When it hammers in small heads

The pain comes suddenly, like a bolt of lightning travelling through Sandra Högl's* head. Then all the 11-year-old wants to do is lie down in bed, pull the covers over her head and sleep. Playing or even studying is out of the question. «She complains of terrible headaches almost every week,» says her mum. Sandra is then completely apathetic, can't stand light or loud noises and doesn't want to eat. «And she can hardly keep up at school because she's absent so often.»
Too little sport, stress at school, too many hours in front of the computer - more and more children and young people are suffering from headaches like Sandra. Experts estimate that around 10 to 15 per cent of young people in Switzerland are affected by migraine attacks and that the proportion of children and young people with tension headaches is even higher.

Headaches can have a considerable impact on school performance.

And not only in this country. Recent studies by the Ludwig-Maximilians-Universität in Munich found that 38 per cent of all younger children in Germany suffer from headaches, and as many as 84 per cent of adolescents. Of these, around 30 per cent complain of migraines and 50 per cent of tension headaches. And headaches become more frequent with increasing age - sometimes with a considerable impact on school performance or social life. «It is therefore crucial to recognise headaches in childhood early and treat them effectively so that they don't become chronic,» says Andreas R. Gantenbein, Head of Neurology at the Reha-Clinic Bad Zurzach and President of the Swiss Headache Society SKG .
Almost every day, desperate parents come to Tobias Iff's practice in Zurich with their headache-plagued offspring. The paediatrician specialising in paediatric neurology is regarded as one of the leading experts on childhood headaches in Switzerland. He examines and questions the young patients in detail in order to first of all rule out the possibility that the complaints are the symptom of another illness. Doctors call this secondary headaches. «Many parents are afraid that their child has a brain tumour,» says Tobias Iff. «Poor eyesight can also cause secondary headaches.»

If it is certain that the child is suffering from primary headaches, i.e. the headache itself is the illness, the doctor determines which type of headache it is. «The majority of children have either migraines or tension headaches,» says the doctor.
Symptoms of a childhood migraine include moderate to severe pulsating or throbbing pain on both sides of the head and the forehead. In adolescence, the pain shifts to one side of the head. Accompanying symptoms are attacks of dizziness, nausea, vomiting, sensitivity to light and noise. Shortly before or during an attack, neurological deficits can occur; those affected see flickering, flashes in front of their eyes, have sensory disturbances in their hands and arms or speech disorders. It is not surprising that children stop playing or learning under such circumstances, want to lie down or adopt a resting posture.
Unlike migraines, tension headaches often spread from both sides of the forehead to the back of the neck and are also dull and pressing, but not pulsating.
«However, the most important experts for headaches are the parents and the child themselves,» says Tobias Iff. «This is because the paediatrician or family doctor can make a diagnosis based on the specific description of the pain, supplemented by physical and neurological examinations.»
A headache calendar specially developed for children (see box below), in which all information about the type, severity and duration of the headache is noted over weeks and months, is crucial for this and for successful treatment.

«Unfortunately, parents are often too hesitant when it comes to administering medication.»

The paediatrician also asks his patients to draw their headache on a piece of paper. «A hammer or a bright flash of lightning striking the head are typical images for a migraine.» A band around the head or a pressing helmet are typical of tension headaches.
So far, medicine knows very little about the actual causes of headaches and the processes that take place in the brain during an attack. «What is certain, however, is that heredity plays an important role in migraines. The same applies to tension headaches, but to a lesser extent,» says the expert. He estimates that 80 to 90 per cent of migraines are inherited. Environmental factors such as caffeinated energy drinks or excessive media consumption (PC, smartphone, TV) also play a role. Tobias Iff: «With tension-type headaches, you have to look at the triggering factors in particular. These are mainly family and school problems, such as parental separation or excessive demands at school.» In such cases, psychotherapy is also helpful. Stress is a trigger factor for both migraines and tension headaches, and is even the most important factor for migraines.
In the treatment of childhood headaches, medicine generally favours non-pharmacological treatment. «If a migraine attack lasts less than 45 minutes, I recommend taking it easy, sleeping and applying something cooling to the forehead,» says Tobias Iff. If the attack lasts longer, there is no getting around painkillers such as paracetamol, ibuprofen or stronger medication - but only in consultation with the doctor.
«Unfortunately, parents are often too hesitant when it comes to giving medication,» Tobias Iff knows from experience. He also advises various measures to prevent headaches, such as a regular daily routine, sufficient sleep and, above all, exercise. «Because endurance sports two to three times a week help just as well as pain medication,» says the paediatric neurologist. «High doses of magnesium and vitamin B2 also help as a preventative measure.» The aim of treatment is always to improve the affected child's quality of life. Tobias Iff: «Migraines cannot be cured. We can only ensure that young patients can live with their illness."
The combined treatment with painkillers and preventative measures has also helped migraine sufferer Sandra Högl. Two months after starting treatment, she already has her attacks much better under control. "Sandra only gets a headache once a month at most,» reports her mother. And the pain is no longer as intense. «Sandra can deal with that. Now she's finally enjoying life again.»
* Name changed by the editors.

My child has a headache - the best tips for parents

• For occasional, mild headaches, it usually helps if the child is given attention and rest. It is enough to observe the child.
• A visit to the doctor is necessary if the child has regular or recurring headaches; if simple measures (rest, sleep, cool cloth on the forehead) do not bring relief and the pain lasts longer than one to two hours.
• Pain medication, including over-the-counter medication, should only be given to the child after consultation with the doctor.
• Headaches can also be symptoms of other illnesses such as colds, head injuries, poor eyesight or misaligned jaws.
• Although life-threatening causes are rare, if your child shows the following symptoms, you should see a doctor immediately:
  • The pain comes on suddenly and severely;
  • the pain increases despite treatment;
  • high fever;
  • cannot bend the head (stiff neck);
  • wakes up at night because of headache, has to vomit and shows severe drowsiness.

Advice and help

The Swiss Headache Society SKG, based in Basel, is an association of around 150 doctors, specialists and scientists who specialise in headaches. Its aim is to promote research, diagnosis and treatment of headaches and to pass on the latest knowledge to doctors, scientists and patients.
On their website www.headache.ch you will find lots of information and tips on the subject of headaches, including paediatric headaches, and a paediatric headache diary to download or print out. Sufferers can also find contact addresses of Swiss headache specialists in their area.

To the author:

Frank Dittersdorf, journalist and author, has been dealing with the topics of medicine and children's health for over 20 years. While researching this report, he was most moved by the impressive drawings of the young headache patients.