For two years before his headaches became constant, Jonathan’ s parents noticed he had problems falling asleep at night and getting up in the morning. These sleep problems exacerbated his headaches and his classroom issues. As a result, his grades dropped, and he occasionally fell asleep during class.
Jonathan’ s primary care physician and neurologist evaluated him, but all laboratory tests came back negative. They tried a regimen of pain medications, but nothing relieved his headaches.
Jonathan was eventually diagnosed as having several problems: insomnia, delayed sleep phase syndrome( a condition in which sleep and wake times get pushed later and later), medication overuse headache and somatoform disorder( a condition in which patients manifest psychological stress in physical ways). He was admitted to the inpatient adolescent pain program at the Cleveland Clinic, where he stopped using medications and caffeine and began a regular sleep routine. He also began daily psychological counseling and group therapy, entered a physical rehabilitation program, engaged in occupational and physical therapy, and ate a more balanced diet free of additives, such as nitrates and MSG.
Within 10 days, he reported changes in his function and attitude. After three weeks, his sleep quality improved dramatically. As for his headaches, they still occurred daily, but they were shorter and less severe and interfered less with his daily activities.
A MULTIDISCIPLINARY TREATMENT APPROACH
Jonathan’ s outpatient treatment addressed the entire spectrum of issues children with headaches typically face. Because there are many co-morbidities associated with pediatric headaches, including school absences, medication overuse and sleep disturbances, a multidisciplinary treatment program is the best approach.
To successfully treat complex headache disorders, it is essential for children to get into a normal sleep pattern. That’ s why a consultation with a sleep specialist or an evaluation in a sleep laboratory can help. An expert diagnosis followed by treatment that promotes restorative sleep is a major component of a successful headache-prevention regimen.
In addition to regulating sleep patterns, it is common to prescribe medications, psychological treatment, and lifestyle changes to relieve chronic headaches and migraines.
Most common sleep problems in pre-adolescent children with headache:
Co-sleeping with parents 25 %
Snoring 23 %
Most common sleep disorders in adolescents with headache:
Insufficient total sleep 66 %
Sleeping too little 42 %
Daytime sleepiness 23 %
Difficulty falling asleep 41 %
If a child experiences headaches for more than 10 days a month— and if the headaches interfere with daily functioning or are associated with medication overuse and frequent school absences— then the child should see a doctor. Though these headaches are not life-threatening, they, along with their associated problems, can have a significant negative impact on quality of life and sleep.
Although the connection between childhood headaches and sleep disorders has held the interest of physicians for many years, more research is needed to fully understand this relationship. In the meantime, a multidisciplinary regimen that combines lifestyle changes— such as getting adequate hydration, eating right, losing weight and exercising regularly— and regulation of sleep patterns is the most effective treatment for these complex disorders. HW
A. DAVID ROTHNER, MD, is the director of the Pediatric / Adolescent Headache Clinic and chairman emeritus of child neurology at the Cleveland Clinic Foundation.
Nocturnal awakenings 38 %
www. headwisemag. org | National Headache Foundation 19