Headache Help (29 page)

P
EER GROUPS OR INDIVIDUAL COUNSELING
is especially useful for adolescents and their parents. Many children and adolescents who get severe headaches drive themselves hard, insist on perfection, participate in many activities, are completely stressed out and prone to depression, and need to explore and share these issues with peers in a similar situation or with a psychotherapist. Talk to your child’s doctor or guidance counselor. If there is not an appropriate group already in your area, think about starting one.

As children move into adolescence, stress in their lives gets more intense, and anxiety and depression become more common. Getting frequent headaches itself is a stressor.

Often, children need individual counseling and/or family therapy to learn better coping skills and to express feelings and thoughts that are bottled up inside. Although biofeedback and relaxation therapies can be useful to children, psychotherapy and family therapy can have even more dramatic positive results.

Some children have so many headaches that they miss weeks, months, or even years of school. Many miss fifty, even sixty days a year. Therapy in almost all these cases is appropriate and necessary if the headaches are to be treated effectively.

RELIEVING HEADACHES IN CHILDREN UNDER AGE ELEVEN

Once headaches start, the fairly simple methods that follow can relieve the vast majority. If the child is older than eleven, the strategies shift toward the management techniques for adults. We’ll address specific adolescent concerns later in this chapter.

At the first sign of a headache, either migraine or tension, get your child comfortable in a dark, quiet room and apply ice to his head. Consult with the doctor about experimenting with limited amounts of acetaminophen or ibuprofen and perhaps some caffeine.

QUICK REFERENCE GUIDE

FIRST-LINE MEDICATIONS FOR CHILDREN’S HEADACHES

OVER-THE-COUNTER

1. A
   CETAMINOPHEN
   (T
   YLENOL AND SIMILAR PRODUCTS
   )
       Mild and safe; add some caffeine with cola, for example.
   
2. I
   BUPROFEN
   (M
   OTRIN
   , A
   DVIL
   , N
   UPRIN
   )
       Stronger, but higher incidence of stomach problems.
   
3. C
   AFFEINE
       Good either by itself (cola, caffeine gum, pills) or with the above medications.
   

PRESCRIPTION

1. N
   APROXEN
   (A
   LEVE
   , N
   APROSYN
   , A
   NAPROX
   )
         Stronger than OTC medications but sometimes cause stomachaches. Add caffeine. Aleve is OTC.
   
2. M
   IDRIN
         Used when the above medications don’t help; these are big capsules but can be emptied into food.
   

SECOND-LINE MEDICATIONS FOR CHILDREN’S HEADACHES

1. B
   UTALBITAL
   C
   OMPOUNDS
         Very effective but a sedative.
   
2. A
   SPIRIN
         Effective, but avoid if child has chicken pox or the flu with a fever. Adding caffeine helps.
   

THIRD-LINE MEDICATIONS FOR CHILDREN’S HEADACHES

1. P
   REDNISONE
         Strong medication that’s used to break the cycle of many migraines.
   
2. M
   IGRANAL
   (DHE) N
   ASAL
   S
   PRAY AND INJECTIONS
         Sometimes the only thing that will work; IV most effective.
   
3. T
   RIPTANS
   (I
   MITREX
   , M
   AXALT
   , A
   MERGE
   , Z
   OMIG
   , R
   ELPAX
   )
         For children over nine, low doses can be helpful.
   

FIRST-LINE MEDICATIONS FOR RELIEVING HEADACHES IN CHILDREN

1. A
CETAMINOPHEN

Acetaminophen, the medication used in Tylenol, is well tolerated, safe, and has few side effects, but it is not as effective as ibuprofen or aspirin. Because it is safe, however, acetaminophen is usually the first medication children should try. Giving the child some caffeine, such as cola, can enhance the drug’s effectiveness. Chewable tablets, liquid, and suppository forms are available.

A
SPIRIN
-F
REE
E
XCEDRIN
combines acetaminophen with 65 mg of caffeine and is more useful for migraine than for daily head ache. Children often need to be at least nine to tolerate this dose of caffeine.

