The child looks pale and ill. He may experience dizziness and has recurring headaches. It is possible he may be suffering from migraine headaches. Although they are often hard to diagnose, migraine headaches don't affect adults only.
"Probably most people will be surprised to find that children have migraines," said Dr. W. Donald Shields, chief of pediatric neurology at UCLA Medical Center.
"The fact is that most of the time you don't really know because migraines in children are different and less specific than migraines in adults."
Shields has explored the occurrence of migraines in children but cautions that information is scarce and inconclusive. Evidence seems to indicate that migraines have a genetic link and thus can be inherited.
By definition, a migraine is a sudden disorder in which a headache is combined with one or several other bodily disturbances, including nausea, vomiting and/or dizziness. Migraines may occur daily or as infrequently as once a year.
People who suffer from migraines have symptoms that precede the actual headache by as much as an hour. These symptoms--such as loss of vision, the illusion of flashing lights or brief defects in speech or body movement--usually subside in 10 to 30 minutes and are followed by severe, throbbing headaches over one or the other temple.
Imagine the difficulty in explaining that to a child and having him understand and use the information.
"It's hard to get a 5-year-old to tell you where it hurts or how it hurts," said Shields. "All he knows most of the time is that he feels bad."
Because of the lack of effective communication, doctors are forced to rely on other information for diagnoses.
"There are a few basic rules that you go by," said Shields. "One is that the headaches are episodic," occurring at varying intervals over a period of time. "Another one is that there should be other symptoms besides just having a headache--nausea, vomiting, abdominal pains. If the child has an aura--a visual aura or an abdominal aura--that makes it easier" to diagnose, he said.
"Migraines are hard to diagnose because they don't last too long," said Shields, "and by the time you get the child to a doctor, the headache is gone."
Dr. David Thompson, a pediatrician who sees scores of children from throughout the San Fernando Valley, said a headache alone does not indicate migraines.
"The fact that a youngster has recurring headaches, that in itself does not establish a migraine. A migraine always has an associated other symptom.
"If you are, in fact, dealing with a child who has recurring headaches, then the possibility of childhood migraines should be entertained," Thompson said.
In most cases, Thompson said, a child who is suffering from a migraine headache looks pale and appears ill during the attack.
It's common for a child who suffers from migraine headaches to have a headache recur once a month, but, said Thompson, "Four times a month is not uncommon.
"A youngster in my practice, 3 going on 4, had episodes of headache, vomiting and what the youngster described as 'spinning of the room.' In medical terms, that's vertigo," said Thompson.
Thompson prescribed medication for the child and now, he said, the boy has headaches only about once a month. "He goes into a preschool situation in September, and we're waiting to see how that affects the child," he said.
Work Can Suffer
Childhood migraines can be more than just physical pain for school-age children. Work can, and frequently does, suffer, and sometimes the recurring migraines can limit extracurricular activities.
"One girl in my practice was missing 20 to 30 days of school each year," Thompson said. "In spite of missing that much school, she had an adequate performance record. She was somewhat of a retiring youngster, somewhat fearful of engaging in competitive sports and had headaches two or three times a month. It was not uncommon for her to have them once or twice a week."
The girl's mother had a history of migraine headaches. After treatment, the girl's school attendance became much more regular. "She is much more cheerful when I see her and much more attentive and more social," Thompson said.
Only in severe cases do doctors recommend daily medication. The goal in those cases is to prevent headaches that occur with more than normal regularity.
Just what causes migraines is a matter still open for research and discussion. However, most doctors agree that there is a genetic connection.
"Migraines have a genetic influence," said Thompson. "There is some type of chemical disturbance that we are not yet smart enough to uncover.
"If one is able to take a very, very good family history from both parents, and one has the time and patience to do this, it shows that 90% of the youngsters who have migraines have at least one parent who had migraines in the past," or has them now.