growing pains
By A. David Rothner, MD
Sweet Dreams
Children and adolescents with chronic headaches can experience a spectrum of sleep disorders, which warrants a multidisciplinary treatment approach.
THE RELATIONSHIP between childhood sleep disturbances and headaches has fascinated physicians for more than a century. Kids who have headaches experience a wide range of sleep problems, including getting too little sleep, snoring, struggling to fall or stay asleep, and having problems staying awake at school. These issues negatively impact physical and psychological health as well as academic performance.
Studies have shown that sleep disorders are more frequent in children and adolescents who have headaches than in the general childhood population. The modern study of this sleep-headache connection dates back to 1962, when Swedish school physician Bo Bille found that 47 percent of children with migraines suffered from sleep disorders, as well. More recent research indicates that children with headaches also have a higher prevalence of other sleep problems, such as excessive daytime sleepiness, narcolepsy and insomnia.
The most common form of headache in preadolescents is migraine, followed by chronic daily headache( CDH), a condition in which headaches occur more than 15 days per month. Adolescents, on the other hand, more frequently have CDH, as opposed to migraine alone.
The sleep disorders seen in young headache sufferers vary depending on their age and headache type( see sidebar). Younger kids with headaches tend to get very little sleep, co-sleep with their parents and snore. If they have migraines, they also tend to resist sleep and have sleep anxiety.
Older children with migraines and headaches don’ t get enough rest because they have difficulty falling asleep and wake frequently during the night. This sleep deprivation can directly impair daytime function, academic performance and overall mood.
JONATHAN’ S STORY
Jonathan was evaluated for chronic headaches when he was 15 years old. His earlier medical history was normal, and his academic performance was above average until his headaches began 18 months prior to his evaluation.
Initially, the headaches were sporadic and moderately severe, but Jonathan soon began to experience them constantly. He described the pain as“ squeezing,” and it worsened with activity. These were not typical migraines, as they were not associated with nausea, vomiting, or sensitivity to light and sound.
18 HEAD WISE | Volume 1, Issue 2 • 2011