Health: Could my child be having migraines?



Despite being common, migraine is often still misunderstood – especially when it comes to children.

“Children do get migraine. The youngest I have ever seen is 18 months, but the usual age range is between six and 15 years,” says consultant paediatric neurologist Dr Arif Khan, who completed his training in the UK and is now based in the Middle East, where he founded children’s neuroscience centre, Neuropedia.

“Migraine awareness has become so prominent in adults that we can forget about children. It is very under-diagnosed.”

Do children get the same migraine symptoms as adults?

Spotting migraine in kids can be trickier than adults. “Typically, if you ask an adult what migraine feels like, they’ll say they have throbbing on one side of their head, and you can associate it with vomiting or nausea, extreme sensitivity to bright light, or loud noises,” says Khan. “The child might not have a textbook description of migraine. They might just say they’re very tired, their head hurts – they often can’t verbalise what’s happening.”

Dr Juliana VanderPluym, associate professor of neurology at Mayo Clinic in Phoenix, Arizona, who has been extensively researching childhood migraine, says there are differences and similarities – but even with children, there can be telltale signs that it’s not a regular headache.

“As in adults, migraine in children and adolescents are often moderate to severe in intensity, have a pulsating quality and may be worsened with physical activity,” she says. “Children may be more likely to have headaches on both sides of the head (bilateral) compared to adults, where often migraines are one-sided (unilateral). Children and adolescents may also have shorter migraine attacks that last only a couple hours, while in adults attacks generally last greater than four hours.

“To diagnose migraine in adults, they must report sensitivity to light and sound and/or nausea or vomiting. But in children, given they may not be able to describe light and sound sensitivity, this can be inferred from their behaviour.” For example, are they avoiding spaces and activities with bright light and sounds? Are they taking themselves off to rest more?

While migraine isn’t always severe, it can be just as debilitating for kids as grown-ups. As VanderPluym puts it: “Migraine can cause significant disability in children and adolescents. It can impact social and familial relationships, and lead to absenteeism and presenteeism in school, extracurricular and recreational activities.”

Why do some children get migraine?

There’s no one-size-fits-all answer. But VanderPluym says: “Migraine is a neurologic disease which we believe has a genetic basis, with its expression being dependent on environmental factors [triggers]. For this reason, migraine commonly runs in families, but does not necessarily look the same in each person.

“Except for a few rare forms of migraine (eg. hemiplegic migraine) that result from a mutation in a single gene, migraine is felt to result from mutations in multiple genes… Recent research has identified well over 50 genes that may be contributory.”

Khan describes migraine as being a “tendency” – meaning somebody has the necessary underlying predisposition, but developing symptoms comes down to triggers, and this can vary. However, the fact migraine runs in families can be useful when it comes to diagnosing the condition in very young children.

For example, with the 18-month-old baby he treated: “The child had inconsolable crying, and untriggered bouts of crying every few hours. It was not until they reached 18 months that we thought, ‘OK, this may be migraine’, because they had a very strong family history of migraine,” Khan recalls. “And once we started using appropriate medications to help control it, it helped.”

Why diagnosis matters

Managing migraine isn’t necessarily the same as managing other types of headache, so getting a proper diagnosis is important. This may mean asking your GP for a referral to a specialist, particularly if your child is having frequent attacks and may need medication to help stop them occurring (Khan explains there are two key medication options – for preventing migraine and treating symptoms).

However, even if migraine is diagnosed, Khan doesn’t “jump into treatment or medication” automatically.

“The first thing we do,” he says, “is understand the lifestyle/environmental factors, and there are four things we are focused on for parents. Number one is rest – sleep duration and consistency have to be maintained. If a child of 10 is only getting six hours of sleep, that will trigger their migraine. A 10-year-old wants at least 10 hours of sleep. Two, they need to drink plenty of water, to try and have at least seven to eight glasses a day – about two litres.

“Three is sometimes foods can trigger migraines. The usual culprits are the four Cs: cheese, chocolate, citrus and coffee. I always ask are they having any of these excessively. And finally, screen time. At least two hours before bedtime, avoid screens, because screens suppress the hormone melatonin, which makes you sleepy.”

