Headache and migraine

Headaches can affect you whatever age you are. They can occur on their own (primary headache) or as a result of another condition (secondary headache). There is a headache clinic at Great Ormond Street Hospital (GOSH) which your doctor might refer you to if the diagnosis of your headache is not certain and treatment has failed.

Primary headaches include migraine and tension-type headaches. The most common primary headache is called ‘migraine without aura’. The warning signs that sometimes come before the migraine, such as disturbed vision, strange taste or smells, or wobbliness, are referred to as an ‘aura’. Migraine without aura in children can be different to that in adults, in that they usually last for a shorter time and affect both sides of the head (bilateral).

Tension type headaches are the second most common primary headache disorder. These differ from migraines in that they last longer and happen more frequently than migraines. However, they are less severe, although they are often also bilateral. 

Although rare, headaches can sometimes be caused by other conditions. Before your doctor can diagnose a headache as primary, they first need to assess you and might need to run some tests to rule out a secondary cause. 

Up to 50 per cent of children aged seven years and up to 80 per cent of 15 year olds have experienced at least one headache. Before puberty, headache affects girls and boys in equal numbers, but after puberty about three times as many girls get headaches compared with boys.

Getting migraines runs in families. If you suffer from migraines, the chances are that someone else in your family suffers from them too. There can also be triggers. Some people who suffer from migraines know the things that trigger them. It’s possible for them to prevent attacks by avoiding these triggers, but it’s rarely as straightforward as that. 

In some people migraines are triggered by eating particular foods or drinking particular drinks. But dietary triggers aren’t that common, except for caffeine and alcohol. Doctors know that migraines are not caused by eye problems, other medical conditions, or having a particular type of personality. 

It's much more usual for migraines to be brought on by a person’s lifestyle. Some lifestyle triggers include stress, fatigue, missed meals, sleeping in and/or any disruption to sleep, and also spending too long on a computer. Unfortunately, these are all factors that are impossible to avoid completely. 

For some people, the temperature of food (hot or cold) can trigger a migraine. 

If you suffer from a headache, and you visit your doctor, he or she will take a detailed medical history, asking about when the headaches started and which part of your head it affects. Your doctor will also ask about any other symptoms that occur at the same time, such as feeling sick, being sensitive to light or having seizures. Your medical history can help your doctor to identify any previous illnesses or current medical conditions that might trigger your headaches. 

Other aspects of your everyday life will be considered too, such as stress or problems at school or home. This will help in identify the triggers for headaches. If other people in your family also have headaches or migraines this will also be discussed as some types of migraine are inherited. The doctor will ask you which headache treatments you’ve tried previously and to what degree they were helpful. Your doctor will also examine your physical condition. 

If your medical history and physical examination don’t raise any concerns, it's unlikely your doctor will suggest further investigation.

Managing headache involves a combination of approaches – making an accurate diagnosis, helping you understand your condition, lifestyle modification including adequate and timely sleep, regular exercise and activity, support at home and school, psychological help, identifying and avoiding triggers, and medicine. 

There are two types of medicine:

• Reliever – these medicines are used during or at the beginning of a headache.
• Preventive – these medicines are taken every day to prevent headaches from occurring.  

A variety of medicines are available, but which ones you can take depends on your age. Sometimes, doctors will prescribe medicines that aren’t licensed for your age group. Unlicensed medicines are often used in children for a number of reasons, for example limited data available for a specific use in children. This is not necessarily unsafe but should be explained and agreed with you before you use them. Your doctor will explain this further to you. As well as medicines, your doctor may suggest other treatments.

• Ibuprofen and paracetamol are both safe to treat headache, unless advised otherwise by your doctor or pharmacist. Both should be used according to the instructions on the bottle or packet.
• Triptans are an alternative to ibuprofen and paracetamol. There are different triptans which are available in various forms, such as tablets, melts, nasal spray and injection. Triptans can cause tingling sensations, warm flushes or tightness.   

Preventative treatment tends to be used if you're getting regular and frequent migraine or headache which affects school attendance or daily life.

• Preventive medicines fall broadly in to four major categories of medicines – antihistamines, anticonvulsants, beta blockers and calcium, and dopaminergic antagonist.
• Medicine commonly used includes pizotifen, propranalol, topiramate, amitriptyline and sodium valproate.
• Flunarizine is believed to be the most effective at preventing migraines.
• There are other medicines but we don’t have good evidence that they work well.  

Psychological ways of managing headaches can be very helpful. Sessions can either be on a one-to-one basis with a psychologist or in a group. You might be asked to keep a diary to identify any emerging patterns, which can point toward the trigger for your headache or migraine. Learning how to cope with headache pain, using relaxation, stress management and guided imagery, can also be helpful.

For most people, migraines improve or end by late their late teens. Finding a way of coping with headache can greatly improve your quality of life. 

We conduct two clinical trials in our headache clinic. If you wish to participate in the trials, you can get in touch with us to find out if you’re a suitable candidate.

Referrals to the headache clinic at GOSH should be made by your local paediatrician to Dr Prabhakar, Consultant in Paediatric Neurology.