A terrible ache that's not all in the head

About one in 10 children in Ireland has migraine but much of it goes undiagnosed

YOUR YOUNG child is off form, a little pale, then has an upset stomach and just wants to sleep it off. Most parents would suspect a tummy bug, administer some sympathy and wait for it to pass. And in many cases they would be right.

But for some of those children the culprit could be migraine. Around 10 per cent of children in Ireland experience the neurological condition, but it often goes undiagnosed, according to Patrick Little, chief executive of the Migraine Association of Ireland.

Roughly 400,000 people in Ireland suffer from migraine, a disorder of how the brain deals with sensory information such as pain, light or sound. In adults the condition can present as a severe one-sided headache, visual disturbance, nausea and sensitivity to light, but in children it often shows up differently, explains Little.

"The primary difference in children is that they can have migraine without headache pain. They are likely to have what's called 'abdominal migraine' which could be stomach ache in the navel area, loss of appetite, nausea and vomiting."

Young children find it hard to explain their migraine symptoms, and are less likely to be able to push for treatment, adds Little. "There's a lot of stigma attached to it as well. People think it's attention seeking without realising how serious it is," he says. "It can affect their lives very seriously and particularly their studies, so we target teachers with information to get them to recognise the effect it can have on young people and there are allowances in exams."

He sees parents as having a central role in being aware of the condition and seeking an accurate diagnosis. But this is sometimes a challenge. He notes: "Migraine is the most misunderstood and misdiagnosed neurological condition. It's not always taken seriously."

Awareness about the condition can vary among GPs, says Little, but where doctors have encountered migraine before it can boost their knowledge for the next patient who presents with it.

"There is an ongoing need to promote the whole migraine issue among GPs, and I think GPs who have experience of working with people who have migraine are more likely to be sharp the next time."

So if a parent who suspects their child has migraine feels that perhaps another opinion is warranted, they should seek it, he adds. "If people are not satisfied then they should change GP and go and find one who is aware of issues around migraine."

But even with better awareness, nailing down a diagnosis of migraine can be particularly difficult in young children because it's based on a history of symptoms, says Esther Tomkins, migraine clinical nurse specialist at Dublin's Beaumont Hospital.

And just because it's hard to name doesn't lessen its potential impact.

"Some kids can miss months of school with it, and they get a label as a 'sick kid', which can affect their self-esteem and confidence," she says.

Once pinned down though, the condition can be managed through lifestyle and medication if needed, explains Tomkins. She encourages parents and children to keep a diary about suspected migraines and potential triggers and to bring it to the GP, nurse or neurologist.

Common migraine triggers in children include anxiety, excitement, tiredness, a change in routine or a major event like moving house or a new baby arriving in the family.

Hormonal changes, skipped meals and even flickering from a computer screen or television can also prompt an attack for some.

Being aware of the triggers is a key to managing migraine and parents can encourage their children to recognise patterns, suggests Tomkins. "But it's important to remember that triggers are only triggers, the migraine is already there," she adds.

Often children will get their first migraine after puberty, when it is three times more common in girls than boys. And attacks, which in children may last only a couple of hours, can be managed with pain relief, or in some cases a doctor may prescribe anti-migraine medication for a young child, says Tomkins.

While some children will continue to suffer migraines into adulthood, the good news is that many grow out of them eventually, she adds.

And by being aware and working with schools, parents can help support children with the condition.

For support and an information pack on migraine in children contact the Migraine Association of Ireland through their helpline 1850 200 378 or e-mail info@migraine.ie

GENERATIONS UNDER ATTACK

LOOKING BACK, Mary Caulfield now realises that her daughter, Cathy, first started to show signs of migraine around age seven.

It didn't come right out of the blue though. Mary suffers from migraine herself and the condition has a strong genetic element.

Mary, from Holles Street in Dublin, had her first experience of migraine shortly after she had Cathy, 16 years ago. But the condition was misdiagnosed and she was put on incorrect medication. "It was like a strait-jacket on my mind," she says, recalling how she spent a week in hospital, and then nine months being treated as an outpatient.

However, when she moved to the US, she got an accurate diagnosis of migraine and started on appropriate drugs to manage the condition, which made a world of difference.

But certain triggers would still spark an attack. "It's very dependent on lifestyle," she says. "The triggers are very individual to a person and I've found they can also change with your life phase."

Cathy was conscious of migraine from being there when her mother's attacks happened. "I remember one time when Cathy was small we were on holiday in Waterford I had an attack and I had to just lie down in a public park," recalls Mary.

So when the young girl started to show signs of having the condition too, Mary trod softly with it. "I didn't want to scare her," she says.

In hindsight Mary now realises that there were hints of the condition in her own childhood, recalling how she had visual disturbances and an awareness that something was up. "I remember being in fourth class and saying 'I have a headache coming'," she recalls.

But thanks to her own experience, Mary also feels more able to support her daughter: "I'd really be in the dark if Cathy had it and I hadn't."

Cathy now keeps over-the-counter medication with her in case of a migraine, and Mary liaises with her daughter's school about the condition.

To support Cathy, the school provides a quiet room where she can lie down to help ease her symptoms if she feels an attack starting. "Even just lying there for 20 minutes can help," explains Mary.

And together mother and daughter take heed of triggers that can prompt an attack and try to avoid them. "The old view of triggers just being wine, cheese and chocolate is antiquated," says Mary, who lists their tripwires as including a dip in blood sugar, eye-strain, certain foodstuffs and even (in Mary's case) changes in the weather.

"There are so many pieces of the jigsaw, you are always learning and joining the dots with it, and you become a manager of it," she says.

"It's a constant balancing act and if you are a good little soldier migraine will treat you well, but step out of line and it's down on you like a tonne of bricks," she adds.

MIGRAINE AND SCHOOLWORK

If your child has migraine, it's important to talk to the school and make them aware of the child's condition, particularly if it is likely to cause absence.

The Migraine Association of Ireland also encourages parents to help their children learn the signs that a migraine is coming, so they can let the teacher know and better manage the attack if it happens in school.

And they offer the following tips for approaching schoolwork:

• Take frequent breaks from long periods of studying, particularly if using a computer screen or if the work is stressful

• Eat regularly throughout the day

• Get some exercise and fresh air during the day - walk or cycle to school if possible

• Watch caffeine intake (present in coffee and some soft drinks) - drink plenty of water instead

• Make the study environment as comfortable as possible: keep good posture, light the area well and do stretching exercises to avoid stiffness and tension

• In extreme circumstances, special arrangements can be made to accommodate a student with migraine taking State exams.

This can include sitting the exam on their own with a superintendent, providing a tape recorder if the student cannot write due to an attack, or allowing a delayed examination start time. Contact the Reasonable Accommodations Section of the State Examinations Commission through  www.examinations.ie

In general, parents should try to reassure children that migraine is nothing to be ashamed of or worried about and encourage them to build up their confidence in managing attacks.

If you suspect your child may have migraine it is important to get an accurate diagnosis, according to the Migraine Association of Ireland.

MIGRAINE THE SYMPTOMS

Clues that your child might be a sufferer include:

• Pain, usually on one side of the head, but sometimes on both sides

• Vomiting or nausea

• Vision disturbances or strange sensations

• History of migraine in close family members - around 60 per cent of migraine sufferers can identify a close blood relative who also has the condition, usually the mother

• Abdominal migraine - stomach ache in the navel area, loss of appetite, nausea and vomiting

See  www.migraine.ie