Keeping a symptom diary can help families identify specific triggers affecting their child, Khan notes – he says it’s a good idea to take this along to your appointments – and you can ask your doctor for advice around food triggers. “Once these things are adjusted, then we talk about medication,” says Khan.

Stress can also be a factor – particularly for teenagers. Khan recommends keeping this in mind – for general wellbeing, he believes it’s helpful for kids to get enough time to switch off too.

“Perhaps trying some relaxation techniques, like meditation, time without screens, and giving them advice on how to calm down,” he suggests. “And I see a lot of regimented schedules; badminton practice, then tennis, barely an hour a day of not doing anything. We all need time to just do what we feel like and relax.”

Could my child have a brain tumour?

It’s also important to see your doctor so you can rule out other conditions. The possibility of a brain tumour can be a big fear for parents when kids have chronic headaches.

Thankfully, brain tumours are rare – but it’s always best to tell your doctor if concerned. “One of the most common warning signs of a brain tumour in children is persistent headaches, which will usually be accompanied by other symptoms too, such as vomiting, balance problems or changes to vision,” says Dr David Jenkinson, chief scientific officer at The Brain Tumour Charity.

“Headaches are of course extremely common, and it can be really difficult to distinguish the symptoms of a brain tumour from other more likely conditions, such as a migraine – but it’s vital to keep an eye out for persistent headaches that occur most days, particularly when waking up. Children who have a headache caused by a brain tumour are likely to be experiencing other symptoms too, such as nausea, abnormal growth, reduced consciousness or seizures.”

The charity’s new Better Safe Than Tumour campaign aims with this very concern, and Jenkinson says its website has a host of helpful tools, including a symptom checker (headsmart.org.uk).





Source link

Why genes hold the clue to curing sepsis


WHEN Aimee King noticed that her 18-month-old son Corey was quieter than usual on Christmas Day last year, she initially suspected that he was feeling “overwhelmed” by a recent house move and the day’s festivities.

Eight months on, the 31-year-old from Edinburgh is still coming to terms with trauma of how quickly he deteriorated as sepsis took hold and saw him fighting for his life in a high-dependency unit just four days later.

“It’s hard sometimes not to dwell on thinking that it could have been worse,” said Mrs King, speaking ahead of World Sepsis Day on Tuesday.

“We’re one of the lucky ones.”

HeraldScotland: Aimee King and son, Corey, who recovered from a life-threatening bout of sepsis last ChristmasAimee King and son, Corey, who recovered from a life-threatening bout of sepsis last Christmas

Corey survived and is now back to full health, but the condition is known to claim at least 4000 lives a year in Scotland.

Exactly why sepsis happens – and why some people are more susceptible to it than others – remains a mystery, but it is a puzzle that scientists in Edinburgh are working to unlock.

Sepsis – sometimes known as septicaemia or blood poisoning – is characterised by a major malfunction of the immune response to an infection, which results in it attacking the patient’s own organs. It can be triggered by both viral or bacterial infections.

Although symptoms can be vague and hard to spot, key signs in younger children include difficulty breathing, a rash that doesn’t fade when a glass is rolled over it, being sleepier than normal, and blue, pale or blotchy skin, lips or tongue.

In older children and adults, confusion or slurred speech can also be a warning sign, while very high or low temperatures, redness and swelling around a wound, vomiting, and a lack of urination should also ring alarm bells.

The leading theory is that some people are genetically predisposed to these abnormal reactions to infection, although precisely which genes and mutations are behind it is still being unravelled.

“Your chances of developing sepsis if a first-degree relative has had sepsis or died from sepsis is very high,” said Dr Catharina Hartman, an Aberdeen-based emergency medicine consultant and trustee for the charity, Sepsis Research FEAT, which is helping to fund GenOMICC – a major study led by Edinburgh University which is analysing the DNA from patients who have become critically ill.

