HEADACHES
How Doctors Spell Relief
If you're like many parents, you probably think of headaches as something kids give you, not something kids get. But research indicates that 50 to 70 percent of all school-age children have experienced a headache, according to Francis J. DiMario, Jr., M.D., assistant professor of pediatrics and neurology at the University of Connecticut in Farmington.
''The causes of children's headaches are very similar to the causes of adult headaches,'' says Dr. DiMario. ''They get tension headaches; headaches associated with injury, illness or fever; and migraines.'' About 10 percent of children with headaches get chronic migraines.
All kinds of kids' headaches usually respond to the same treatments used for adult headaches, from over-the-counter pain relievers and warm compresses for occasional headaches to prescription drugs and biofeedback for chronic headaches. Even if your child's headache requires professional intervention, the experts say there are still measures you can take at home to help make the medical treatment more effective.
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| When to See the Doctor Though rare, headaches can sometimes be symptoms of a serious problem such as meningitis, a brain tumor or bleeding in the brain, according to Loraine Stern, M.D., associate clinical professor of pediatrics at the University of California, Los Angeles, and author of When Do I Call the Doctor? She says you should call your doctor if your child's headache: * Is accompanied by a fever, vomiting, stiff neck, lethargy or confusion. * Follows a head injury. * Occurs in the morning, accompanied by nausea. * Increases in severity over the course of a day or from one day to the next. * Is suddenly brought on by a sneeze or cough. * Interferes with school or other activities. * Is restricted to one side of the head. |
Before attempting any of these home remedies, however, read the ''Medical Alert'' above to determine if your child's headache might be the symptom of something more serious.
Turn to a proven painkiller. ''Simple analgesics such as acetaminophen [Children's Tylenol] are perfectly acceptable and effective for children's headaches, just as they are for adults','' says Dr. DiMario. Check the package directions for the correct dosage for your child's age and weight.
Apply a soothing compress. ''Some kids like warm cloths on their heads, others like cold cloths. You just need to experiment,'' says William Womack, M.D., associate professor in the Department of Child Psychiatry at the University of Washington School of Medicine and codirector of the Stress Management Clinic of Children's Hospital and Medical Center, both in Seattle. ''Keep the compress on for about 30 minutes, rewetting it as necessary,'' he says.
Head for bed. ''Rest seems to be one of the most effective ways to reduce a migraine headache,'' says Dr. DiMario. ''Many school nurses allow kids with headaches to lie down for half an hour. Often that is all that's necessary. They don't necessarily have to go to sleep. Just a half-hour of lying quietly can help.'' If your child is very sensitive to bright light during a migraine episode, you should draw the shades so he can rest in a darkened room, adds Dr. Womack.
Rub away the ache. Like adults, kids with tension headaches can often find relief by reducing stress. ''If your child is stressed out, relaxing massage might help,'' says Alexander Mauskop, M.D., director of the New York Headache Center in New York City and assistant professor of neurology at the State University of New York Health Science Center.
''If the muscles around the scalp or temples are tender, gently rubbing them can be helpful,'' says Dr. DiMario. ''But some kids don't like it because the scalp is too tender to touch.'' If your child says stop, don't insist--but many children do like that soothing touch of a parent's fingertips.
Make meal-skipping a misdemeanor. Make sure your child doesn't skip meals, especially breakfast, which is the most important one, warns Dr. Mauskop. ''Going all day without eating is a good way to get a headache or aggravate one you already have,'' he says.
Watch that egg roll, hold that pizza. By paying attention to what your child eats and when he gets his headaches, you may be able to spot a link. ''In some susceptible children, headaches are triggered by certain things they eat, such as chocolate, peanuts, processed meat and aged cheese,'' says Dr. DiMario. ''Pizza and Chinese food, if they contain monosodium glutamate, can bring on headaches in some children.'' If you think you've uncovered a connection, have your child avoid the suspect food and see what happens.
Curb the caffeine. Like grown-ups deprived of their customary morning coffee, kids can suffer from withdrawal headaches when they don't get their daily ''fix'' of caffeine. ''Caffeine withdrawal headaches are common in children who drink cola and eat a lot of chocolate--both of which contain caffeine,'' says Dr. Mauskop. If your child is susceptible, you may need to strictly limit these items, offering them only as an occasional treat.
