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Addressing Headaches in Children: Prevention and Treatment Strategies
Le Bonheur Pediatric Neurologist and Director of the Neuroscience Institute's Comprehensive Headache Center Ankita Ghosh, MD, discusses headaches in kids - what to look for, how to prevent them and when to seek a higher level of care for your child.
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Learn more about Ankita Ghosh, MD
Ankita Ghosh, MD
Ankita Ghosh, MD is an Assistant Professor, University of Tennessee Health Science Center.Learn more about Ankita Ghosh, MD
Transcription:
Maggie McKay: There are several kinds of headaches. Chronic, migraine, tension, just to name a few. But when your child is suffering from one, how do you know if it's a more serious type and what can you do to prevent them. Here to tell us more about addressing headaches in children, prevention and treatment strategies is Dr. Ankita Ghosh, Assistant Professor of Child Neurology and the Director of the Comprehensive Headache Center at Le Bonheur Children's Hospital. This is The Peds Pod by Le Bonheur Children's Hospital. I'm Maggie McKay. so great to have you here, Dr. Gauche
Dr. Ankita Ghosh: Hey, thank you so much for having me.
Maggie McKay: Absolutely. Let's get right to it. What are some of the basic ways to prevent and control headaches at home?
Dr. Ankita Ghosh: I tell my patients relentlessly about making lifestyle modifications, which they can do at home from the very beginning to prevent the threshold and frequency of headaches. So I always recommend all my patients to eat regularly three meals a day and have some snacks in between. This is very important because we all need steady balance of glucose and, when someone skips meals, that could lead to more headaches. I also recommend adding green vegetables, dairy and protein in the diet. This is because green vegetables are high in folic acid and vitamin B2, which is also called as riboflavin. Dairy products are rich in vitamin D and protein such as meat, or if someone is vegetarian, like tofu, beans, et cetera, has coenzyme Q10. So there is now evidence that these vitamins are very beneficial for migraine and headaches in general. I also recommend adding these vitamin supplements in diet through daily multivitamins. And exercising at least three times a week is definitely recommended. helps with mood, anxiety, depression, migraine headaches as well, it helps your brain to secrete a really good hormone called endorphins, which helps you to stay motivated and happy in life. And lastly, keeping yourself very well-hydrated with drinking water. I would suggest like at least eight to ten glasses a day maintaining sleep hygiene is very critical and important.
Maggie McKay: That's a tall order. Not really. I know we're supposed to be doing all of that. That's a good reminder of what we are supposed to be doing.
Dr. Ankita Ghosh: Exactly.
Maggie McKay: Yeah. What should I do if this headache hygiene doesn't work? How do I know when my child's headaches are serious enough to see a neurologist?
Dr. Ankita Ghosh: Headaches are an almost universal experience with people noting at least one headache in a lifetime. And the good thing is that most headaches are mild and transient and they do not warrant a visit to a healthcare provider. However, almost 30 million Americans, they suffer from chronic disabling headaches that impact quality of life.
Headaches are symptoms, and I think everyone who is suffering from disabling headaches should definitely see a healthcare provider to get diagnosed properly. The most common misconception in general is that, "Oh, I have headaches. That means do I have a brain tumor?" I just want to throw it out there the good news is that about 80% to 90% of headaches people experience a primary headaches, they're not associated with any underlying anatomic or physiological abnormality. However, the other 10% to 20% of headaches can be secondary and it can be due to underlying illness or medication exposures, et cetera.
So there are some red flags which every neurologist are aware about. However, I just want to talk about some most common red flags someone should look out for and seek an opinion from a neurologist. So one, for example, if is experiencing some systemic symptoms along with the headaches. For example, they're having like loss or fever along with the headaches, then they should definitely see a healthcare provider or a neurologist. If someone is experiencing sudden onset of headaches, these are also called a thunderclap headaches and, by that, I mean that you can experience the worst headache of your life and the onset is within a minute. And this could be something because of an underlying condition like subarachnoid hemorrhage. If patients are endorsing headaches, which wakes them up at night, any positional exacerbation of headaches, such as headaches are worse with standing or lying supine, I think these concerns definitely warrant an evaluation by a neurologist.
Maggie McKay: What if you wake up with headaches on a regular basis?
Dr. Ankita Ghosh: So primary headache disorders such as migraine or tension headaches, they usually do not wake you up at night time. However, when you have like secondary eiology, for example like a space-occupying lesion in your brain, you can sometimes actually wake up with a very disabling headache and it can be associated with nausea and vomiting. So definitely go and get evaluated by a neurologist, maybe that would warrant like an MRI brain or other
Maggie McKay: Dr. Ghosh, how does Le Bonheur's Headache Center treat headaches?