She added: “It’s a bit like cancer, where some families have a high susceptibility to certain cancers. The same thing happens with sepsis so the answer must be somewhere in our genome – in that the way you respond to certain infection is determined by your genetic make up.”

READ MORE: Five key signs for deadly sepsis

In Corey’s case, doctors believe that bacterial infections caused by streptococcus A and B had led to his sepsis – even though he experienced no obvious symptoms of the infections.

His mother became alarmed on December 27 when his skin became “really pale and grey, and his temperature was sky high”.

He also had diarrhoea and had stopped eating.

She rushed him to A&E where doctors started Corey on antibiotics, but by the evening of December 28 the lymph nodes on his neck had become swollen and he was shivering uncontrollably.

“That’s when I noticed the rash on his hands – he had this mottled look on his hands, and he just kept crying. It sounded like a ‘help me’ cry,” said Mrs King.

“It hit me that Corey was dying. The sepsis had completely taken control of his body at this point.”

HeraldScotland: Corey during his fight against sepsisCorey during his fight against sepsis

On December 29, Corey was underwent emergency blood and platelet transfusions and doctors placed him into an induced coma to give his body a rest.

“It was touch and go,” said Mrs King, a mother-of-eight.

“His blood pressure was really hard to stabilise – it was still too low. It was his lungs and his heart that were struggling with the sepsis.”

By day 14, however, Corey was well enough to leave intensive care and was finally discharged home after nearly four weeks in hospital.

HeraldScotland: Corey King in recovery from sepsisCorey King in recovery from sepsis

He is among the sepsis patients whose blood has been donated to GenOMICC Acute – a pilot study within GenOMICC which is specifically geared to understanding how DNA affects the immune response.

Professor Kenneth Baillie, a critical care consultant and chief investigator for GenOMICC, said: “In the larger GenOMICC study, the one that we’ve been running for the last seven years, we’re just looking at DNA. So that’s pretty much static code that has existed in your body since you were conceived and encodes everything necessary to create a functioning human. The DNA code does that by sending molecular signals and different messages around individual cells in your body.

“In GenOMICC Acute, our pilot study, what we’re doing is looking at some of those signals to look deeper into the mechanisms at a molecular level by which genetic changes influence the function of the immune system. So that means we’re getting samples from patients shortly after their arrival in the intensive care unit.”

READ MORE: Sepsis survivor takes on North Coast 500

Scientists will seek to identify specific genetic mutations common to all or most sepsis patients, and then match that with drugs – some of which may already be available – which can target this particular area in order to reverse an abnormal immune response.

Dr Hartmann said: “We’re looking at what exactly happens to the genes in those patients who get so sick. Once we understand what happens when people get so sick from sepsis, we can start to figure out what we need to do – what’s the treatment we need to find, and where does it have to work on the genome to treat sepsis.”

In the meantime, however, she noted that one of the biggest concerns around sepsis for those currently on the frontline are the delays in patients accessing care due to overcrowded A&E departments and ambulances unable to respond to 999 calls because they are stuck outside emergency departments, waiting to offload patients.

Dr Hartman said: “It’s a worry for any time-critical illness – whether that’s a heart attack, stroke, or anything, like sepsis, where we know that the longer the wait the worse the damage.

“The ambulance service have protocols in place in terms of being able to give antibiotics and IV fluids, but it’s not quite the same.

“What a patient with sepsis needs is actually really intensive emergency medicine and critical care. That’s not the sort of thing you can deliver in the back of an ambulance.”

READ MORE: Disabled have borne brunt of Covid and cost of living 

Colin Graham, chief operating officer at Sepsis Research FEAT, called for more accurate recording of sepsis figures amid fears that too many cases are missed and under-counted.

He said: “Since our first joint campaign, Scottish Government figures note that there are 4,000 deaths from sepsis in Scotland every year.

“However, we believe this figure is understated and actual figures for sepsis in Scotland, and indeed in the wider UK, are probably much higher than reported.

“While we understand the difficulties of collecting statistics due to sepsis often masquerading as other illnesses, we would encourage the Government and the NHS to regularly report the true figures regarding sepsis.”





Source link