Study: Migraines affect a child’s school performance

29 Oct

According to Tara Parker Pope in the New York Times article, Returning to Classrooms, and to Severe Headaches:

Doctors say frequent headaches and migraines are among the most common childhood health complaints, yet the problem gets surprisingly little attention from the medical community. Many pediatricians and parents view migraines as an adult condition. And because many children complain of headaches more often during the school year than the summer, parents often think a child is exaggerating symptoms to get out of schoolwork….

Parents often have a hard time distinguishing between real pain and the imaginary maladies that young children sometimes invent. Dr. Hershey tells the story of a 6-year-old boy with daily headaches, whose parents thought he was just trying to avoid school. His parents finally sought treatment and by the time he was in the third grade the headaches were under control. “He was a different kid, more active and happy all the time,” said Dr. Hershey. “The parents realized he really had been having headaches, but they had been denying it.”

But parents also say they have struggled to find doctors who take a child’s headache complaints seriously. When Cathy Glaser’s daughter began suffering migraines as a toddler, her New York pediatrician couldn’t help. By the age of 15, her daughter was virtually disabled by migraines, but finally found help at the Michigan Headache and Neurological Institute in Chelsea, Mich.

The experience prompted Ms. Glaser to help create the Migraine Research Foundation. The group’s “For Our Children” initiative raises awareness and money for pediatric migraine research. The group’s Web site, www.migraineresearchfoundation.org, also offers a list of headache centers that treat children. “It’s astounding that so little attention is being paid to such a disabling and socially expensive problem,” she says. http://well.blogs.nytimes.com/2010/08/30/returning-to-classrooms-and-to-severe-headaches/

Parents need to be alert for the possibility that a child’s complaints about headaches may be serious.

Medical News Today is reporting in the article, Migraines Linked To Behavioral Problems In Kids:

Marco Arruda, director of the Glia Institute in São Paulo, Brazil, together with Marcelo Bigal of the Albert Einstein College of Medicine in New York, conducted a study of 1,856 Brazilian children ages 5 to 11 which looked at the connection of emotional symptoms with migraine and tension-type headaches (TTH).

The study used headache surveys, in addition to the Child Behavior Checklist (CBCL), to measure emotional symptoms. The researchers instructed teachers how to walk parents through the questionnaires, step by step.

Children with migraines had a much greater probability of irregular behavioral scores than children without headaches, primarily in social, anxiety-depressive, internalizing, and attention areas.

Children with TTH were affected in the same areas, but to a lesser extent. With more frequency of headaches, abnormal behavioral scores increased. Over half of the migraine sufferers had issues with internalizing behaviors. Externalizing behaviors, such as breaking rules or becoming aggressive, were no more likely among the children with headaches. The authors advised that the CBCL may not be efficient enough to measure this correlation in detail.

Arruda explains:

“As previously reported by others, we found that migraine was associated with social problems. The ‘social’ domain identifies difficulties in social engagement as well as infantilized behavior for the age and this may be associated with important impact on the personal and social life.”Children frequently suffer from migraines, which affect over three percent to one fifth of children from early childhood to adolescence. Earlier research has suggested that children with migraines are more likely to have other psychological and physical problems, including depression, anxiety, hyperactivity, and attention disorders. http://www.medicalnewstoday.com/articles/250331.php

Citation:

Migraine and migraine subtypes in preadolescent children

Association with school performance

  1. Marco A. Arruda, MD, PhD and
  2. Marcelo E. Bigal, MD, PhD

+ Author Affiliations

  1. From the Glia Institute (M.A.A.), Ribeirão Preto, SP, Brazil; Global Center for Scientific Affairs, Office of the Chief Medical Officer (M.E.B.), Merck & Co., Inc., West Point, PA; and Department of Neurology (M.E.B.), Albert Einstein College of Medicine, Bronx, NY.
  1. Correspondence & reprint requests to Dr. Bigal: Marcelo_Bigal@merck.com

View Complete Disclosures

Abstract

Objectives: To conduct a population-based study describing school performance in children with episodic migraine (EM), chronic migraine (CM), and probable migraine (PM), relative to controls.

Methods: Children (n = 5,671) from 87 cities and 18 Brazilian states were interviewed by their teachers (n = 124). First, teachers were asked to provide information on the performance of the students while at school, which consisted of the same information provided to the educational board, with measurements of the overall achievement of competencies for the school year. The MTA-SNAP-IV scale was then used to capture symptoms of attention-deficit/hyperactivity disorder, and to provide objective information on the performance of the students. Parents were interviewed using a validated headache questionnaire and the Strengths and Difficulties Questionnaire, which measures behavior in 5 domains. Multivariate models estimated determinants of school performance as a function of headache status.

Results: EM occurred in 9% of the children, PM in 17.6%, and CM in 0.6%. Poor performance at school was significantly more likely in children with EM and CM, relative to children without headaches, and was significantly influenced by severity (p < 0.001) and duration (p < 0.001) of headache attacks, by abnormal scores of mental health (p < 0.001), and by nausea (p < 0.001), as well as by headache frequency, use of analgesics, and gender.

