schooling , children may miss school because they are anxious or because parents are afraid to send their children to school with headaches . Unfortunately , this merely keeps children from their daily activities and does not address the root of the problem ( the headaches or any underlying stress ). It is best to keep children in their normal environments , keep them working on school-related activities and prepare them to manage their headaches in the real world . Headache specialists cannot truly help children with CDH unless the patient stops overusing over-thecounter medications and moves forward with school and daily activities .
TREATING ALL ASPECTS OF THE CHILD ’ S LIFE
The treatment program for CDH should involve a holistic approach , addressing everything from lifestyle to diet . Medication is only part of the equation .
First , it should be noted that all teens have stress , and this might be especially prevalent among teens who put pressure on themselves to be straight-A students or the best in their activity . Many children also encounter stress at home or bullying from their peers . Because stress can trigger headache , it should be managed ; a stress management program might incorporate cognitive behavioral therapy or biofeedback .
Other aspects of the child ’ s lifestyle should also be addressed . This includes ensuring the child receives eight hours of sleep each night , drinks six to eight glasses of water per day , has a routine eating schedule with no skipped meals , reduces over-the-counter medication usage to no more than two days per week , does cardio exercise three times a week for an hour each time , and returns to school . A specific diet may also be helpful . This should exclude food additives , caffeine , chocolate , lunch meat , aged cheese and MSG ( which can be found in everything from Ramen noodles to Doritos ).
MEDICATION , ONLY PART OF THE EQUATION
Headache specialists typically prescribe both rescue medications and preventive treatments . Rescue medications can help the child abort a particularly severe headache or migraine . For CDH patients with tensiontype headache and migraine , a headache specialist may advise the use of Zofran ® ( ondansetron ), used for the treatment of nausea and vomiting . To help the child abort a severe attack , the medication can be combined with a cold compress , a quiet place to rest , Benedryl ® ( diphenhydramine ) to help the child sleep , and Aleve ® ( naproxen ) to help with the pain ( the dosage will depend on the child ’ s weight ). This approach should not be used more than two days a week , to avoid medication overuse headache .
Preventive medication can also effectively reduce the number of headaches and can be prescribed based on comorbidities . For example , for anxious or depressed patients , Elavil ® ( amitriptyline ) may be prescribed ; for thin patients who have trouble sleeping , Periactin ® ( cyproheptadine ) can be effective as it improves sleep and increases appetite ; and for obese or overweight patients , Topamax ® ( topiramate ) can both reduce the headaches and decrease appetite ( see page 30 ). Many physicians start treatment with a low dose and increase the dose slowly to avoid side effects and to find the lowest dose possible that benefits the child . Regardless of the dose , the child will probably need to use the medication for 6-8 weeks in order to see improvement .
Medications like propranolol ( e . g ., Inderal ® ) are used less frequently . Propranolol can cause depression or lower heart rates in teens , thereby reducing the teen ’ s ability to increase their heart rate to the level needed for competitive sports .
Complementary therapies can be effective in CDH patients , in addition to traditional treatments . Complementary therapies include biofeedback , cognitive behavioral therapy , acupuncture , yoga , and vitamins and minerals ( e . g ., magnesium , riboflavin , butterbur and coenzyme Q10 ). An inpatient rehabilitation program can also be beneficial for children who are missing excessive amounts of school and are overusing medication . Inpatient programs focus on treatment as well as teaching the child to cope with headaches and lead a normal life .
Today ’ s children are tomorrow ’ s adults . Preparing them now to manage daily headaches amid their circumstances and within their everyday environment will empower children to become productive adults who can advocate for their own health . HW
A . DAVID ROTHNER , MD , is director of the Pediatric / Adolescent Headache Program , chairman emeritus of Child Neurology at the Cleveland Clinic in Cleveland , and a member of the Head Wise editorial board .
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