Headache Help (31 page)

Help your teen use other self-help techniques, such as avoiding trigger foods, not missing meals, and getting enough sleep (most adolescents need eight to ten hours; they rarely get enough and almost always go to bed too late).

A small group of kids miss weeks, months, or even years of school because of head pain. Typically, these adolescents and their families have complex issues to confront, and physicians have been remarkably unsuccessful in helping their headaches without counseling. In general, a “tough-love” approach, with virtually no excuse accepted for missing school, is usually best. Nevertheless, a few adolescents do fare better with home tutoring.

The goal with adolescents is to help the headaches, but minimize medications. Although most adolescents don’t need preventive medication, many do need abortive medication to relieve a headache in progress. During periods of severe or frequent headaches, however, daily preventive medication may be necessary on a temporary basis. Preventive medication may also be called for if your teen chases after headaches all day with abortive medications, which can trigger rebound headaches. Occasionally, adolescents might also use a daily preventive medication if they are anxious or depressed, or if they have trouble sleeping.

Tension and migraine headaches are treated similarly in teens, except that migraine sufferers often need an antinausea medication as well. Teens take the same medications as children do, except that they may use aspirin more readily and may be able to tolerate some stronger medications. Because we have detailed all these medications elsewhere, we simply list them here to indicate the order in which they are usually prescribed for adolescents, as well as their most prominent features and the most typical doses for teenagers. These doses tend to be the same as the low-range doses for adults. As always, these medications should be taken with food.

In general, doctors use daily anti-inflammatories for this age range (the ibuprofen/Aleve type of medications) because they do not cause sedation or cognitive problems, such as “spaciness” or memory problems. Although the anti-inflammatories are associated with a high rate of stomach problems, this age group usually experiences fewer stomach problems with these medications than do other age groups. In general, the younger the person, the safer the anti-inflammatories; however, they can cause ulcers in any age.

MEDICATIONS FOR TREATING HEADACHES IN ADOLESCENTS

Begin with these medications to try to relieve tension headaches in your adolescent. Note that they may also be effective for migraines, which we will discuss in the next section. The first four groups of medications are over-the-counter.

1. A
CETAMINOPHEN

Best tolerated, least effective. Commonly known as Tylenol. Typical dose: 325 to 650 mg every four to six hours, as needed. Limit to 1,300 mg per day at most.

2. I
BUPROFEN

More effective than acetaminophen but causes more side effects, especially stomach upset. Typical dose: 200 or 400 mg every four to six hours, as needed. Take with food. Taking with small amounts of caffeine may enhance effectiveness. Limit to 1200 mg in one day.

3. Naproxen (Aleve, Naprosyn, Anaprox)

Widely used in adolescents, but stomach upset is common. Typical dose: For Aleve, 220-mg tablet every eight hours: for Naprosyn, 250-mg pill every eight hours. Taking with caffeine may help. Older adolescents may take two Aleve at a time.

4. A
SPIRIN
, A
SPIRIN
-F
REE
E
XCEDRIN
, A
NACIN
, E
XCEDRIN
E
XTRA
-S
TRENGTH
, E
XCEDRIN
M
IGRAINE

• A
  SPIRIN
  Typical dose: 325 mg every four to six hours, as needed.
  
• A
  SPIRIN
  -F
  REE
  E
  XCEDRIN
  Typical dose: one tablet every four to six hours, as needed.
  
• A
  NACIN
  (A
  SPIRIN AND
  C
  AFFEINE
  )
  Stomach upset is common and nervousness may occur. Typical dose: one Anacin tablet every four to six hours, as needed.
  
• E
  XCEDRIN
  E
  XTRA
  -S
  TRENGTH
  , E
  XCEDRIN
  M
  IGRAINE
  (A
  CETAMINOPHEN
  , A
  SPIRIN, AND
  C
  AFFEINE
  )
  Most effective medication in this group but causes more side effects, such as rebound headaches, gastrointestinal upset, and nervousness. Typical dose: one tablet every four to six hours, as needed. For older adolescents, two tablets at the onset of a migraine may be effective.
  

5. N
ORGESIC
F
ORTE
(A
SPIRIN
, C
AFFEINE, AND AN
A
NTIHISTAMINE
, O
RPHENADRINE CITRATE, WITH MUSCLE RELAXANT PROPERTIES
)

Strong but nonaddicting. Typical dose: half to one pill every four hours, as needed, two in a day at most. Side effects include nervousness, drowsiness, a dry mouth, and stomach irritation because of the large amount of aspirin (770 mg aspirin per tablet).

6. K
ETOPROFEN
(O
RUDIS
KT,
GENERIC KETOPROFEN
)

OrudisKT (or the generic) is a low-dose (12.5 mg) anti-inflammatory, useful for tension and migraine headaches. Typical dose: two tablets every three to four hours, with food. Stomach irritation may occur, as with the other anti-inflammatories. Taking with caffeine may help.

