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Chronic Illness in Children

Chronic Illness in Children: Migraine Headaches
Faith Jones
Southern University School of Nursing
Chronic Illness of Children: Migraine Headaches
Pain is a subjective experience, so when assessing someone with a migraine, the data that you receive relies on what the patient tells you. But this can become cumbersome when the migraine is in a child that may not be able to clearly explain what is going on. However, this can be a result of the migraine being underassessed. Although migraine headaches in infants are uncommon, it has been reported in children “as young as 18 months”. The onset is earlier in boys (7.2 vs. 10.9 years), but when puberty hits girls have a “twofold increase in migraine headaches” (Hockenbery & Wilson, 2015).
The symptoms experienced during a migraine headache depend on the age of the child. Some common symptoms are: “nausea, vomiting, and abdominal pain”, but these go away with sleep (Hockenberry & Wilson, 2015). However, when it comes down to toddlers they may display “episodic pallor, decreased activity, and vomiting” (Hockenberry & Wilson, 2015). The onset of a migraine in children often occurs in the afternoon and can be “bifrontal, temporal, bilateral or unilateral” (Hockenberry & Wilson, 2015). Children have a shorter duration of migraines than adults. A child’s migraine usually last for about an hour while an adult would last for up to 4 hours. In the Sahd-Brown ; Ruth-Sahd 2018 study, they stated that the pathophysiology of migraine headaches is unknown, but it is researched:
that in the brainstem that leads to diffuse projections from the locus coeruleus to other parts of the brain, leading to an unstable trigeminovascular reflex. This causes increased discharge of the spinal nucleus of the trigeminal nerve and basal thalamic nucleus. When migraine occurs, blood flow increases in the cingulate in the cerebral hemispheres, auditory and visual cortices, and brainstem. Antidromic rather than orthodromic (or normal) trigeminal nerve stimulation results in the release of substance P, calcitonin gene-related peptide, and other peptides, leading to vasodilation and pain. These events lead to neurogenic inflammation (pg 26).

Migraines are classified as without aura and with aura. Migraines without aura have moderate or severe pain, a change in their appetites, and can be faced with a sensitivity to light and a sensitivity to loud sounds. They may also complain about their heads pulsating. However, migraines with aura can be visual, which is the most common, and hemiparethetic, which comes in second. Hemiparethetic consists of having a tingling and numbness feeling in the lips and lower face. Sporadic Hemiplegic Migraine consist of motor weakness and someone who has basilar-type migraine may have recurrent attacks (Sahd-Brown ; Ruth-Sahd, 2018). The prognosis of a migraine headache has a good outlook, it is a condition that can impulsively resolves itself with or without treatment does not cause a major threat to a child’s health.
However, stressful events can make daily living a bit of a struggle. An example of a stressful effect that migraines can have on a child is missing out on the opportunity to participate in extracurricular activities, such as sports and clubs. Also, family vacations may have to be canceled because the child may not be able to handle the stimulants that come along with the activities of the trip. Sometimes the child may feel guilty, sad, or frustrated because the family must work around the child’s condition. Some children may suffer from the thoughts that they are putting a burden on their family because of short tempers and their irritability. Their also may be sibling rivalry in view of the amount of attention the child is getting from the parents. Moreover, the child may endure the idea that they are causing their parents hardships when it comes to money since they must take off work to go to appointments.

