Many chronic headache sufferers end up at a headache specialist (usually a neurologist) for a constant, throbbing headache. But could the drugs used be to blame?
This is certainly not the first time that I’ve been on a rant about how we treat headaches in children. Let me reiterate again that we should never, ever, never, not even for a second, accept that any type of head pain in children is “normal.”
There is always something wrong and, in the vast majority of cases, there can be a quick and easy fix. It may be something that a few visits to a chiropractor could fix. I see this very commonly in kids whose backpack is way too heavy (it should not exceed 10% of body weight). When the pack is too heavy, the child leans forward to keep from falling backward. At this point they tilt their heads up so he or she is looking straight ahead. This overuses the muscles just under the base of the skull (called the suboccipital muscles), leading to headaches.
Other times it has to do with their diet. The brain is a pretty sensitive organ. If we send it too much toxic goo (think Twinkie on the brain…) or the child skips breakfast and becomes hypoglycemic, it may kick off a headache. This doesn’t need medication. It needs the situation that caused it to be eliminated and gone.
Unfortunately, when a child has head pain, the concerned parent does what society accepts–they go to the pediatrician instead of a chiropractor. At this point, recommendations for pain medications, whether prescription or over the counter, are frequently given. I don’t know that I’ve ever had a child brought into my office at the request of the pediatrician, although my biased opinion and years of experience would suggest this would be the best direction to take.
But what if the medications used to control the headache actually create the head pain?
It is called a medication overuse headache, or rebound headache. The criteria are as follows:
- Medication has been used for at least 10-15 days/month (varies based on type of medication in question) and has been used for more than three months
- Commonly used medications include: ergotamine, triptans (i.e. Imitrex), opioids (i.e. Percocet, Vicodin, Oxycodone) or combinations of these medications
- Headache has gotten worse or developed since taking medication (i.e. if you were taking medication for knee pain and a headache started)
- Simple over the counter analgesics (Tylenol, ibuprofen) are considered overused when they are taken on > 15 days/month for >3 months
These types of headaches have always been thought to be pretty rare (0.3-0.5%) in children. Of course we would–who would ever consider long term use of pain controlling medication in a child??
This particular study kind of blows these estimates out of the water.
Researchers looked at a group of 118 kids with headaches, looking for how many of them would meet the criteria for a medication overuse headache. The findings were much, much higher than expected.
- 9.3% of the children met the criteria for medication overuse head pain
- In the group of children who experienced chronic daily headache, this number jumped to 20.8%
If you happen to like math and statistics (and really–who doesn’t??), you have already figured out that this is at least 18.6 times higher frequency of medication overuse head pain than previously thought.
What does this tell us? It tells us that society’s numbing to the use of medications to control pain and discomfort in adults is bleeding over into our children and adolescents, and our comfort level of using them in on our children is rising. Never a good thing.
What have you found that helps your child’s headache go away?