Treating Headaches in the Youngest Patients
Date: October 22, 2013
For Madison Burkhardt, now 16, the headaches started two years ago. Without warning, and seemingly without cause, the high school student would be debilitated with pain up to five days every week. Lying in bed in a dark room or taking ibuprofen or acetaminophen sometimes helped. But when these measures didn’t work, says her mother, Sara, Madison would sometimes vomit.
Nearly a year later, Madison’s sister, Camden, also developed unbearable migraines.
“My husband and I knew that nobody, especially a child, should have a headache every day,” Sara says. “We thought, what are we doing wrong?”
For answers, they turned to Johns Hopkins, where both Madison and Camden came Funder the care of Chris Oakley, director of Johns Hopkins’ Pediatric Headache Clinic. The clinic is one of the few centers in the country that specifically treats headaches in children.
Most patients of Oakley and his physician assistant, Candie Marchand, have nearly daily, primary headaches, with no known etiology of tumor, infection, trauma or other causes. For the vast majority, Oakley says, the most important part of his workup is taking a detailed history.
“I spend about 45 minutes talking with each patient,” he says. “If I had my say, I’d probably be spending hours. It’s critical to truly understand each patient and family and build a relationship.”
It’s that solid relationship that makes patients more likely to follow his treatment recommendations on the sometimes-long road to easing chronic headaches, Oakley explains. While researchers are working toward gaining a better understanding of headaches, it’s still unclear what causes them, and there is no cure—only ways to manage the pain and prevent onset.
Working toward that goal, Oakley and Marchand use a three-pronged approach. The team first helps patients attain a healthy lifestyle, complete with maintaining good hydration, getting enough exercise, not skipping meals, eating a healthy diet, getting enough rest, and minimizing stress and anxiety. Establishing good habits can help prevent headaches before they start, Oakley says.
Next, based on each patient’s lifestyle, they suggest some alternative approaches, such as physical therapy, meditation, biofeedback and behavioral therapy.
Finally, if these don’t significantly reduce the number and severity of a patient’s headaches, Oakley and Marchand prescribe preventive drugs for daily use and abortive drugs for acute headaches.
“I stress to patients and their families that medicines are not a cure. Our goal is to decrease the headache frequency and severity by as much as possible,” he says. “If we decrease their headaches by 50 percent, that’s a success from a medication perspective. We try to do much better than that and are often successful.”
At the new clinic, Oakley and Marchand see patients together for the initial visit, and Marchand sees them for follow-up visits.
“I tell families up front that I don’t focus on how many headaches kids have and what they feel like. I focus on disability and dysfunction,” Oakley says. “I want kids to get back to themselves and feel normal again.”
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