2002-09-01

Watching a miserable child lying in a darkened room, battling with a throbbing headache, sickness and tummy pains is not only agonizing for parents, but deeply frustrating, too. All too often, the advice from GPs is to administer sympathy and paracetamol, and hope that the child will grow out of migraines.

Migraines: people can miss work because of an attack

The trouble is that, in many cases, children don't. About one in nine is affected, and some have symptoms from as young as four months. A new survey by the Migraine Trust has found that one sufferer in 10 has his or her first migraine under the age of 10, and one in five between the ages of 11 and 15. For girls, the onset often coincides with puberty. Up to 18 per cent of women and six per cent of men are affected. One estimate is that, every day in Britain, 90,000 people miss school or work because of an attack.

Professor Peter Goadsby, paediatric neurologist at the National Hospital for Neurology in London, thinks many migraine sufferers get a raw deal from the NHS. "We need a sea change in thinking," he says. "Too many children are suffering for too long. Studies suggest childhood migraine is vastly under-recognized and under-treated. Many doctors seem nervous about treating children with migraines."

Children, he says, need good management strategies to ease them through their teenage years and exams, and into adulthood. "Even for children with severely disabling migraines, there are very few specialist centres and only one advanced tertiary centre for the most difficult cases. But there are so many good drugs and new ones being researched that no one should simply put up with migraines."

Alexander Statham, aged six, suffers full-blown attacks. "They really hurt me and are very bad," he says. "I get a sore tummy, too." His mother Caroline, who also gets them, says the first sign with Alexander is usually that he complains of a tummy ache. "The attacks started when he was four and a half, and he suffers bad attacks about three or four times a year, usually during the stress of term time. Each time, he is in bed for about a day with an extremely severe headache. At other times, attacks start, but then fade away if he is put in a quiet place without bright lights.

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"He was diagnosed quickly, but all he has been offered by the doctor is paracetamol. We follow all the good advice, but now I wonder if there could be a more effective drug for him to take at the outset, or as a preventative measure. He has had more tummy aches recently and the condition is affecting his quality of life. Even small things, like missing the school photo, mean a lot to a six-year-old."

The symptoms of adult migraines tend to be one-sided headaches and throbbing pain, along with sickness, nausea and sensitivity to light, sound and head movements. Children tend to have a headache on both sides, but often the abdominal pain, nausea and vomiting are more pronounced. Some also suffer projectile vomiting and unsteadiness.

Only 10 to 15 per cent of adult sufferers experience an "aura" - blurred vision, and flashing lights and zigzags in front of the eyes - before the headache starts. However, these may be more common in children, according to the Migraine Action Association. The "aura" can include an Alice in Wonderland feeling of becoming smaller, clumsiness, pins and needles or seeing fireworks or snakes in front of the eyes.

Susceptibility to migraine is inherited in most cases. It stems from a brain disorder, in which the sensory pathways for pain, light, sound, taste, smell and even touch are not properly "tuned". This means the brain reacts abnormally to some normal signals or migraine triggers. Brain imaging studies relate this abnormal response to a focal point of "excitable" tissue in the brain stem. The result is a sequence of neurochemical reactions that cause the brain's blood vessels to dilate and leak blood into the brain tissue, causing the searing pain.

Common headache triggers include cheese, chocolate, red wine and citrus fruits, but stress, infections such as common colds and too little or too much sleep can also set them off. The "excitable" area in the brain varies between individuals, which explains the wide number of triggers.

The Migraine Trust has just published a leaflet about children's migraines, written by Dr Judith Hockaday, a consultant in pediatric neurology at the John Radcliffe Hospital in Oxford. In it, she encourages parents to try simple solutions first, such as avoiding possible triggers and administering painkillers at the first sign of an attack.

She is not, as a general rule, keen to prescribe preventative tablets. If, however, the child is very distressed by the rate of attacks, she advises parents to ask for a referral to a pediatric neurologist or migraine clinic. "Some widely available specific migraine preventative drugs are suitable for children and might be tried under close supervision," she says. Some doctors with a wide range of experience will prescribe adult drugs, such as beta blockers, in low doses.

Dr Andrew Dowson, chairman of Management of Migraine by Primary Care Advisers, believes that new guidelines drawn up by the group might improve care for adults and children. "Migraine cannot be cured, but can be managed successfully in the vast majority of cases".

Tips for parents

• Never let your child miss a meal. Lowered blood sugar and dehydration can contribute to an attack. A sugary drink might help if a child is off food.
• Try to find the trigger. Consider a possible link between attacks and caffeinated drinks, such as cola, monosodium glutamate, cheese, chocolate, citrus fruit - especially oranges - or wheat. Keep a diary of potential triggers, including bright flashing lights, eyesight problems, noise and even teeth grinding.
• Exercise is good for children, but remember that strenuous exercise depletes blood sugar and is dehydrating.
• Avoid a situation where your child gets too little sleep, or too much.
• Anxiety about exams, sibling rivalry or parental tension raises stress levels and can provoke an attack. Plan calm activities before bedtime.
• Look out for the early signs of a migraine - pallor, tummy ache, fussiness about strong smells or light, sensitivity to being touched or irritability.
• Ask your doctor and your pharmacist for advice. If you are not happy with your child's progress, ask for a referral to a migraine clinic or specialist.
• Alternative remedies, including riboflavin or vitamin B2, magnesium and feverfew, can help. Relaxation techniques and massage reduce tension. A new study suggests that coloured lenses may help some people: for details of where Intuitive Colorimetry tests can be carried out, call 01580 765211. Always check with your doctor or pharmacist before giving supplements to children.
• Soothe the brow and neck with Mentholatum Migraine Ice Patches (£3.99); Kool 'n' Soothe Migraine soft gel sheets (£2.99); or MigraStick, which contains relaxing lavender and peppermint (£3.95). All are available in supermarkets.

For a copy of the Migraine Trust's leaflet about children and migraines or information on a public session at the trust's international conference this month, tel: 020 7831 4818, or visit www.migrainetrust.org

For a copy of the Migraine Action Association's leaflet or details of studies requiring adult recruits, tel: 01536 461333, or visit www.migraine.org.uk