Chart those mood swings. Some kids' headaches have emotional rather than food triggers, says Kenneth Covelman, Ph.D., director of psychosocial services for the Pediatric Pain Management Program at Children's Hospital of Philadelphia and clinical assistant professor of psychology in psychiatry at the University of Pennsylvania School of Medicine, also in Philadelphia. ''By charting not just your child's headaches but also his moods and activities for several days or weeks, you can sometimes see a pattern. For example, headaches may occur just before tests in school, or after arguments,'' says Dr. Covelman.
Have a plan to defuse tensions. ''If you've identified an emotional trigger of your child's headaches,'' says Dr. Covelman, ''help him formulate a plan for dealing with it.'' Your child may feel a lot better if he has more control over situations, he suggests.
''For example, if headaches occur after upsetting fights with his sister, talk about what he can do differently the next time they're playing together. Through role-playing, rehearse what he might say to her, such as, 'I don't like when you do this to me, so I'm not going to play with you until you apologize.' '' Having a plan of action can help defuse the tension that leads to the headaches, says Dr. Covelman.
Don't rule out random events. If no dietary or emotional triggers emerge after a few weeks of charting your child's headaches, broaden the scope of your search, suggests Loraine Stern, M.D., associate clinical professor of pediatrics at the University of California, Los Angeles, and author of When Do I Call the Doctor? '' Write down what the weather was like, how much your child slept the night before his headache. . . every possible factor you can think of.
''I had one child whose headaches seemed to come from the sunlight that shimmered on the surface of the family pool,'' Dr. Stern says. ''Her parents noticed that if she went into the pool at a certain time of day, the light reflecting off the water gave her a headache. Often it's cockamamy things like that you might miss if you don't keep a record.''
Reserve some time for fun. Many children who suffer from recurring headaches have fallen into the ''all work and no play'' trap, according to Dr. Womack. They need to schedule some fun.
''I see a lot of well-motivated, high-achieving, but overly intense kids in my clinic,'' he says. ''They're in a lot of extracurricular activities, and they're preoccupied with getting good grades. They're perfectionists, type-A personalities who are really driven to achieve. For them, headaches have become a barometer of the stress in their lives.''
If your child is like this, Dr. Womack suggests that you help your child decide which pursuits are most important and cut back on the rest. ''That will free up some time for relaxation and fun,'' says Dr. Womack. ''Children need to remember that things don't have to always be heavy and serious, and their efforts don't have to be perfect all the time.''
Neutralize the Nintendo headache. Muscular tension headaches are often the result of mental stress. But sometimes they can have a purely physical cause, says Dr. Stern. For example, if your child plays a lot of video games or does work on a computer, he may be inviting a headache by holding his head in one position too long. Encourage him to roll his head occasionally or take frequent breaks.
Harness imagination's healing power. Visualization, biofeedback and other special relaxation techniques are often employed by professionals to help their patients head off headaches. But it's possible for parents to teach kids some basic relaxation skills at home, Dr. Womack says.
He suggests trying this technique: ''Ask the child to imagine he's taking a warm shower and that everywhere the water strikes his body instantly feels more relaxed. Or have him picture himself stepping into a warm pool where the water gradually rises over his toes, his feet, his ankles and on up. This is a form of progressive muscle relaxation that kids find less boring than formal progressive muscle relaxation exercises.''
Put yourself in the picture, too. If your child is learning relaxation techniques, you should also learn them, says Dr. Covelman. '' Younger children may need some help practicing the techniques at home, and it's very helpful for parents to be able to do them, too,'' he says.
Support without nagging. Kids with chronic headaches need to practice their relaxation skills regularly, says Dr. Womack. ''Unfortunately, many kids find repetitive practicing of any kind boring, like having to practice the piano.'' But if you nag them about it, he says, it's counterproductive--it just creates more stress. Be supportive instead.
''In addition to making space and time available for the child to practice,'' says Dr. Womack, ''you need to remind him that this is something important that he should want to be doing for himself. If you give the child primary responsibility but make it clear that you want to help him to succeed, most kids will go along with it.''
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