Herbal Health

“Lisa has been having headaches for a year or more, Doctor, but these past few months they’ve become more frequent. Now she has one several times a week, and she is missing a lot of school. She says that they are all over her head, but mainly start behind her eyes. She has to come home from school and feels sick to her stomach. She usually goes to bed and wants the lights off because they bother her eyes. Sometimes she will throw up, and then she feels better. She sleeps for a few hours and then is fine. She hasn’t had any seizures for almost two years now, but the headache is like the ones she sometimes had after her big seizures. Do you think she could have migraine? I used to have migraine attacks when I was young.”

Migraine headaches are not uncommon in children but often do not resemble adult migraine. They rarely are unilateral or associated with warnings (auras) such as flashing lights or unilateral sensory symptoms. Migraine headaches in children may build up as pounding headaches, with nausea, and sometimes with vomiting. The child usually tries to avoid light, goes to his room, lies down, and goes to sleep. Such headaches typically last for hours. In children these headaches are often bilateral. This kind of an attack is not like a seizure, but the episode is sometimes confused with a seizure when the headache component is less severe or when nausea and vomiting are less prominent.

Migraine commonly occurs in families, hence there appears to be a genetic predisposition. Longer duration of the episode and nausea suggest migraine. The presence of other seizures may indicate, however, that the headaches are related to a seizure. Both the headache of the migraine attack and the headache after a seizure can be similar since both are caused by dilation of blood vessels in the brain.

The EEG may be abnormal both in persons with migraine and in those with seizures; therefore, the EEG is an unreliable procedure for deciding which kind of episode has occurred. In some instances, it may not be possible at all to differentiate between migraine headaches and headaches related to seizures (epileptic cephalgia). Indeed, as noted, migraine and seizures may coexist. Migraine is more common in those individuals and families with a history of seizures, and seizures are more common in those with a history of migraine. If the doctor thinks these events are more likely to be seizures, he may suggest a trial of anticonvulsant medication; a good response to these drugs suggests that the events were, indeed, seizures. If the doctor thinks these are more likely migraine attacks, he will prescribe antimigraine drugs. Again, a good response to this medication will suggest that he was right. Migraine has been known to respond to some anticonvulsants, but it is doubtful that seizures will respond to some medications now used to treat migraine.

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There is some good news, however. A slight decline in direct costs (from $45.2 billion to $44.1 billion) occurred between 1992 and 1997. This decline was in the face of the increasing prevalence of diabetes and a steady, modest increase in the rate of inflation, both of which should have increased direct costs. The decrease in direct costs was most likely due to a dramatic decrease in the mean length of hospital stay and to a shift in site of service to the outpatient arena. In 1992, 20.2 million inpatient days were attributed to diabetes; this figure decreased about 31% to 13.9 million days in 1997. Inpatient costs decreased from $37.2 billion in 1992 to $27.5 billion in 1997. Concomitantly, there was a large increase in outpatient expenditures and home health care for people with diabetes. Intensive glycemic regulation in type 1 and in type 2 diabetes was shown to delay progression of microvascular complications at a reasonable cost.

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