Migraine is one of the most common, recurrent headaches in childhood.
While it is less common in early childhood, its frequency increases towards adolescence.
Migraine attacks are seen especially in infancy and early childhood. Unlike adults, patients may present with symptoms such as recurrent abdominal pain, vomiting attacks, and dizziness.
The fact that these symptoms precede the headache and are more pronounced may make it difficult to diagnose migraine. Towards adolescence, migraine begins to show its symptoms more clearly in adults and diagnosis becomes easier. Since it is difficult to diagnose migraine in childhood due to these features, conditions such as recurrent abdominal pain, vomiting, dizziness, even neck stiffness (torticollis) and headache in childhood should be questioned carefully. Even if there is no headache, the possibility of migraine should always be kept in mind. In addition, such conditions may be accompanied by motion sickness and sleep disorders such as sleepwalking, teeth grinding, night terrors, and restless legs syndrome. If migraine is not recognized and treated, it can negatively affect the child's school life (the loss of school days in children with migraine is twice as high as in children without migraine) and social life, and may reduce the quality of life. In addition, there is a lot of scientific data stating that migraine, which is not correctly diagnosed and treated correctly, can become chronic and cause depression, mood disorders, substance use and increased risk of suicide in children and adolescents. For this reason, it is very important to correctly diagnose migraine headaches that occur in childhood and adolescence and to treat these headaches in a timely and appropriate manner.
CHARACTERISTICS OF MIGRAINE HEADACHE IN CHILDHOOD
Childhood. In adult migraineurs, headache attack symptoms, aura symptoms, and symptoms during a headache attack may differ from those of adult migraineurs. Symptoms such as excessive activity or decreased activity starting the day before, introversion, depressive mood, sleep disorders, yawning, feeling of thirst, and appetite changes may occur.
-AURA
Aura symptoms may appear more colorful and diverse than in adult migraines. Auras related to vision occur most frequently. They can see objects as larger, smaller, more colorful or in different shapes. This condition has even been described as 'Alice in Wonderland Syndrome'. The aura begins 10 to 30 minutes before the pain attack and lasts 5-10 minutes. It should not be forgotten that in childhood migraines, there may be alarming and serious aura symptoms such as difficulty in perception, difficulty in understanding, forgetfulness, slurred speech, balance disorder, dizziness, sensory loss and paralysis.
- HEADACHE PHASE
Migraine headache in children has different characteristics than migraine headache in adults. Pain attacks are usually shorter than 4 hours. However, it may take up to two days. Pain intensity is less than in adults. Smell sensitivity can be quite noticeable during a pain attack. During the headache, many accompanying symptoms may be present, such as excessive sweating, cold hands and feet, feeling of nausea, vomiting, diarrhea, increased urine output, feeling of dizziness, dizziness, imbalance, numbness, and discomfort from light and sound. Unlike adults, it presents as headaches affecting the forehead and temple area on both sides of the head, rather than unilateral headaches affecting one half of the head. Headaches often occur in the afternoon and evening. As we get older, migraine headache characteristics begin to resemble those of adults. The most effective behavior to stop headaches in childhood migraines is sleeping. In almost 80% of children suffering from migraine headache attacks, the headache attack disappears in a short time with sleep.
MIGRINE TREATMENT IN CHILDREN AND ADOLESCENT
1. DETERMINATION OF TRIGGERS AND NON-DRUG PRECAUTIONS
It is necessary to inform a child diagnosed with migraine and their parents about the disease and explain the situation. Whether or not drug treatment is required, explain to the child and his family that migraine attacks can be significantly reduced by identifying the factors that trigger migraine, staying away from triggers, and making some changes in lifestyle. should be done. Instead of immediately taking medication for headaches in children and adolescents, identifying trigger factors and taking precautions against these factors can significantly reduce the frequency, number of attacks and severity of headaches. With the habit of keeping a regular headache diary, important clues can be obtained about the severity of pain, times of occurrence (such as weekdays, weekends, holidays, etc.) and even triggers, and precautions can be taken. Making adjustments to eating habits, such as not going hungry, not skipping meals, and staying away from foods that may trigger migraines, can prevent many migraine attacks from occurring. Since sleeping too little or sleeping too much can increase migraine attacks, it is also very important to develop regular sleep habits, especially in school-aged migraineurs, and to inform the child and family about sleep hygiene rules. In addition, meeting with the family and even the teacher of the child with migraine to determine the stress factors, if any, to prevent these factors and to teach the child relaxation techniques with non-drug methods will be very useful in preventing many headache attacks. Apart from all these, gaining habits such as regular fluid intake and regular moderate exercise can be effective in preventing headache attacks.
What are migraine triggers?
School and family problems, stress, weather change (south winds, temperature change), lack of sleep or oversleeping, noise, bright light, bad smell, perfume, extreme sports, heavy exercise, skipping meals, staying hungry, snacks, chocolate, nitrite and nitrate. Some foods containing monosodium glutamate (MSG) include salami, sausages, smoked fish, old cheeses, pizza. However, not every trigger may trigger a headache in every migraineur. For this reason, migraineurs should know the triggers in general and determine which trigger triggers their migraines and avoid that trigger.
TREATMENT OF 2nd HEADACHE ATTACKS TREATMENT OF ACUTE ATTACKS
Childhood. In modern migraines, migraine headache attacks may still occur despite all these precautions. Especially in mild and infrequent attacks, immediate relief Instead of taking painkillers, applying some non-drug methods may be more useful than you think in getting over headache attacks without taking medication. Examples of these methods include taking the child to a cold, quiet, dark room, applying relaxation techniques, or applying cold or pressure to the area affected by the pain. However, in more severe attacks that cannot be stopped, simple painkillers or migraine-specific painkillers called "triptans" can be used. However, it should not be forgotten that there are very important points to consider when using painkillers. The child's age, weight and presence of comorbidities are very decisive in choosing simple painkillers or triptans. Additionally, it should not be forgotten that indiscriminate and frequent use of painkillers for headaches can cause 'painkiller overuse' and turn the headache into a 'chronic daily headache'! For this reason, even if it is a simple painkiller, it is necessary to consult a physician about painkillers to be given for childhood headache attacks!
PREVENTIVE TREATMENT
Increasing frequency and severity Increasing headache attacks begin to negatively affect the child's school life and social life. In addition, migraine attacks that occur frequently and are not intervened and controlled in time may become chronic and more difficult to treat. In such cases, preventive treatment is required. Medicines such as heart rhythm drugs (beta blockers, calcium channel blockers), antidepressants, antiepileptics, riboflavin (vitamin B2) and acetylsalicylic acid are used in preventive treatments. Which of these drugs will be given to which child with migraine, in what dosage and for how long, will vary depending on many factors such as the child's age, weight, and whether he/she has additional diseases. For this reason, the decision for preventive treatment in childhood migraines should be made by a specialist physician after a meticulous evaluation.
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