Conclusion: Children with migraine are at an increased risk of having impairments in their school performance and factors associated with impairment have been mapped. Future studies should address the directionality of the association and putative mechanisms to explain it.

Footnotes

  • Study funding: This study was conducted without financial support.
  • Received February 21, 2012.
  • Accepted July 9, 2012.
  • Copyright © 2012 by AAN Enterprises, Inc.

Articles citing this article

See, Migraines May Affect Children’s School Performance, Study Suggests http://www.huffingtonpost.com/2012/10/29/migraines-school-performance_n_2041082.html?utm_hp_ref=education&ir=Education

The Cleveland Clinic has an excellent article, Migraines in Children and Adolescents:

Migraines in Children and Adolescents

Migraine is a moderate-to-severe headache that lasts from 2 to 4 hours and usually occurs two to four times per month. (These episodic migraines are also called acute recurrent headaches.)

Migraines affect about 2% of children by age 7 and about 7 to 10% of children and adolescents by age 15. Disability from headaches – anything that interferes with activities – can be significant.

In early childhood and before puberty, migraines are more frequent among boys. In adolescence, migraines affect young women more than young men. As adults, women are three times more likely to suffer from migraines than men.

What causes a migraine?

Migraines tend to run in families – that is, they are hereditary. Approximately 70% of people who have migraines also have an immediate family member (mother, father, sister or brother) who suffers, or may have suffered, from migraines in their childhood. Migraines cause a person to experience significant discomfort and disability, but they do not usually cause damage to the body. Migraines are not related to brain tumors or strokes.

Until recently, the cause of migraine was thought to be vascular – caused by the constriction and expansion of blood vessels in the brain. Today, migraine is thought to be an episodic brain malfunction –”a central nervous system (CNS) disorder” of primarily the brain and nerves, and secondarily of the blood vessels. The “malfunction” is caused, in part, by changes in the level of circulating neurotransmitters (chemicals in the CNS), and involving serotonin in particular.

What are the types of migraine in children and adolescents?

  • Common migraine or migraine without aura* — is the most frequent type in children and adolescents, accounting for 70 to 85% of all migraines.
  • Classic migraine or migraine with aura* — is less frequent than common migraine, accounting for about 15 to 30% of all migraines. In young children, migraine often begins in the late afternoon. As the child gets older, the onset of migraine may change to early morning.

* An aura is a warning sign that a migraine is about to begin. An aura usually occurs about 10 to 30 minutes before the onset of a migraine. The most common auras are visual and include blurred or distorted vision; blind spots; or brightly colored, flashing or moving lights or lines. Other auras may include speech disturbances, motor weakness or sensory changes. The duration of an aura varies, but it generally lasts about 20 minutes.

  • Complicated migraine syndromes are associated with neurological symptoms, including:
    • Ophthalmoplegic migraine, which causes abnormal paralysis of the motor nerves of the eye and a dilated pupil
    • Hemiplegic migraine, which causes weakness on one side of the body
    • Basilar artery migraine, which causes pain at the base of the skull as well as numbness, tingling, visual changes and balance difficulties (such as vertigo, a spinning sensation)
    • Confusional migraine, which causes a temporary period of confusion and speech and language problems, and is often initiated by minor head injury

Patients with complicated migraine syndromes require a complete neurological evaluation, which may require laboratory tests and two types of imaging tests, MRI (magnetic resonance imaging) and MRA (magnetic resonance imaging of the arteries) scans. These tests allow the tissues and arteries within the brain to be seen and evaluated. Most patients with complicated migraine recover completely, and a structural abnormality is rarely found.

  • Migraine variants are disorders in which the symptoms appear and disappear from time to time. Headache may be absent. Migraine variants, which are more common in children, include:
    •  Paroxysmal vertigo—dizziness and vertigo (spinning) that is brief, sudden, and intense
    • Paroxysmal torticollis—sudden contraction of one side of the neck muscles that causes the head to “tilt” to one side
    • Cyclic vomiting—uncontrolled vomiting that lasts about 24 hours and occurs every 30 to 60 days. Many have a family history of and/or develop migraine later in life.

The key to diagnosing these migraine variants, which can be confused with other neurological syndromes, is their tendency to recur at intervals. The person does not have symptoms between attacks. Patients with migraine variants may also have a positive family history of migraine, and have a history of or develop migraine headaches.

What are the symptoms of migraine?

Although symptoms can vary from person to person, the general symptoms of common and classic migraine are:

  • Pounding or throbbing head pain. In children, the pain usually affects the front or both sides of the head. In adolescents and adults, the pain usually affects one side of the head.
  • Pallor, or paleness of the skin
  • Irritability
  • Phonophobia or sensitivity to sound
  • Photophobia or sensitivity to light
  • Loss of appetite
  • Nausea and/or vomiting, abdominal pain

What are some migraine triggers?