Dr. Ankita Ghosh: So we have a comprehensive headache center here at Le Bonheur Children's Hospital. And we actually practice our goal, which is as a team, we just don't want to treat kids with medications, but actually educate them about the headache disorder. I think that is the most important thing, what we can do for them, so that they feel empowered to get help promptly. Like a detailed history is the most critical tool making diagnosis. So we have a very detailed questionnaire for both new and followup visits to make the correct diagnosis. And besides me and my team, we have a psychologist, a nurse practitioner, and a nurse coordinator. And as a team, we have a very comprehensive approach to address every aspect of the headache disorder.
During every visit, we teach patients about the acute and preventative management, some lifestyle changes they can make to decrease the frequency of headaches, realizing in general like what the triggers are for the headaches and how to avoid them.
And what I believe is that like migraine and headache sufferers of any age can be very anxious about the headache attacks. So a psychologist, she helps them to learn like coping skills and also does something like cognitive behavioral therapy sessions. So in total, like we believe in educating them and treating it as a holistic with a wholesome approach.
Maggie McKay: That's great. So beyond medication, you teach them all about headaches and why they're being caused, what you can do to prevent them. What are some strategies for parents to handle the nonmedical side of headaches, like, you know, school, relationship issues, et cetera?
Dr. Ankita Ghosh: Yeah. I think schools are really important and I always encourage parents who have children with migraine or any other headache disorder to have a chat at school. Because the more we educate schools, the more they would be empathetic and understanding, and we could reduce the impact on school attendance badly. So whenever we see any patient, we actually give a patient something like a school letter, which states that whenever they feel like they're going to have their migraine attack or the headaches is coming up, they could sit in a quiet dark place, they can get their acute abortive medication, which has been prescribed to them and rest for a while. And that is very important because, most importantly, I think like rest and drinking water at that time and getting like medication on time is really important when you are in school so that you can feel more functional you can function as a normal kid. So we also give resources to parents to help them advocate for their children.
Maggie McKay: What's the difference between a migraine and other headaches?
Dr. Ankita Ghosh: is actually the second most disabling disease in the whole entire world.
Yeah. And it is the most common brain disease. Migraine is more than just headaches. It is a genetic disease, so it runs in families. And for example, if both your parents are suffering from migraine, then there's a likely situation that you can suffer from migraine as well. However, sometimes some people, they don't know if there's a history of migraine in the family, mostly because like in past people were just not labeled or diagnosed with it. But it just doesn't mean that it is not a genetic condition.
We know at least 42 genes now, which can cause migraine. thinking about like how you can get migraine, like the pathophysiology of the migraine, we don't the whole process, but what we know is that your brain, especially your brainstem gets more activated when you get the migraine attack and it leads to of the nerves. That is the simplest way I can put it out there. And children who have migraine, they can have disabling headaches that can last anywhere from 2 to 72 hours as compared to adults when it can last anywhere from 4 to 72 hours. And usually in kids, we see migraine attack in both sided, like bilateral locations as compared to adults where we see it strictly as a unilateral location, one-sided location. And the headaches are associated with sometimes like nausea, vomiting, photophobia, which is like light sensitivity phonophobia, which is sound sensitivity. So it is just more than headaches in general and it is a disease and migraine is the disease and headaches are your symptoms. So definitely, if you're suffering from chronic disabling migraine, definitely see your headache neurologist or your primary care physician.
Maggie McKay: Dr. Gauche. Does caffeine play a part in headaches
Dr. Ankita Ghosh: That is a great question. So there was a misconception before that caffeine in general would relieve headaches, because we used to think that migraine or headaches in general is caused because of dilation around the nerves caffeine causes constriction, and so it helps. However, now, what we know is that caffeine and like overusage of caffeine, which I usually see in teenager, kids, it can cause caffeine withdrawal, headaches, and it can make your migraine worse.
So in general, I do recommend all my patients to stay away from caffeine as much as they can. So if they like sweet tea, definitely go for a decaf version because you want all the hydration, which you're taking with drinking water every day, that caffeine can make you dehydrated and it can make your headaches worse.
Maggie McKay: That's all very helpful information. Thank you so much. It's been really informative.
Dr. Ankita Ghosh: Thank you for having me.
