July 10, 2023 – Eileen Brewer is the mother of an 11-year-old who often has severe headaches.
“She started showing signs of headaches when she was a baby,” Brewer said from Columbia, Md., where she is president of Clusterbusters, a company that supports research into cluster headache treatments and advocacy who’re fighting this disease.
Brewer's daughter often cried for as much as 8-10 hours a day. A pediatrician said she had colic. But as she got a little bit older, she began banging her head on the bottom or hitting her head along with her hands. The pediatrician said it was all behavioral.
But at preschool, the teacher told Brewer that on shiny sunny days her daughter complained of a headache after playing outside. “She went and laid down in the book corner,” Brewer said. The teacher suspected that the little girl could have had a migraine.
“I was surprised and a little embarrassed that I had missed the signs, including frequent vomiting,” Brewer said. “I myself have migraines and it is genetic. And I work in the headache field, not only at Clusterbusters, but also as the administrative director for the Alliance for Headache Disorders. And I am a member of the National Headache Foundation’s Patient Leadership Council.”
The pediatrician referred Brewer to several specialists, including an ear, nose and throat doctor, a pediatric ophthalmologist, a dentist and a pediatric neurologist. There were no problems along with her child's ears, sinuses or teeth, however the ophthalmologist found a blocked tear duct and tracking problems.
“This means that when my daughter got to the end of a reading line, it was difficult for her to find the next line because the way her eyes moved was different to the way her eyes moved Most people’s eyes move,” Brewer said.
Despite receiving physical therapy for her eyes, Brewer's daughter continued to suffer from headaches. The neurologist diagnosed her with chronic migraines. Now she takes Propranolola medicine sometimes used to stop migraine attacks, as well Sumatriptana medicine used when a migraine attack has already begun.
“Window to the Brain”
About 60% of kids and adolescents experience headaches, based on a study cited by the authors new study published within the diary Ophthalmological epidemiology. These headaches can impact a baby's quality of life, affect their performance, and impact school attendance and performance.
The authors of the brand new study desired to learn how common eye problems are in children with headaches. They studied children who visited an ophthalmologist with complaints of headaches, said lead study writer Lisa Lin, MD, a graduate of the ophthalmology residency program at Massachusetts Eye and Ear in Boston. The study was conducted at Children's Hospital of Philadelphia, where Lin attended medical school.
Lin and her colleagues reviewed the medical records of 1,878 children ages 2 to 18 who had headache symptoms at an outpatient eye clinic.
All children got an eye fixed exam to find out in the event that they had any eye problems or other problems that could lead on to headaches.
The researchers found that a few quarter of the kids had a number of recent eye findings which will have contributed to their headaches.
Almost a fifth of the kids had refractive eye problemsakin to nearsightedness, farsightedness or astigmatism.
The second commonest eye disease, occurring in 4.4% of kids, was Strabismus (eye misalignment). A really small percentage of kids had other conditions that might cause eye pain or be an indication of an intracranial problem, including Uveitis, glaucomaand elevation of the optic nerve.
Patients with eye problems typically had shorter-lasting headaches, but there was no association between eye problems and the frequency of their headaches, sensitivity to light, nausea/vomiting, and vision problems.
Lin acknowledges that the study was “limited” because researchers didn’t follow the kids to see whether their headaches improved when the attention problem was corrected; for instance by wearing glasses.
But the findings are necessary because about “a quarter of children had a treatable eye condition.” The eyes are sometimes a “window to the brain” and should should be examined when children complain of headaches, she said.
Take children's headaches seriously
Paul G. Mathew, MD, assistant professor of neurology at Harvard Medical School, said he was not surprised by the outcomes.
“Most of the children with eye problems in the study had refractive problems and probably needed glasses,” he said.
He said the usual tests doctors use cannot find all eye problems and that sometimes a more thorough eye exam is obligatory.
“I think it makes sense for a child to see an ophthalmologist if the child has a headache and vision problems, but I would also caution against sending every single child with a headache to an ophthalmologist, as this increases the cost of care and assessment and would delay treatment for children with more urgent ophthalmological problems,” Mathew said.
Eye problems may cause headaches, but can even make headaches worse in individuals with conditions akin to migraines. He warned not to disregard or dismiss a baby who complains of a headache.
“I've noticed that parents often don't take headaches in children seriously enough, especially when they occur infrequently or episodically,” said Mathew, who sits on the board of the National Headache Foundation. “All too often, children are told, 'You're just being dramatic' or 'You're exaggerating.'”
Mathew, whose 11-year-old daughter has headaches, said there’s more awareness of migraines in children. “In the past, children with migraine received inadequate treatment at best, but now more treatment options are available and migraine in children is being taken more seriously.”
He is completely satisfied about that because “when children suffer from headaches that keep them from school, sports and other activities, it is detrimental to their development.”
Advice for folks
If your child has a headache, Mathew recommends first seeing a pediatrician, who can determine whether the kid needs further consultations with a specialist akin to an ophthalmologist or a neurologist.
“Take nausea and vomiting seriously,” he said. “Children often undergo appropriate comprehensive gastrointestinal examinations, but these stomach problems can be symptoms of a migraine.”
Even though the episodes are usually not quite common, Mathew believes they shouldn’t be ignored as they will turn into more frequent and intense after puberty, especially in girls.
If your pediatrician doesn't take the issue seriously, Brewer recommends getting one other opinion. “You know your child better than anyone. Even if you are a new parent, trust your gut and push for the best diagnostic efforts,” she said. “Advocate for your child and don’t stop until you find someone who takes the symptoms seriously and has a good answer for you.”
Mathew also advisable being aware of headache triggers, akin to lack of sleep, stress, dehydration, late meals and changes within the weather. “At this point, my daughter's headaches are still infrequent and fairly predictable,” he said. “They usually occur after air travel or when there is a severe lack of sleep. So when we go on vacation, we schedule plenty of time off to make sure she gets enough rest.”
This is a very important message for today's parents, lots of whom have children who’re under great pressure from combining schoolwork and extracurricular activities. “Make sure your child has enough free time, eats regular nutritious meals, stays hydrated and gets enough sleep, and be mindful of what might be triggering their seizures,” Mathew said.