The leadership and discharge role of the nurse is to discuss with the parent and child, if applicable, the concerns they have regarding the migraine. The nurse will teach the parent and child about the different types headaches, recording what triggers the headaches (such as lack of sleep, a poor diet, environment or stress), and how to use prescribed or over the couther medicine safely and appropriately. The caregiver can also keep a log of the headaches, sort of like a headache diary, to record the qualities of the headaches. The nurse will also recommend ways of managing the headache triggers. Moreover, bringing the diary to all doctor appointments can help the healthcare providers correctly treat the child’s headaches just in case there are some alarming characteristics that can lead to the need for diagnostic tests.
Furthermore, there are 3 different types of migraine medication such as, symptomatic relief which is used to relieve the symptoms experienced when having the migraines. Abortive therapy is used at the first sign of a migraine to stop the migraine in its tracks while preventive therapy can be used to relieve those who suffer with frequent and tense headaches. When the medications are used in conjunction with other therapeutic techniques, such as dietary and relaxation therapy the medication seems to be more effective (Gladstein & Rothner, 2013). The child may be administered antiemetics, analgesics, and sedatives to combat the symptoms. Furthermore, calcium channel blockers, or tricyclics can be given for those who have frequent headaches.
Consumer groups are helpful for the patient because they are amongst people who are suffering from the same condition that they are going through. Although there are not a lot of children support groups for headaches, the caregiver can still attend support groups and ask those who are suffering from what the child is suffering and perhaps the supporters can divulge some tips that will ease the pain such as nonpharmacologic techniques since some medications that adults take may be contraindicated in a child. A few consumer groups that caregivers and the child, if appropriate, may gain information from are: the Alliance for Headache Disorders Advocacy, American Headache and Migraine Association, American Headache Society, American Migraine Foundation, Association of Migraine Disorders, Danielle Bryon Henry Migraine Foundation, and the National Headache Foundation. Each consumer group does something differently, but collectively have the same goal in mind. The Alliance for Headache Disorders Advocacy is dedicated to searching for treatment that can result in better results for those suffering with migraine headaches.
Moreover, the American Headache Society strives to trade information and thoughts involving the causes and treatments of headaches. Also, the American Migraine Foundation involves a community of supporters who advocate for those who suffer with migraines, as well as supporting meaningful research efforts that can be transformed into treatments for the suffers. In addition to the American Migraine Foundation, the Danielle Bryon Henry Migraine Foundation strive to assist and provide an avenue for treatment for families that are living with migraines, particularly for children and young adults.
In view of optimal health, there are some strategies that I would recommend promoting that strives for optimal wellness in the family unit. For example, remembering what may have been eaten or sipped before the onset of an episode can help find out if there is something chemically triggering the headache and will suggest making certain dietary changes to avoid future migraines. Secondly, not skipping meals can assist with the reduction in migraines since the migraine may be contributed to the lack of eating. Furthermore, not getting enough sleep could be an unnoticeably trigger so making sure that the child gets their recommended amount of sleep can also be helpful. Thirdly, I would suggest the caregivers keep the child well hydrated by drinking the recommended amount of water a day, 8 8oz glasses of water, because dehydration can be a cause for a migraine.

Also, even if the parent may have to write a letter to the teacher/principal to allow the child to take water breaks throughout the day while in school, this could be a great strategy to keep the child hydrated as well as eliminate the headaches. If the child may be a girl going through puberty, the migraines may be attributed to her menstruation and having some ibuprofen available during that time can also be a helpful form of treatment.
All in all, migraine headaches can be treated with medications and a few preventive measures. So if you know of anyone who suffers from what seems to be migraine headaches, take them seriously, and see a health care professional so that you and the child can get answers.
Reference
Gladstein, J., & Rothner, A. D. (2013). Chronic Daily Headache in Children and Adolescents. Seminars in Pediatric Neurology, 17(2), 88-92. doi:10.1016/j.spen.2010.04.003
Hershey, A. D., Powers, S. W., Coffey, C. S., Eklund, D. D., Chamberlin, L. A., & Korbee, L. L. (2013). Childhood and Adolescent Migraine Prevention ( CHAMP) Study: A Double-Blinded, Placebo-Controlled, Comparative Effectiveness Study of Amitriptyline, Topiramate, and Placebo in the Prevention of Childhood and Adolescent Migraine. Headache: The Journal of Head & Face Pain, 53(5), 799. Retrieved from https://subr.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=87233115&site=eds-live&custid=s2835722Hockenberry, M. J., & Wilson, D. (2015). Wongs nursing care of infants and children. St. Louis, MO: Elsevier/Mosby
Sahd-Brown, K. E., BSN, RN, CPN, & Ruth-Sahd, L. A., DEd, RN, MSN, CEN, CCRN. (April 2018). Acute Migraine Headache in Children. Nursing, 48(4), 24-29. doi:10.1097/01.nurse.0000532038.75225.4f