Maggie McKay: Visit lebonheur.org/neuroscience to learn more about Le Bonheur's Neuroscience institute. And be sure to subscribe to The Peds Podcast on Apple Podcasts, Google Podcasts, or wherever you listen to your podcasts or you can check out the lebonheur.org podcast page for the full podcast library. If you found this podcast helpful, please share it on all your social channels. This is Peds Pod by Le Bonheur Children's Hospital. I'm Maggie McKay. Thank you for listening.
Maggie McKay: There are several kinds of headaches. Chronic, migraine, tension, just to name a few. But when your child is suffering from one, how do you know if it's a more serious type and what can you do to prevent them. Here to tell us more about addressing headaches in children, prevention and treatment strategies is Dr. Ankita Ghosh, Assistant Professor of Child Neurology and the Director of the Comprehensive Headache Center at Le Bonheur Children's Hospital. This is The Peds Pod by Le Bonheur Children's Hospital. I'm Maggie McKay. so great to have you here, Dr. Gauche
Dr. Ankita Ghosh: Hey, thank you so much for having me.
Maggie McKay: Absolutely. Let's get right to it. What are some of the basic ways to prevent and control headaches at home?
Dr. Ankita Ghosh: I tell my patients relentlessly about making lifestyle modifications, which they can do at home from the very beginning to prevent the threshold and frequency of headaches. So I always recommend all my patients to eat regularly three meals a day and have some snacks in between. This is very important because we all need steady balance of glucose and, when someone skips meals, that could lead to more headaches. I also recommend adding green vegetables, dairy and protein in the diet. This is because green vegetables are high in folic acid and vitamin B2, which is also called as riboflavin. Dairy products are rich in vitamin D and protein such as meat, or if someone is vegetarian, like tofu, beans, et cetera, has coenzyme Q10. So there is now evidence that these vitamins are very beneficial for migraine and headaches in general. I also recommend adding these vitamin supplements in diet through daily multivitamins. And exercising at least three times a week is definitely recommended. helps with mood, anxiety, depression, migraine headaches as well, it helps your brain to secrete a really good hormone called endorphins, which helps you to stay motivated and happy in life. And lastly, keeping yourself very well-hydrated with drinking water. I would suggest like at least eight to ten glasses a day maintaining sleep hygiene is very critical and important.
Maggie McKay: That's a tall order. Not really. I know we're supposed to be doing all of that. That's a good reminder of what we are supposed to be doing.
Dr. Ankita Ghosh: Exactly.
Maggie McKay: Yeah. What should I do if this headache hygiene doesn't work? How do I know when my child's headaches are serious enough to see a neurologist?
Dr. Ankita Ghosh: Headaches are an almost universal experience with people noting at least one headache in a lifetime. And the good thing is that most headaches are mild and transient and they do not warrant a visit to a healthcare provider. However, almost 30 million Americans, they suffer from chronic disabling headaches that impact quality of life.
Headaches are symptoms, and I think everyone who is suffering from disabling headaches should definitely see a healthcare provider to get diagnosed properly. The most common misconception in general is that, "Oh, I have headaches. That means do I have a brain tumor?" I just want to throw it out there the good news is that about 80% to 90% of headaches people experience a primary headaches, they're not associated with any underlying anatomic or physiological abnormality. However, the other 10% to 20% of headaches can be secondary and it can be due to underlying illness or medication exposures, et cetera.
So there are some red flags which every neurologist are aware about. However, I just want to talk about some most common red flags someone should look out for and seek an opinion from a neurologist. So one, for example, if is experiencing some systemic symptoms along with the headaches. For example, they're having like loss or fever along with the headaches, then they should definitely see a healthcare provider or a neurologist. If someone is experiencing sudden onset of headaches, these are also called a thunderclap headaches and, by that, I mean that you can experience the worst headache of your life and the onset is within a minute. And this could be something because of an underlying condition like subarachnoid hemorrhage. If patients are endorsing headaches, which wakes them up at night, any positional exacerbation of headaches, such as headaches are worse with standing or lying supine, I think these concerns definitely warrant an evaluation by a neurologist.
Maggie McKay: What if you wake up with headaches on a regular basis?
Dr. Ankita Ghosh: So primary headache disorders such as migraine or tension headaches, they usually do not wake you up at night time. However, when you have like secondary eiology, for example like a space-occupying lesion in your brain, you can sometimes actually wake up with a very disabling headache and it can be associated with nausea and vomiting. So definitely go and get evaluated by a neurologist, maybe that would warrant like an MRI brain or other
Maggie McKay: Dr. Ghosh, how does Le Bonheur's Headache Center treat headaches?
