19 May Kids Korner: Child's Headaches Are Unpredictable
Q. My child’s headaches seem to be unpredictable. Are there other factors, besides food and weather, that may be bringing them on?
A. There are certain characteristics of children predisposed to migraine that can influence the frequency and severity of attacks. Addressing these characteristics not only helps children potentially reduce their susceptibility to migraine, but can also help them cope with the ups and downs of life.
Hyperexcitability of the brain and nervous system: Migraine is influenced by genetics. Children with the disorder live with a nervous system that is highly sensitive, or hyperexcitable. Providing a predictable schedule helps them manage this inherited nervous system sensitivity. This includes regular sleep and wake times; regular mealtimes, ideally with the entire family around the table at breakfast and/or supper; and private time before bedtime to wind down, relax, practice biofeedback and welcome sleep. Free time to play with friends, during which the child’s performance is not being evaluated by coaches, teammates or parents, is also important.
Perfectionism: The child wants to live up to others’ expectations, especially Mom and Dad’s. He or she wants to get straight A’s and be best at chosen extracurricular activities (there is usually more than one extracurricular activity and the child may need to be guided into limiting involvement). S/he wants to be best friends with everyone and be included in all major social activities. Parents can counteract this tendency by reassuring the child that, “I love you just the way you are.”
Difficulty saying no: The child may take on too many activities and responsibilities because s/he can’t say no, for fear of alienating others. This child needs reassurance that it is okay not to be involved in everything.
Putting self last: The child may put others’ wishes and demands ahead of his or her own. Even though this may be interpreted as selflessness, the child needs to understand that his or her ideas, plans and preferences are just as important as those of friends or relatives.
Absorbing the feelings of others: A child with migraine often picks up the feelings of others. This happens automatically without the child even realizing what’s happening. S/he may take on these feelings as a way to help the other person. This ability applies to family members, for example, when there is tension in the household, as well as at school. The first step in helping the child cope with this ability is to identify his/her feeling at the moment by saying, “Are you sad (or mad, glad, jealous or hurt)?” and acknowledging your own feelings. This opens up a channel of communication where the child feels free to talk about the private world of feelings that s/he has kept secret. The next step is discussing whether any of his or her friends are sad (or mad, glad, jealous or hurt) and what the child can do about the friends’ feelings (talking about feelings with friends is the best way to heal them).
Light sleeper: When sleep is disrupted, the migraine threshold is lowered, making the child more prone to a migraine attack. The child requires quiet, dim light, a comfortable bed and homey room in which s/he feels safe and protected in order to get restorative sleep.
Other factors associated with childhood headaches include:
Fear of the next attack: When a disabling headache is not adequately treated pharmacologically, the child fears that the next attack will be equally painful and disruptive. S/he may stop participating in favorite events for fear of triggering another attack. Medical consultation and a treatment plan that addresses abortive and rescue medications will help alleviate the child’s anxiety. Training in biofeedback will also give the child a tool to help regulate the nervous system to prevent attacks or stop attacks during the prodromal (early) stage.
Trauma: When a child experiences an event that is perceived as traumatic, perhaps shameful, it may be difficult for him or her to discuss the event with anyone. When headaches become more frequent, more severe or less responsive to treatment, exploring possibly upsetting situations may be instrumental in reversing the headache problem. Keeping an open mind, listening without interruption and consoling the child may be enough to resolve the problem. If not, a therapist may help heal the injury.