Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, March 12, 1990 TAG: 9003102482
SECTION: EXTRA PAGE: E-1 EDITION: METRO
SOURCE: Jane E. Brody
DATELINE: LENGTH: Long
A third grader, usually an agreeable and cooperative child, suddenly becomes agitated and aggressive and disrupts the classroom several times a month.
A high school sophomore has daily pain in her head that varies in intensity but never really goes away. She thinks something horrid must be wrong with her.
All three of these children are suffering from chronic headaches, a disorder sometimes missed or misdiagnosed because it can produce unusual symptoms in the young.
Most people think of headaches as a plague of adults, but physicians now realize that headaches are also a common problem among children, some as young as a few months of age.
Parents who know the signs and symptoms of childhood headaches and who appreciate their diverse causes - albeit usually benign - can help physicians make a proper diagnosis and find safe treatments.
Comprehensive surveys of the incidence of headaches among American children are lacking, but Scandinavian studies have revealed that more than half of schoolchildren 7 to 15 years old suffer from headaches.
For example, a Swedish survey in 1982 found that 7 percent of 7-year-olds suffered from headaches more than once a month, and the prevalence and severity of head pain rose with age. A Finnish study in 1983 found that migraine headaches plagued 2.7 percent of 7-year-olds, rising to 10.6 percent by age 14.
An earlier survey in Uppsala, Sweden, among 9,000 schoolchildren found that only 41 percent never had headaches, 48 percent suffered from infrequent non-migraine headaches, nearly 7 percent had frequent non-migraine headaches and nearly 4 percent had recurrent migraines.
Dr. A. David Rothner, a pediatric neurologist and expert on childhood headaches at The Cleveland Clinic, says smaller studies here suggest that similar headache patterns exist among American children.
When a child suffers from frequent or severe headaches, parents typically assume the pain is a sign of an underlying disorder, like a visual defect, food allergy, sinus infection or even a brain tumor. It is understandably hard to believe that a young child can suffer so with head pain if nothing is seriously wrong.
Fortunately, only 5 to 13 percent of chronic headaches in children can be traced to an organic cause, and only rarely is the cause a potentially life-threatening problem like a tumor, a hemorrhage or an infection in the brain.
Most headaches in the young are stress-related, and about 40 percent of those with chronic headaches are afflicted with migraines, which run in families.
Rothner has summarized the types of headaches that afflict children.
\ Psychogenic: Adults call this most common type a "tension" headache. It can occur only once in a while or as often as every day. The pain is steady in the forehead region and may get worse as the day wears on or with physical activity. The pain does not worsen with subsequent headaches, although tension headaches can become more frequent if the underlying problems are not resolved.
These stress-related headaches typically result from anxiety or depression stemming from problems at home, in school or at play. The precipitating factor can be an actual or impending divorce, parental or other family strife, pressure to meet unduly high parental expectations, sibling rivalry or conflicts with peers.
Dr. Bruce Masek, psychologist at the Children's Hospital in Boston, noted that "parents often inadvertently encourage their child's headaches by being overly concerned" about them. And children, who learn by example, sometimes acquire headaches as a stress symptom because a parent often complains of having a headache.
\ Migraines: These recurrent headaches result from an instability in blood vessels in the head that is usually inherited. Nearly all young sufferers have at least one parent who also gets migraines.
In migraine, scalp vessels suddenly constrict, then dilate, causing a variety of symptoms, from visual distortions and dizziness to throbbing head pain, nausea and vomiting.
Unlike adults whose migraines are on only one side of the head, in children with migraine the pain may occur on both sides and is nearly always accompanied by nausea and vomiting and a desire to sleep. Childhood migraines typically disappear after several hours of sleep.
Dr. Arthur L. Prensky, pediatric neurologist at Washington University School of Medicine in St. Louis, estimates from one-quarter to one-half of chronic headaches in children are migraines. In one in five adults with migraines, Rothner reported, symptoms of chronic vascular headaches first appeared before age 5.
Attacks of migraine can be set off or made worse by heat, excitement, stress, depression, trauma, exercise, illness, fatigue, menses, certain medications (like birth control pills) and certain foods like chocolate, cheese or preserved meats.
In older children, the headache may be preceded by what is called an aura, a visual disturbance, a sense of bodily distortions, speech abnormality or dizziness. Sometimes the auras, which can occur alone without being followed by a headache, resemble the bizarre distortions depicted in Alice in Wonderland and are mistaken for a psychosis or toxic drug reaction.
Dr. Gerald S. Golden of the University of Texas Medical Branch of Galveston described an 11-year-old with migraine auras who hallucinated a bloody body popping out from the seat on which she sat.
\ Migraine variants: Especially in young children, migraine can produce confusing symptoms without head pain that may be forerunners of more classic migraine headaches when they are older. Among the symptoms are periods of confusion and agitation, vertigo, unexplained episodes of severe vomiting and neurological disturbances like unsteady gait, dizziness and occasionally even loss of consciousness.
\ Organic disorders: Most often these are problems in the head but outside the brain that are relatively easy to diagnose and treat, bringing permanent headache relief. They include sinus infection, with pain usually between the eyes; eye disorders, which typically result in front-of-the-head pain late in the day or after watching television or doing schoolwork; dental disorders, including a bad bite, tooth decay and malfunction of the joint between the jaws, and infections of the ear or throat.
Injuries to the head can cause pain at the site of impact or a more generalized postconcussion syndrome that causes long-lasting headache often accompanied by insomnia, restlessness, irritability, personality change, listlessness, memory problems, school problems and dizziness.
Potentially far more serious, but much more rare, are chronic headaches resulting from a disorder that causes increased pressure in the skull.
The head pain is often accompanied by symptoms like nausea and vomiting, unsteady gait, weakness, seizures, lethargy or personality change. Over a period of days, weeks or months, such headaches become more frequent and more severe.
Possible causes include tumors, a buildup of fluid within the brain, a clot on the brain surface, a brain abscess or increased pressure within the brain that may result from excessive intake of vitamin A, obesity, menstrual irregularity or the use of outdated tetracycline.
NEXT WEEK: The diagnosis and treatment of children's headaches.
by CNB