I remember my first migraine; I had no idea what I was experiencing. I was about 12 years of age and had just started soccer practice. First, my vision was affected…I could make out objects but not from looking straight at them. And then the stars came…or shall I say, I began “seeing stars.” I tried to carry on but once the nausea came, I was done. And until my parents were able to come and pick me up, all I could do was shut my eyes and not move, as at that point, the throbbing headache was present as well.
I found out at that time my mom had been a migraine sufferer as well and after a couple of Advil or Tylenol or whatever she gave me, I put a cool compress on my forehead, went into my room and turned the lights out. I woke up a few hours later feeling better but groggy. Since that time, I’ve had my share of them but fortunately for me, as I’ve aged, the frequency of them has significantly dropped off. And I know for some that is not always the case.
When I have a tween or teen in the office sharing that he or she has begun experiencing migraines (and almost always there is a family history to go along with it), I have the greatest of sympathy and empathy for that child. But I do discuss there are treatment measures available for them…albeit, not perfect ones.
What I’d like to focus on for the rest of this blog is treatment measures for the child who suffers from migraines…while remembering that the early use of medication is key for treating children with migraines. But remember, before using medications, it is important to make sure they are truly migraines because improper use of some of these medications can lead to something called medication overuse headache.
- First and foremost, if a child is feeling the beginning of a migraine, get him/her into a dark and quiet room with a cool cloth over the forehead (thank you mom, for doing that with my first one.)
- NSAIDS (e.g. ibuprofen or naproxen) and acetaminophen (brand name Tylenol): Again, early use is key. I can’t say one is better than the other but anecdotally, most of my patients prefer the NSAIDS.
- Triptans (e.g sumatriptan): These can be game changers for many of those children with migraines. Although the exact mechanisms of how they work are not fully clear, they are primarily given either orally or nasally.
- Anti-vomiting medications: As migraine sufferers know, the nausea that can accompany migraines can be overwhelming and some anti-vomiting medications can be so very helpful. These days, I typically use ondansetron (brand name Zofran), but best to further discuss with your child’s physician first.
- IV medications: Obviously, if the migraines are so overwhelming, then a trip to the ER may be in order. This usually occurs after oral (or nasal) medications have failed. Two medications that might be used in the ER setting include dihydroergotamine or an anti-seizure medication.
As far as the opioids and barbiturates, they should not be used in treating children with migraines as they can become habit forming.
And for those children who are constant migraine sufferers, there are prophylactic treatments out there (e.g. beta blockers and anti-seizure medications, among others), so please discuss with your child’s physician if those should be looked at more closely.
- Dr. Jeremy
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