TYPICAL DOSE
: When calculated by weight, the dose is approximately 3 to 5 mg per pound (5 to 10 mg per kg) every two to four hours (maximum per day of 15 or zo mg per pound or 30 or 40 mg per kg). Three doses in twenty-four hours at most.

By age, rather than weight, typical doses are 240 mg per dose for four- and five-year-olds, 3 20 mg per dose for six- to eight-year-olds, 400 mg for nine- and ten-year-olds, and 480 mg per dose for eleven-year-olds. Three doses per twenty-four hours should be the maximum. If your child needs more than one dose a day,
every day
, however, consider preventive medication.

Acetaminophen is available in many forms, including chewable tablets in 80, 120, and 160 mg; regular (nonchewable) tablets in 325, 500, and 650 mg; capsules in 325 or 500 mg; and syrup in concentrations of 80, 120, 160, and 325 mg per teaspoon. There is also a Tylenol Extra-Strength liquid with 500 mg per three teaspoons.

Suppositories are available in strengths of 120, 125, 325, 600, and 650 mg. Finally, there is a fizzy antacid with buffered acetaminophen that contains 325 mg per three-quarters of a cap, as well as sodium bicarbonate and citric acid.

SIDE EFFECTS
: Rare. Occasional fatigue.

2. I
BUPROFEN

Ibuprofen is the generic chemical used in Advil, Motrin, and Nuprin, among others. It is more effective for migraines and tension headaches than acetaminophen but poses a greater risk of causing gastrointestinal upset, nausea, fatigue, and dizziness. Nevertheless, it is generally well tolerated. Again, giving your child caffeine in some form can enhance the drug’s effectiveness. Liquid Advil is useful for younger children.

TYPICAL DOSE
: Ages four to five, 100 mg (one teaspoon of the Children’s Advil liquid) every three to four hours, as needed; ages six to eight, 100 to 150 mg (one to one and a half teaspoons) every three to four hours, as needed; ages nine to ten, 150 to 200 mg per dose; ages eleven to twelve, 200 to 400 mg per dose. Three doses per day at most. Maximum daily dose is 15 mg per pound (30 mg per kg) per day.

3. C
AFFEINE

Caffeine can be used by itself (in a cola drink or in pill form) or with acetaminophen or ibuprofen. It can help either a tension or a migraine headache. When used in limited amounts, its side effects are minimal.

FIRST-LINE PRESCRIPTION MEDICATIONS FOR TREATING HEADACHES IN CHILDREN

When the simpler combinations of acetaminophen, ibuprofen, and caffeine aren’t powerful enough to help your child, you’ll probably need to identify with your child’s doctor a stronger abortive medication to relieve a headache in progress. In the vast majority of cases with children, a good abortive is all that you’ll need. However, if the abortive needs to be used more than three times a week or the headaches are sporadic but severe (and therefore usually considered migraines), the doctor may recommend a preventive medication.

As we discuss in other chapters, many medications helpful for headache have not received specific approval from the FDA for headache or for children. You should fully understand the risks, side effects, and problems associated with any medication before you give it to your child. Check a medication reference book or the package insert. Any discussion of medications here is for information, not a suggestion for use. Only a physician who knows your child’s individual situation can make an informed recommendation.

If you know from experience that you will want to give the child an abortive medication if a headache starts, do so as early as possible to make it most effective. If the child is nauseated, either wait for the nausea to subside or for the child to vomit, and then use the abortive medication, or consider an antinausea medication. Rectal suppositories for combating nausea are more effective than oral medication and more useful when oral medications are not well tolerated; many children, however, feel too embarrassed to use them. Remember also that almost all of the medications listed in this chapter may be formulated by pharmacists into flavored lozenges for children who cannot swallow pills or are too nauseated to swallow medication.

If your child is ten or younger and a combination of caffeine, acetaminophen, and ibuprofen doesn’t work, your doctor will probably recommend one of these medications.