MEDICATIONS FOR TREATING MIGRAINE HEADACHES IN ADOLESCENTS

All these medications are discussed at length in Chapter 5.

1. T
RIPTANS
(I
MITREX
, Z
OMIG
, M
AXALT
, A
MERGE
, R
ELPAX
)

While not officially indicated for use in adolescents, the triptans have been widely used in this age group. Low doses (half a tablet) are usually used first, but most adolescents require the usual adult dose. The side effects follow the same pattern as in adults.

2. M
IDRIN

Especially good for migraines. Typical dose: One capsule (two may be needed at onset), repeated every two hours if needed; daily maximum dose is four or five capsules. Fatigue and dizziness are common.

3. B
UTALBITAL
C
OMPOUNDS
(F
IORINAL
, F
IORICET
, E
SGIC
, P
HRENILIN
)

Habit-forming. Typical dose: Varies by medication but typically between the child and adult doses. Must be limited and not used more than one or two days per week.

4. O
VER-THE
-C
OUNTER
A
NTI
-I
NFLAMMATORIES
(
IBUPROFEN, NAPROXEN, AND ASPIRIN
[M
OTRIN
, A
LEVE, AND
B
AYER, RESPECTIVELY
],
AS WELL AS
E
XCEDRIN
E
XTRA
-S
TRENGTH AND
E
XCEDRIN
M
IGRAINE
)

See Chapter 2 and Chapter 5 for detailed discussions.

5. M
IGRANAL
(DHE) N
ASAL
S
PRAY

Well tolerated, Migranal is safe and effective. See the previous section in this chapter and also Chapter 5.

PREVENTING HEADACHES IN ADOLESCENTS OVER AGE ELEVEN

As with adults, psychotherapy or biofeedback can help some adolescents a great deal. But others who chase pain frequently with abortive medications, which can cause rebound headaches, will need a daily preventive for moderate or severe headaches.

When choosing preventives for this age range, the goal is to:

• minimize medications
  
• treat any concurrent conditions (such as depression or anxiety)
  
• get the adolescent off medications as quickly as possible—many do outgrow the headaches.
  

Since patterns of tension and migraine headaches are more prominent in teenagers than in younger children, the treatments do differ somewhat, as they do in adults. One major difference, however, is that as children become adolescents, the anti-inflammatories become a first-choice preventive for chronic daily headaches because they are so well tolerated by this age group. Again, these medications are detailed elsewhere, and we list them here in order of preference. The doses fall between those recommended for children and adults and will vary depending upon your teen’s age and weight.

MEDICATIONS FOR PREVENTING TENSION HEADACHES IN ADOLESCENTS

(See Chapter 6 and Chapter 9 for detailed discussions.)

1. A
NTI-INFLAMMATORIES
: (I
BUPROFEN
, N
APROXEN, AND
K
ETOPROFEN
)

Very well tolerated and often effective, though they may cause stomach upset. Ibuprofen is relatively short acting and so is not ideal as a preventive medication. Ketoprofen is available over the counter as OrudisKT or as a once-daily prescription capsule (Oruvail).

2. A
NTIDEPRESSANTS
: SSRIS (P
ROZAC
, P
AXIL
, Z
OLOFT
), N
ORTRIPTYLINE
(P
AMELOR
, A
VENTYL
), P
ROTRIPTYLINE
(V
IVACTIL
), A
MITRIPTYLINE
(E
LAVIL
)

These are the most effective preventives for migraines and daily headaches, but they cause more side effects (memory and concentration problems, a dry mouth, and dizziness are common) than the anti-inflammatories. Usually well tolerated in low doses and safe for long-term use. The SSRIs are generally much better tolerated than the older antidepressants. (See Chapters 6 and 9.)

3. V
ALPROATE
(D
EPAKOTE
)

Extensively used for both migraine and tension headaches, Depakote has become a first-line medication for adolescents and adults. Low doses are used for adolescents. Side effects include weight gain, nausea, or fatigue.

MEDICATIONS FOR PREVENTING MIGRAINES IN ADOLESCENTS

If your adolescent is getting more than four migraines a month or if the migraines are very severe and fairly regular, the doctor will probably recommend preventive therapy. Sometimes preventive medication is even recommended for as little as one or two migraines per month if they are very severe and disruptive. The goal, as always, is to decrease frequency or severity by at least 70 percent, with as little medication as possible.

The first choices for preventing migraines in adolescents, in order of preference, are as follows:

1. A
NTI-INFLAMMATORIES

The first choices, as they are for tension headaches.

2. V
ERAPAMIL
(I
SOPTIN
, C
ALAN
, V
ERELAN
)

Often a good choice. Generally well tolerated, but constipation is common.

3. A
NTIDEPRESSANTS

Highly effective. Tricyclics are the older antidepressants, such as amitriptyline, as opposed to the newer ones, like Prozac, Zoloft, and Paxil.