Behavioral therapy may treat migraines in kids, teens

Children and teens with chronic migraines may find headache relief when they pair medication with psychotherapy, according to a new study.

Researchers found that kids who received cognitive behavioral therapy, a type of psychotherapy that teaches relaxation and coping techniques, had significantly fewer days with headaches.

“This is a learning based treatment in a sense that you as a young person can learn skills and apply them to everyday life,” Dr. Scott Powers said.

Powers is the study’s lead author and co-director of the Headache Center at Cincinnati Children’s Hospital Medical Center in Ohio.

Migraines are severe headaches - sometimes accompanied by light sensitivity, visual hallucinations or nausea - that can disable a person for hours or even days at a time. The majority of migraine sufferers are women.

About 2 percent of adults suffer from chronic migraine, which is defined as having the severe headaches for at least 15 days per month. About 1.75 percent of children have the chronic condition, Powers and his colleagues write in JAMA.

Migraine is not just a bad headache. It is a neurological disease, with head pain and associated symptoms, such as nausea, vomiting, dizziness, sensitivity to touch, sound, light, and odors, abdominal pain, and mood changes. While children generally have fewer and shorter migraine attacks than adult sufferers, childhood migraine can be just as disabling, and it can seriously affect the child’s quality of life.  A doctor should be consulted if a child suffers from frequent or disabling headaches or migraine symptoms.

 Behavioral therapy may treat migraines in kids, teens Despite the severity of chronic migraine and how common the condition is in children and teens, there are currently no treatments for kids approved by the U.S. Food and Drug Administration.

Instead, the antidepressant amitriptyline (first sold as Elavil by AstraZeneca), which has been found to help prevent migraines, is sometimes prescribed for kids.

Some studies have also suggested that cognitive behavioral therapy (CBT), a form of talk therapy that emphasizes changing one’s responses to problems, may help children and teens to manage chronic pain.

To see whether CBT could improve kids’ ability to cope with chronic migraine, the researchers randomly assigned 135 chronic migraine sufferers between the ages of 10 and 17 to undergo either CBT or an education program about headaches. All the participants were also taking amitriptyline.

Recognizing Migraine in Children

Migraine often goes undiagnosed in children and adolescents.  In childhood migraine, head pain may be less severe than other symptoms, such as unexplained nausea or vomiting, abdominal pain, or dizziness. These non-headache symptoms are referred to as migraine equivalents. Children may experience migraine with or without aura.  (An aura is a visual disturbance, such as blurry vision, flashing lights, colored spots, or even dizziness, which occurs within an hour prior to the headache.) However, migraine without aura is more common in children.

Before a migraine begins, parents may observe changes in their children’s behavior, including loss of appetite, irritability, yawning, food cravings, lethargy, withdrawal, and mood swings. Sensitivity to light, touch, smell, and/or sound are also common. Other indicators may include sleep walking, sleep talking and night terrors. Motion sickness may be an early warning of the predisposition to childhood migraine.

The most common migraine triggers in children are inadequate or altered sleep, skipping meals, stress, weather changes, bright lights, loud noises, strong odors, and hormonal fluctuations. Contrary to popular belief, food triggers affect only 5-15% of sufferers.

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