1. N
APROXEN
(A
LEVE
, N
APROSYN
, A
NAPROX
)

More effective than acetaminophen or ibuprofen, naproxen does often cause temporary gastrointestinal distress. Sedation also occasionally occurs. Its liquid form can be particularly useful for children. Having a small amount of caffeine with naproxen can usually enhance its effectiveness. A lower-dose naproxen tablet (Aleve, 220 mg) is available over the counter but should be used only under a doctor’s supervision, as is true for all prescription medications.

If used daily, kidney and liver functions need be monitored.

TYPICAL DOSE
: For a fifty-pound child, one teaspoon, or 125 mg, to start; may be repeated once per day. For an eighty-five-pound child, one to one and a half teaspoons, or 125 to about 185 mg per dose; may be repeated once only. For a child one hundred pounds or more, 275 mg of Anaprox or 250 mg of naproxen or 220 mg of Aleve.

2. M
IDRIN

Usually Midrin is recommended when neither the over-the-counter medications nor naproxen works well. This medication, available in capsule form, consists of acetaminophen, a mild vasoconstrictor (isometheptene mucate), and a nonaddicting sedative (dichloralphenazone). The large capsules may be taken apart and emptied into applesauce or juice (the capsule shell itself does not need to be swallowed). Midrin tends to be reasonably effective and may be used in children as young as age seven. (See Chapter 5 for more details.)

TYPICAL DOSE
: For ages seven and eight, a quarter or half capsule, repeated every two hours if necessary but limited to two full capsules in one day. For ages nine and ten, a half or whole capsule, repeated if necessary at two-hour intervals, three in one day at the most.

SIDE EFFECTS
: Sedation and lightheadedness, occasional stomach upset.

If these first-line medications are ineffective or inappropriate for your child, the doctor may then recommend:

SECOND-LINE MEDICATIONS FOR TREATING HEADACHES IN CHILDREN

1. BUTALB1TAL COMPOUNDS

These medications are generally well tolerated and extremely effective. The butalbital is a sedative, which in most cases is useful to help the child sleep away the headache.

Fiorinal (which contains aspirin) is more effective than Esgic or Fioricet (which contains acetaminophen and caffeine), which, in turn, is more effective than Phrenilin (acetaminophen but no caffeine). See Chapter 5 for more information.

• F
  IORINAL
  Fiorinal contains 50 mg of the short-acting sedative butalbital, 325 mg of aspirin, and 40 mg of caffeine, which helps offset the sedative. The tablets may be cut in half for children. Because of the aspirin component, this medication must be used with caution to avoid the risk of Reye’s syndrome, a disease of the brain, marked by fever, vomiting, and swelling of the kidneys and brain.
  TYPICAL DOSE
  : For ages seven and eight, half a tablet, which may be repeated within an hour or two, but daily maximum should be no more than one tablet per day. For ages nine and ten, a half or whole tablet, which may be repeated in three hours, with a maximum of two tablets in one day.
  SIDE EFFECTS
  : Fatigue and sometimes nervousness; nausea or gastrointestinal pain from the aspirin; lightheadedness, dizziness, or euphoria from the butalbital.
  
• E
  SGIC
  , F
  IORICET
  These medications, which are identical except that Esgic is available in capsule or pill form and Fioricet only in pill form, are less effective than Fiorinal but better tolerated because they contain acetaminophen rather than aspirin. They consist of 50 mg of butalbital, 325 mg of acetaminophen, and 40 mg of caffeine. Since the brand name medications are usually more effective the generic is best avoided.
  TYPICAL DOSE
  : Same as for Fiorinal.
  SIDE EFFECTS
  : Fatigue, occasional nervousness; nausea but less so than with Fiorinal. Lightheadedness, dizziness, and euphoria may occur.
  
• P
  HRENILIN
  Phrenilin (50 mg of butalbital and 325 mg of acetaminophen) is the same as Esgic but has no caffeine. It is particularly helpful for children who cannot take caffeine or aspirin.
  TYPICAL DOSE
  : Same as for Fiorinal.
  SIDE EFFECTS
  : Usually mild, though sedation is very common. Lightheadedness, dizziness, and euphoria may occur.