In many children and adolescents, migraines are triggered by external factors. These “triggers” vary for each person. Some common migraine triggers include:

  • Stress—especially resulting from school and family problems. Carefully reviewing what causes stress can help determine what stress factors to avoid. Stress management includes regular exercise, adequate rest and diet, and promoting pleasant activities such as enjoyable hobbies.
  • Lack of sleep—results in less energy for coping with stress.
  • Menstruation—normal hormonal changes caused by the menstrual cycle can trigger migraines.
  • Changes in normal eating patterns—skipping meals lowers the body’s blood sugar and can cause migraines. Eating three regular meals and not skipping breakfast can help.
  • Caffeine—Caffeine is a habit-forming substance and headache is a major symptom of caffeine ingestion and withdrawal. If you are trying to cut back on caffeine, do so gradually.
  • Weather changes—volatile weather, such as storm fronts or changes in barometric pressure, trigger migraines in some people.
  • Medications—some medications—such as oral contraceptives (birth control pills), asthma treatments, and stimulants (including many of the drugs used to treat attention-deficit hyperactivity disorder [ADHD])—may trigger a migraine. Ask your doctor if there are alternatives to these medications.
  • Alcohol—may cause the brain’s arteries to expand, resulting in a migraine.
  • Travel —the motion sickness sometimes caused by travel in a car or boat can trigger a migraine.
  • Diet—some migraine sufferers find that certain foods or food additives trigger a migraine. These foods include aged cheeses, pizza, luncheon meats, sausage or hot dogs (which contain nitrates), chocolate, caffeine, Doritos®, Ramen® noodles, monosodium glutamate or MSG (a seasoning used in Oriental foods). Recalling what was eaten prior to a migraine attack may help identify certain foods that are potential triggers so you can avoid them in the future.
  • Changes in regular routine—such as lack of sleep, travel, or illness can trigger a migraine. Exercising regularly and getting adequate rest can decrease the number of migraine attacks.

By identifying your migraine triggers, you can take steps to avoid the trigger to decrease the frequency and severity of your migraines and make life more enjoyable. http://my.clevelandclinic.org/disorders/headaches/hic_migraines_in_children_and_adolescents.aspx

The Migraine Foundation’s article, Migraine in Children recommends:

Treatment for childhood and adolescent migraine depends on the age of the child and the frequency and severity of the attacks. Expert help from headache doctors or centers specializing in migraine may be indicated for children for whom diagnosis is difficult or who don’t respond to typical first-line treatments.

  • For some children, sleep alone is an effective treatment.   
  • Although there are well over 100 drugs used to prevent or treat migraine symptoms, none has been approved for use in children. However, they have been studied by researchers and are prescribed.  These drugs include triptans, ergot preparations, and NSAIDs (nonsteroidal anti-inflammatory drugs).  
  • Certain over-the-counter products may relieve some migraines.  For mild to moderate migraine, general pain medications, such as acetaminophen (Tylenol), ibuprofen (Advil), and naproxen sodium (Alleve) used early in the course of the headache are often effective.
  • Since lack of appetite, abdominal pain, and vomiting occur in 90% of child sufferers, drugs that treat nausea and vomiting specifically (antiemetics) can be useful. 
  • Because of the potential for medication-overuse (rebound) headaches, all medications should be used with care, including over-the-counter drugs and barbiturates. If a child is taking any medication for headache more than twice a week, a doctor should be consulted.

There are three general approaches to treatment:

1. Acute treatment uses drugs to relieve the symptoms when they occur. 

2.Preventive treatmentuses drugs taken daily to reduce the number of attacks and lessen the intensity of the pain.  If a child has three or four disabling headaches a month, the doctor should consider using preventive medication, which includes certain anticonvulsants, antidepressants, antihistamines, beta-blockers, calcium channel blockers, and NSAIDs. Sometimes herbals and supplements, such as butterbur, magnesium, riboflavin, CoQ10, and feverfew, are recommended.

3.Complementary treatment does not use drugs and includes relaxation techniques (biofeedback, imagery, hypnosis, etc.), cognitive-behavioral therapy, acupuncture, exercise, and proper rest and diet to help avoid attack triggers.  For some children, eating a balanced diet without skipping meals, getting regular exercise, and rising and going to bed at the same time every day help reduce migraine frequency and severity. http://www.migraineresearchfoundation.org/Migraine%20in%20Children.html

Diagnosing a migraine in a child must be undertaken by a skilled medical professional. Any treatment of a child’s migraine must be conducted under supervision by a medical professional. The National Association of Children’s Hospitals and Related Institutions can direct you toward competent medical professionals in your state. http://www.childrenshospitals.net//AM/Template.cfm?Section=Home3

Resources:

Your Child’s Headache or Migraine                            http://www.webmd.com/migraines-headaches/guide/your-childs-headache

Migraine Headache in Children                       http://www.emedicinehealth.com/migraine_headache_in_children/article_em.htm

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