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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