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Migraine Headache in Children (cont.)

Headache Types and Migraine Phases

Primary headaches

Primary headaches are conditions in which the headache is the medical condition and no underlying internal cause is present. Treatment is aimed at the specific headache disorder. Primary types include:

  • migraine headaches,
  • tension headaches,
  • chronic daily headaches , and
  • cluster headaches.

The doctor must find out which type of headache a child has, because the best treatments are different for each category. Headaches that come back again and again are usually the result of primary disorders.

Secondary headaches

Secondary headaches are a result of some underlying condition. When that condition is treated, the associated headache usually gets better or goes away. Secondary headaches can be caused by many conditions, from harmless to life-threatening. The following are examples of such conditions:

  • Infections (inside the head or elsewhere)
  • Head tumors or masses
  • Injuries to the head or neck
  • Fever (for example, from flu)
  • Meningitis (inflammation of the membranes of the brain or spinal cord)
  • Encephalitis (inflammation of the brain)
  • Sinusitis (inflammation of the mucous membrane of any sinus)
  • Dental abscesses
  • Subarachnoid hemorrhage (bleeding in the brain membranes)
  • High blood pressure
  • Vision problems

A physician evaluating a patient with headache must consider that a patient with a primary headache disorder may also have a secondary headache disorder.

Phases of a migraine attack

A migraine attack has four possible phases.

  1. premonitory phase or prodrome
  2. aura
  3. headache
  4. postdrome

Premonitory phase or prodrome: Both migraine headaches with aura (see below) and migraines without aura have a premonitory phase (a phase that precedes and forewarns), which may start up to 24 hours before the headache phase. During this prodrome phase many symptoms may develop. These include:

  • irritability,
  • joy or sadness,
  • talkativeness or social withdrawal,
  • increased or decreased appetite,
  • food craving or anorexia (lack of appetite, distaste for food),
  • water retention, and/or
  • sleep disturbances.

These prodrome symptoms are often more evident in migraine without aura than in migraine with aura. Children with frequent migraine headaches or migraine variants often have a vague feeling that something is different in their world. They often learn to recognize these early signs but have trouble explaining or describing them to parents or health care practitioners.

Aura

An aura is a focused symptom that happens right before a migraine headache or when one begins. An aura may occur without headache, or it may be more severe than the following migraine headache. Only 15% to 30% of children with migraine headaches experience auras; however, under- reporting may exist due to the inability of young patients to verbally explain their sensations. The aura usually occurs less than 30 minutes before the migraine headache and lasts for 5 to 20 minutes. Motor auras (those affecting a person's coordination) tend to last longer than other forms. Visual disturbances are the most common form of aura. Numbness and tingling of one side of the face and tingling of fingers on the same side are the second most common type of aura. Disorder of speech is a rare aura presentation. Complete recovery of aura symptoms should be expected.

Children are often unable to recognize or describe their auras; picture cards that show typical visual auras may help the doctor get an accurate history. Visual auras are often reported as moving or changing shapes and are the most common form in children.

Visual auras consist of the following:

  • Blurred vision
  • Fortification spectra (zigzag lines)
  • Scotomata (defects in the field of vision)
  • Scintillations (sparks or flashes of light)
  • Black dots
  • Kaleidoscopic patterns of various colors
  • Micropsia (perception of objects as smaller than they are)
  • Macropsia (perception of objects as larger than they are)
  • Alice in Wonderland syndrome [the illusion of dreams, feelings of levitation (floating or rising), and altered sense of the passage of time]

Other types of auras include the following:

  • Attention loss
  • Confusion
  • Amnesia (forgetfulness, memory failure)
  • Agitation
  • Aphasia (impaired or absent understanding or production of or communication by speech, writing, or signs)
  • Ataxia (an inability to coordinate muscle activity during voluntary movement)
  • Dizziness
  • Vertigo (a sensation of spinning or twirling, implying a definite feeling of rotation)
  • Paresthesia (an abnormal feeling of burning, pricking, tickling, tingling, etc)
  • Hemiparesis (weakness affecting one side of the body)

Aura symptoms can vary widely within and between attacks for the same individual.

Headache

The actual headache phase of a migraine attack is usually shorter in children than in adults. Children's headaches can last 30 minutes to 48 hours but usually last less than 4 hours. Some children report short headaches lasting 10 to 20 minutes. The headache phase is often associated with the following:

  • Cold extremities
  • Nausea
  • Anorexia
  • Vomiting
  • Diarrhea
  • Increased urination
  • Constipation
  • Dizziness
  • Chills
  • Excessive sweating
  • Ataxia
  • Numbness
  • Photophobia (sensitivity to light)
  • Phonophobia (sensitivity to sound)
  • Osmophobia (sensitivity to smell)
  • Memory loss
  • Confusion

Postdrome

After the headache phase, the migraineur (person who has migraines) may feel elated and energized or, more typically, exhausted and lethargic (weary, tired) in the stage known as the postdrome. This stage of migraine may last from hours to days.

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