly before she turned 2, Shantel Arvi experienced recurring attacks that appeared to be seizures, according to her mom, Maria Ortiz. The babyís eyes would seem to roll upward and become glossy. Sheíd lose her balance and fall down.

After diagnostic tests, including CT scans, EEGs and MRIs, failed to provide a definitive explanation, Shantelís doctors prescribed anti-seizure medication. But the episodes continued, about once every three months, although the symptoms began to change. Shantel started vomiting when new episodes occurred, and it became obvious that she was extremely sensitive to light.

ìLight bothers her a lot,î said Maria. ìShe has to wear sunglasses because even if she doesnít have a headache, sheís very sensitive to the light. But she gets a headache quite often. She wonít be able to play or do anything all day. If she gets a headache in the morningóand they usually happen in the morningóshe wonít be able to be up. Sheíll be in bed all day and sheíll be vomiting. It takes her all day to recuperate from it.î

The diagnosis and treatment of Shantelís headaches were complicated by the fact that she has asthma and she was born with a heart condition that has required three operations, the first when she was only one month old. In prescribing medications for Shantelís headaches, doctors had to be sure there would be no conflicts with other drugs sheís taking and no adverse impact on her heart.

Cedars-Sinai Medical Center offers a Pediatric Headache Clinic that specializes in diagnosing and treating the headaches of children and adolescents, especially challenging and complicated cases such as Shantelís. Because headaches can be caused by a host of sourcesóranging from tension and hormonal dysfunctions to meningitis and brain tumorsóan occasional headache should not be overly alarming but recurring headaches should not be overlooked, according to John H. Menkes, M.D., director of Pediatric Neurology at Cedars-Sinai.

ìA parent should consider taking a child to a doctor if the headache interferes with the childís lifeóschool work, play activity or relating with other children,î said Dr. Menkes. ìOn the other hand, it probably isnít necessary to worry about the kind of headache that responds to a dose of Tylenol.î

Arielle Brannon, now age 10, missed six months of school because of severe headaches that started in early 1997 when she came down with symptoms of the flu. ìWhen the flu symptoms went away, the headaches didnít,î said her mother, Cindy Brannon. ìThey got so bad, she couldnít do her school work. She would just end up crying, going to the nurseís office, and they would send her home.î

Over-the-counter medications were of no help and Cindy said some doctors suspected the headaches were caused by stress or even an abusive home situation. Eventually, Cindy took Arielle to the Emergency Department at Cedars-Sinai. Doctors there referred her to the Pediatric Headache Clinic.

Cindy said Dr. Menkes performed a thorough physical exam and had blood drawn for lab work. At their next visit, Dr. Menkes asked Arielle if she had ever had pet mice. When she said she had white mice the year before, he asked if they had ever bitten her. Both Arielle and Cindy remembered that they had. ìShe came crying to me and said, ëThe mouse bit me in the thumb.íî

Arielle had contracted lymphocytic choriomeningitis, a viral infection of the membranes surrounding the brain and spinal cord. Apparently carried by the mice, the virus took up residence in Arielleís system, remaining dormant until she became ill many months later.

ìHe had seen three or four cases of children who had these headaches,î said Cindy. ìHe just nailed it right away. She had to take medication for a while but now the headaches have gone completely away and sheís well. Weíre so grateful to him for that.î

Unlike Arielleís situation, most of the headaches experienced by children under age 12 are migraines, according to Dr. Menkes, author of ìTextbook of Child Neurology.î Above that age, migraine is still prevalent but many adolescents come to the clinic because of tension headaches and headaches that are a secondary symptom of depression.

Although headache is commonly considered a grown-up malady, 25 percent of patients with headache examined in an emergency department were under age 17, according to one study. In another, 39 percent of children starting their first year of school had already experienced headaches. It is estimated that 3.2 percent to 10.6 percent of all children suffer from migraine. Most headache research, however, is performed among the adult population. While the mechanisms that cause headaches may be the same for both adults and children, the signs, symptoms and treatments may vary.

For example, compared with the migraine headaches experienced by adults, childrenís migraines tend to be more frequent but shorter in duration, according to Dr. Menkes. Also, while adults may sense flashing lights and other ìpremonitory symptomsîóan auraóthat signal a looming attack, childrenís migraines typically start without warning, and theyíre rarely focused on one side of the head the way adult migraines are.

Shantel Arvi, now 5 years old, informs her mother the moment she feels a headache coming. ìSheíll get a headache and then every three to seven minutes or so sheíll get a sharp, shooting pain that will make her scream,î said Maria. This pattern of mild headache interrupted by flashes of intense pain continues for several hours.

Dr. Menkes said physicians usually will treat children who have occasional migraines on an episode-by-episode basis, intending to relieve the symptoms as quickly and thoroughly as possible. But when a child has frequent attacks, a preventive approach is preferred. Two drugs, propranolol and valproic acid, offer the greatest promise for prevention. Still, according to Dr. Menkes, while migraines can be controlled for most children, there currently is no cure. ìA child with migraine is very likely to grow up to become an adult with migraine. It is a lifelong predisposition,î he said.

During an initial visit to the Pediatric Headache Clinic, patient and family medical histories are taken and a physical exam is performed by a pediatric neurologist. ìWhen the assessment is done carefully, as it has to be done, it takes about an hour,î according to Dr. Menkes. ìIn the large majority of patients, neurodiagnostic studiesóelectroencephalograms and imaging studies such as MRIs and CT scansóprobably do not need to be done. But there is the occasional child who, for one reason or another will require a follow-up study, such as a brain wave study or an MRI. That might require one or two later visits.î

Dr. Menkes said children who suffer from migraines tend to be ìvery, very bright, very cheerful, charming little kids.î Many are able to provide a detailed description of their headaches. But very young children and those who are not able to verbalize their experiences can be especially challenging to diagnose and treat. In these cases, information provided by the parent becomes invaluable. Helpful clues include the frequency of the headaches, the time of day they occur, whether or not there are triggering factors, and whether or not anything seems to help in relieving them.

ìSmall children who have migraine often have early symptoms of recurrent, unexplained vomiting or recurrent pallor, recurrent abdominal pain and also recurrent carsickness,î said Dr. Menkes. Because nausea and sensitivity to light are among the most common and significant features of migraine, a little child who cannot explain his or her symptoms will often seek a dark, quiet room and lie down.

Most headaches can be diagnosed quickly and therapy can be started right away, but in those instances when more detailed follow-up is required, Cedars-Sinaiís specialists in ophthalmology, otolaryngology, genetics, neuropsychology and psychiatry, and neurophysiology are readily available to lend their expertise. A treatment plan, developed by the childís pediatric neurologist, may include medication, a dietary program, biofeedback training, an exercise program and yoga, depending on the diagnosis and any underlying precipitating factors.

For information about the Pediatric Headache Clinic, located in the Mark Goodson Building at 444 South San Vicente Boulevard in Los Angeles, call 310-855-4441.

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