Dr. Ankita Ghosh: So we have a comprehensive headache center here at Le Bonheur Children's Hospital. And we actually practice our goal, which is as a team, we just don't want to treat kids with medications, but actually educate them about the headache disorder. I think that is the most important thing, what we can do for them, so that they feel empowered to get help promptly. Like a detailed history is the most critical tool making diagnosis. So we have a very detailed questionnaire for both new and followup visits to make the correct diagnosis. And besides me and my team, we have a psychologist, a nurse practitioner, and a nurse coordinator. And as a team, we have a very comprehensive approach to address every aspect of the headache disorder.
During every visit, we teach patients about the acute and preventative management, some lifestyle changes they can make to decrease the frequency of headaches, realizing in general like what the triggers are for the headaches and how to avoid them.
And what I believe is that like migraine and headache sufferers of any age can be very anxious about the headache attacks. So a psychologist, she helps them to learn like coping skills and also does something like cognitive behavioral therapy sessions. So in total, like we believe in educating them and treating it as a holistic with a wholesome approach.
Maggie McKay: That's great. So beyond medication, you teach them all about headaches and why they're being caused, what you can do to prevent them. What are some strategies for parents to handle the nonmedical side of headaches, like, you know, school, relationship issues, et cetera?
Dr. Ankita Ghosh: Yeah. I think schools are really important and I always encourage parents who have children with migraine or any other headache disorder to have a chat at school. Because the more we educate schools, the more they would be empathetic and understanding, and we could reduce the impact on school attendance badly. So whenever we see any patient, we actually give a patient something like a school letter, which states that whenever they feel like they're going to have their migraine attack or the headaches is coming up, they could sit in a quiet dark place, they can get their acute abortive medication, which has been prescribed to them and rest for a while. And that is very important because, most importantly, I think like rest and drinking water at that time and getting like medication on time is really important when you are in school so that you can feel more functional you can function as a normal kid. So we also give resources to parents to help them advocate for their children.
Maggie McKay: What's the difference between a migraine and other headaches?
Dr. Ankita Ghosh: is actually the second most disabling disease in the whole entire world.
Yeah. And it is the most common brain disease. Migraine is more than just headaches. It is a genetic disease, so it runs in families. And for example, if both your parents are suffering from migraine, then there's a likely situation that you can suffer from migraine as well. However, sometimes some people, they don't know if there's a history of migraine in the family, mostly because like in past people were just not labeled or diagnosed with it. But it just doesn't mean that it is not a genetic condition.
We know at least 42 genes now, which can cause migraine. thinking about like how you can get migraine, like the pathophysiology of the migraine, we don't the whole process, but what we know is that your brain, especially your brainstem gets more activated when you get the migraine attack and it leads to of the nerves. That is the simplest way I can put it out there. And children who have migraine, they can have disabling headaches that can last anywhere from 2 to 72 hours as compared to adults when it can last anywhere from 4 to 72 hours. And usually in kids, we see migraine attack in both sided, like bilateral locations as compared to adults where we see it strictly as a unilateral location, one-sided location. And the headaches are associated with sometimes like nausea, vomiting, photophobia, which is like light sensitivity phonophobia, which is sound sensitivity. So it is just more than headaches in general and it is a disease and migraine is the disease and headaches are your symptoms. So definitely, if you're suffering from chronic disabling migraine, definitely see your headache neurologist or your primary care physician.
Maggie McKay: Dr. Gauche. Does caffeine play a part in headaches
Dr. Ankita Ghosh: That is a great question. So there was a misconception before that caffeine in general would relieve headaches, because we used to think that migraine or headaches in general is caused because of dilation around the nerves caffeine causes constriction, and so it helps. However, now, what we know is that caffeine and like overusage of caffeine, which I usually see in teenager, kids, it can cause caffeine withdrawal, headaches, and it can make your migraine worse.
So in general, I do recommend all my patients to stay away from caffeine as much as they can. So if they like sweet tea, definitely go for a decaf version because you want all the hydration, which you're taking with drinking water every day, that caffeine can make you dehydrated and it can make your headaches worse.
Maggie McKay: That's all very helpful information. Thank you so much. It's been really informative.
Dr. Ankita Ghosh: Thank you for having me.
Maggie McKay: Visit lebonheur.org/neuroscience to learn more about Le Bonheur's Neuroscience institute. And be sure to subscribe to The Peds Podcast on Apple Podcasts, Google Podcasts, or wherever you listen to your podcasts or you can check out the lebonheur.org podcast page for the full podcast library. If you found this podcast helpful, please share it on all your social channels. This is Peds Pod by Le Bonheur Children's Hospital. I'm Maggie McKay. Thank you for listening.