What Does A Migraine Feel Like?

This is an approximation of the zig-zag visual disturbance that I experience as a migraine aura. The picture hardly does it justice! In reality it moves and vibrates, expanding and slowly fading away over the course of about 20 minutes.

Some patients experience an “aura” 5-20 minutes before the onset of a headache.  This sensation usually stops within one hour of the headache starting.  Auras include vision changes such as shimmering or flashing lights, lights surrounding a blind spot, or zig zags.  They can also involve abnormal sensations such as numbness, burning, or tingling.  Less commonly an aura involves focal muscle weakness or problems with speech.

“Classic Migraines” are migraines that involve an aura.

“Common Migraines” are migraines that do not involve an aura and are much more common than “Classic Migraines.”

“Complicated Migraines” are migraines that are associated with additional physical changes; examples include focal weakness, dizziness, loss of consciousness, problems walking, loss of vision, and problems moving the eyes.  When these symptoms are present, the diagnosis of migraine is usually only made after a work up is completed to exclude other causes.

Migraines in children and adolescents tend to last 1-48 hours.  Although headaches are often hard to describe, for migraine-type headaches, children and adolescents are usually able to express a pulsating or throbbing sensation (ie: “it feels like my heart is beating inside of my head”).  In adults, these usually occur on one side of the head, but with children they can occur on one or both sides of the front or sides of the head.  They tend to be moderate to severe in intensity and stop children from their typical fun activities.  Most children and adolescents will seek out a dark, quiet space to sleep as the headaches tend to be aggravated by movement, frequently involve nausea with or without vomiting, and may be associated with sensitivity to light and/or sounds.  Sleep tends to make migraines better.

There are also “pediatric migraine variants” which are unusual events that occur in children, often in families where other members have migraine.  These might look like sudden onset of the child walking funny or falling down lasting a few minutes, or sudden onset of an infant or toddler’s head turning to one side.  It can be stomachaches or vomiting that occur on a recurring basis.  Sometimes children can become acutely confused, usually associated with a headache.  And, oddly enough, some children can have all of the symptoms that are associated with a migraine, but not have the actual headache!  Most of the children with these variants go on to have more typical migraines later in life.

For more information on migraines, feel free to visit the resources section of my website (ocpedsneuro.com)…..and stay tuned to my blog!  More migraine and headache information to come!

Kids Get Headaches?!?!?

Many parents are surprised to find out that headaches are fairly common in children and adolescents.  There are migraine variants that start as young as toddler-age and various headache types that are seen throughout childhood and adolescence.  In fact, about 5-10 percent of children under 12 get migraines and 10-20 percent of adolescents get migraines. 

There are many reasons that children and adolescents get headaches.  Some headaches are caused by external influences on the body (secondary headaches), and some just happen (primary headaches).  Certainly tumors are a cause of secondary headaches and, although not common, are frequently the top concern for parents and providers alike.  Other causes of secondary headaches include head injury, TMJ, bleeding in the brain, increased pressure from fluid in the brain, and infections such as sinusitis, meningitis, dental carries, or even just having a fever.  Examples of primary headaches include tension-type headaches, migraines, new persistent daily headaches (chronic daily headaches), and less commonly cluster headaches. 

Primary headaches are much more common than secondary.  Although primary headaches can be disabling, in general they do not cause harm.  Secondary headaches, on the other hand, may have detrimental effects if not diagnosed early.  As a pediatric neurologist, I am trained to determine the cause of headaches and to treat primary headache disorders.

How do I do that?  By talking with and examining my patients (why I love neurology).   If there are any “red flags” in the history or physical exam that make me concerned for a secondary headache, I use neuroimaging (MRI or CT scan) to help me with my diagnosis. 

Treatment for headaches is tailored to the underlying cause.  Clearly, if there are external influences, such as tumors or infection, the treatment is to address those.  Primary headache treatment is often more complex and less straight forward as it is specific to each patient.  There are times when treatment is quick and easy, but more often than not, treatment requires lifestyle changes on the part of the patient, sometimes in combination with medications.  When medications are used, they often take up to two weeks to have any affect and up to 2 months to achieve their full effect. 

Although headaches are often scary for families, more often than not they are treatable and not caused by something big, bad, or ugly.  Unfortunately, sometimes it takes time to find the best course of treatment for an individual's headache.  I stay in close contact with my headache patients until their pain is resolved.  Although it often takes time, headache management is very rewarding as patients tend to become empowered by understanding their individual triggers and how to manage their lifestyle to decrease headache occurrence.  In addition, in the long run (and sometimes immediately) medications do tend to be effective when used for the right patient at the right dose for the right amount of time.

For more headache resources and information, feel free to visit the resources section of my webpage at ocpedsneuro.com......and stay tuned for my next blog entry!