kids’ korner
By A. David Rothner, MD
A L L E R G Y A N D H E A D A C H E Fact & Fiction
A common question at the conclusion of a pediatric headache consultation is:
Are my child’ s allergies causing the headache? The answer to the question is multifaceted. It could involve a discussion of seasonal allergies, sinus issues, food allergies, gluten and celiac disease, and the effect that chemical additives in food can have on the body.
Allergies of all kinds, abdominal pain, sinus symptoms, and headaches are among the most common maladies that children and teens experience. The high frequency of these various disorders contributes to the misconception that they are related. It is, therefore, entirely reasonable that patients experience more than one of these conditions and mistakenly conclude that one( allergy) causes the other( headache). Let’ s examine the facts.
Definition Prior to proceeding with this discussion, it is important to define Migraine and Tension-Type Headache( T. T. H.). Neither of these conditions have been proven to be caused by allergies.
Episodic migraine in children and adolescents, in over 80 percent of cases, is genetic in origin. If a mother experiences episodic migraine, each of her children stands a 50 percent chance of having migraine. The usual childhood migraine is not daily and occurs 2 to 8 times per month. The patients often become quiet, appear pale, have dark circles under the eyes, become listless or irritable, and develop a strong pounding headache. The child may want to lie down, stop activity, and become sensitive to light and noise. Most lose their appetite and refuse food. Many children experience relief after sleep. The entire episode may last 1 to 4 hours. Both analgesics and triptans may be needed.
The cause of T. T. H. is less clear. Stress, heredity, environment, and G. O. K.( God only knows) have all been implicated. In most instances, it is occasional, occurring once or so per week, but it may become more frequent. If it occurs less than 15 days per month, it is called Episodic T. T. H. If it occurs more than 15 days per month, for months on end, it may be called Chronic Daily Headache( C. D. H.). In many patients with C. D. H., occasional episodic migraine is also seen. In patients with T. T. H, pallor and dark circles are less prominent, and personality changes are less marked. The headaches are less pounding and severe, the patients are less sensitive to light and noise, and do not lose their appetite, develop nausea, or vomit. Simple analgesics are often effective.
24 HEAD WISE | Volume 3, Issue 1 • 2013