My child has been referred to a headache specialist, which has us scared that something is seriously wrong. Can you tell us what to expect?
Headache is a very common complaint in children. Most of the time, the pain results from simple, self-limited illnesses like colds or flu, which primary care doctors can comfortably diagnose and treat. Once in while, the features are beyond what is easily explained and the primary care doctor will ask for assistance from a specialist to sort out the cause and best treatments for your child’s headaches. What should you expect when your child is referred for evaluation for headache?
Taking your child to a specialist can be very scary. It is natural to worry about serious problems like brain tumors or life-threatening diseases. One of the first things to understand is that the specialist appreciates your fears and will consider all possible explanations for the pain in order to determine the source of the problem, offer solutions and, most importantly, provide reassurance!
In order to provide that vital reassurance, specialists must first reassure themselves as to what is going on. Our evaluation begins with a thorough medical history, followed by a physical examination with measurement of vital signs, particularly blood pressure, and a complete neurological examination including careful examination of the eyes. In most cases, this standard medical approach will yield the correct diagnosis without need for further testing.
During the history, we will search for clues to the presence of any worrisome problems by asking a series of questions about such symptoms as an increasing severity of pain, headache that awakens the child, or nighttime vomiting. We will ask about associated symptoms such as balance or vision problems. Family history is important since many types of headache, like migraine, tend to run in families. We will also look to see if there are any other medical problems or medications that may be contributing to the headache.
Once the history is completed, a physical and neurological examination will be conducted to look for such signs as weakness, clumsiness, eye movement disorders or pressure behind the eyes. A detailed neurological examination is essential since over 98% of children with serious illnesses will have neurological findings like abnormal eye movements, pressure behind the eyes, weakness, coordination disturbances or abnormal reflexes. Sometimes, the specialist will decide that other tests are needed, depending upon the findings of the history and physical examinations.
The good news is, the vast majority of children’s headaches are benign. Once the history and physical examinations are completed, the doctor can usually tell you exactly what is going on and outline a series of steps to take to ease the pain and suffering caused by the headache and, most importantly, reassure you that there is no life-threatening problem!
—Donald W. Lewis, MD, Professor and Chairman, Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, Virginia
A Visit to the Psychologist
After the medical headache specialist evaluates your child, you may be introduced to a behavioral headache specialist. Headache specialists typically partner with psychologists who are trained to teach patients behavioral tools that can help control disabling headaches. The most common recurrent headache in children is migraine and it is comforting to realize that your child will be able to use behavioral tools to manage his highly sensitive nervous system throughout his lifetime—during as well as between migraine attacks.
The psychologist, too, evaluates your child in terms of lifestyle issues. Because individuals prone to headache have highly excitable brains, change affects them more than people without headaches. The psychologist will ask about recent changes in your child’s life, important people and activities. These include home life and siblings; school, grades and friends; and extracurricular commitments, such as sports, religious activities, dance, music and pets.
There are certain personality traits commonly found in those prone to headaches. Often, the person is achievement oriented, demanding a great deal of himself. He puts high expectations on himself and assumes others expect him to be perfect, which can be stressful. One way to assess stress is by measuring finger temperature. Migraineurs often have a finger temperature in the 70s, indicating that stress may be influencing the headache pattern. If that’s the case for your child, he will be given thermal biofeedback training to learn to increase blood flow to his extremities. This as well as other stress management trainings will begin in the next session.
—Kathleen Farmer, Psy.D., Headache Care Center, Springfield, Missouri