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