Dr. Greene, our son Andrew has been having frequent severe headaches. What exactly are migraines? What can be done about them?

Even the unbridled energy of childhood can be squelched by a pounding migraine headache. As the pain mounts, a normally curious and active child will slow and then stop playing, brought down by the migraine. Migraines are not just any type of bad headaches -- they are a specific condition. And they are much more common than most people suspect. Migraines are the most important and frequent type of headache in children, affecting more than one in twelve kids -- yet only 20 percent of children with migraines are ever properly diagnosed and treated (Headache, May 1997).

Migraines are caused by an inherited extra-sensitivity of certain blood vessels to the nerve and chemical signals that normally cause these vessels to dilate or constrict (especially to serotonin, norepinephrine, and substance P). When these over-exuberant blood vessels expand and contract, the resulting changes in pressure produce pain (Pediatric Annals, September 1995). The medicines for migraines decrease the responsiveness of these vessels.

Migraines are defined as recurrent headaches (in which the child is well between episodes) accompanied by at least 3 of the following symptoms:

• abdominal pain
• nausea or vomiting
• throbbing headache
• specific location of pain
• sensitivity to light and sound
• associated "aura"
• relief with sleep (headaches that awaken children, or early morning)
• family history of migraines

Before puberty, migraines are more common in boys than in girls (the reverse is true afterwards). Most kids do not have an aura (changes in vision or tingling hands or feet), but most do have a throbbing or pounding headache, often at both temples, accompanied by nausea and vomiting. The headaches typically last for one to three hours -- but they can last for 24 hours or longer. Kids often appear pale and are sensitive to light during a migraine. They feel crummy!

Helping kids with migraines begins with carefully observing the circumstances when the headaches begin. A big difference in kids' lives can be made by identifying and avoiding their migraine triggers.

A number of foods have been shown to be the triggers for some individuals. The most common of these are nuts, chocolate, cola drinks, hot dogs and luncheon meats (probably the nitrates and nitrites), pepperoni and sausage (thought, perhaps, to be the spices), kippers (though I have never yet seen a kid eat kippers!), and MSG (found in Chinese food and in restaurant salads -- another non-issue for most kids). Both alcohol and birth control pills are associated with migraines, but there are better reasons than headaches to avoid these in young children.

Bright flashing lights can also trigger migraines. This happened recently on a large scale to many children watching a cartoon in Japan (this cartoon also triggered seizures in many children, which of course captured more attention than the migraines).

Children who get migraines are more likely to get them when they are over-tired or have gone too long without eating.