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Column originally published Mar 22, 2000

Stress And Lack Of Sleep Are Common Triggers For Migraine Headache

Question: Our seven-year-old daughter has been having headaches for about two years. At the beginning, the headaches would come every few months. However, in the last two months, she has had four headaches already. Every time she would get sick and vomit, and then go to sleep for a while. When she gets up, she is back to her normal self. We are really worried that there is something wrong inside her head. Our paediatrician did a thorough examination, including checking her brain function, and said that everything was fine. He said that she doesn’t need a CAT scan. Should we push for more tests?


From your description, your daughter most likely has migraine headache, and test like CAT scan does not help. Let me explain to you in greater detail about headaches in general, and migraine in particular, so that you may have a better understanding of your daughter’s condition.

The most common cause of headaches for children and adults is common cold due to virus infection. The headache generally lasts for a day or two, and gets better when the cold is over. Sinus infection, which is a complication of colds or allergies, can also cause sinus headaches.

Dentists will remind us that headaches can be caused by rotten teeth and problems with TMJ (temporomandibular joint, the joint that opens and closes the mouth). Grinding of teeth and chewing gum excessively may affect the TMJ.

Many parents of children who have recurrent headaches are worried about brain tumour. This is a legitimate concern. However, headaches caused by brain tumour have several characteristics. They are often located at a constant area of the head. As time goes on, they become increasingly severe, and often occur daily.

Because of the presence of tumour in the brain, there is increase of pressure inside the skull. As a result, activities that further increase the pressure will make the headaches worse: lying down, bending over, coughing, and having a bowel movement. Very often, headache will wake up the child in the morning, and vomiting can relieve the headache for a while, but it will return.

Other symptoms can suggest presence of brain tumour. These include loss of function (including feeling) or weakness in parts of the body. Some children can become more clumsy with loss of balance. Parents may notice a change of personality or appetite. When the physician performs a detailed neurological examination, there will be abnormalities that would suggest presence of tumour.

The headaches that you described are more likely migraine headaches. They are usually located on one side of the head, although occasionally they can involve both sides. Most children will describe the headache as pounding or throbbing. During the headache, these children appear to be sick, sometimes with dark circles under their eyes. Not infrequently, bright light and loud noises can make the headache worse. Things that relieve headaches include vomiting and sleeping in a dark room.

Some children may experience an “aura” before the onset of headaches. Most of the time, “aura” involves visual symptoms like blinking lights, black dots, blurred vision, partial loss of vision, or things appear to be larger or smaller than what they really are. The “aura” can last 5 to 20 minutes, although occasionally it can continue for a while after the headache is over.

The frequency of migraine can be quite variable. Some children may have headaches every few months for a while, and then become more frequent over a few weeks. The important thing is that in between the headaches, these children are completely normal.

Many people with migraine can recognize certain triggers for their headache. The most common triggers are stress, inadequate sleep, low blood sugar (from missing a meal), certain foods (chocolate, nuts, processed meat, monosodium glutamate) and some medications.

Most, but not all, children with migraine have a family history. Someone in the family often is known to have migraine, or has significant headaches not yet diagnosed by a physician.

Another common type of recurrent headache is tension headache. As the name implies, this is directly related to stress. The headache is often described as a pressure band across the head. The pain is more constant, and can last for days. The headache generally does not affect a person’s activities, and vomiting is uncommon. The source of stress, however, may not be obvious to the child or the family.

There are still many more causes of headache than I can describe here. Your daughter’s headaches, however, is most likely due to migraine. If your paediatrician has done a thorough neurological examination, I would agree that a CAT scan is not necessary.

Moreover, you should watch for “triggers” of your daughter’s headaches, and see whether you can avoid some of them. If stress is a major reason, sometimes counselling may be necessary. Most parents find that avoiding late nights and certain foods will prevent most, if not all, of the headaches.

When migraine occurs, it is useful to give simple pain medications like acetaminophen, ibuprofen, or naproxen. Check with your doctor to find out what is the effective dose for her. The sooner you give the medicine, at the beginning of the headache, the more effective it is. If headaches are very frequent, there are additional medications that can prevent them.

If your daughter’s headaches change in nature or severity, or if you see some of the symptoms that suggest brain tumour, you should check with your physician right away.