If 13-year-old Matthew tried to count all of the things he’s missed out on due to his migraine headaches, he would be counting for a very long time.

That’s what happens with children who have migraine disorder. Without treatment, they miss out. They miss ballgames. They miss parties. They miss school. They miss family time. And even when they’re physically present, the suffering brought on by a migraine attack often keeps them from any joy or value the experience might otherwise bring.

Matthew first began experiencing debilitating headaches at 8 years old, when his family lived in Michigan.

“I would get this intense pain, mostly behind my eyes,” Matthew says. “I would have to finish the rest of the day in bed. I really couldn’t do anything else.”

“He would have to come home from school,” says Matthew’s mom, Diana. “There were many times he would feel so sick that he couldn’t eat dinner. He would just go to sleep.”

Sometimes Matthew’s pain was so intense that his parents had to take him to a hospital emergency center, where he would receive a combination of I.V. medications to mitigate his pain and nausea.

What was causing Matthew to suffer?

Diagnosis

Diana was relieved when his doctors in Michigan were able to rule out things like tumors or blood clots, but she was still surprised at her son’s diagnosis of migraine disorder.

“At first, I was shocked. I couldn’t believe it,” Diana says. “I had migraines growing up and into adulthood, but I thought mainly women got them because of hormones and their cycles. I never thought my little boy would have to suffer with them.”

Migraine is a neurological disorder with a profound genetic basis that can impact almost all of the brain’s functions. It’s often characterized by a severe headache, nausea, sensitivity to light, sound and smell. There may also be difficulty focusing, inability to sleep, moodiness or irritability. A migraine can last hours or even days.

Clarimar Borrero-Meijas, M.D., is a pediatric neurologist who specializes in migraine and headache disorders at Johns Hopkins All Children’s Hospital in St. Petersburg, Florida.

While there is no absolute cure for migraine disorder, she says the clinical and scientific communities know much more about migraine management today than was known even a decade ago.

“While we don’t know everything, we’ve gained a good understanding of the complex cascade of electrical and chemical reactions that go awry, or that are not working as they should in people with these disorders,” Borrero-Mejias says.

As much as 10% of school-age kids, and 28% of adolescents, both boys and girls, are impacted by migraine. Too many of these kids go without the comprehensive care needed to manage what can be a disabling condition.

Matthew’s family moved to Florida when he was 9 years old, where they continued to struggle to find the level of clinical care that could lead to real solutions for their son.

Then, on one of Matthew’s doctor visits, the family learned about a higher level of subspecialty care through the Pediatric Neurology Program at Johns Hopkins All Children’s.

Matthew was able to meet with Borrero-Mejias at the hospital’s Outpatient Care Clinic in Brandon.

The family noticed a difference in care from the very first visit.

Advanced Care

“Dr. Borrero was very sympathetic, not only to Matthew’s migraines, but to his entire well-being as a person,” Diana says. “She really took the time to understand Matthew’s day-to-day activities and functions.”

While medications can play a role in stopping or preventing migraine attacks in children, lifestyle and behavioral management are perhaps more important.

For her patients, Borrero-Mejias recommends eight hours of sleep each night, good hydration (at least one ounce of water for every one pound of weight), regular meals, and 30 minutes of exercise each day.

One of the keys to managing a migraine disorder lies in understanding what elements in a child’s environment tend to trigger the attacks — and then learning how to shape daily living in such a way that helps to avoid or mitigate those triggers.

This takes time and can become something of a family project. Borrero-Mejias often asks parents to help their child keep a calendar of when they get a migraine and what is going on when they do.

“Dr. Borrero would ask Matthew questions like, ‘Where were you and what were you doing when you got the migraine?” Diana says. “Or questions such as ‘Had you been eating regular meals? What was the lighting like? What was the weather like?’”

Over time, Matthew and his family began to understand what would sometimes bring on a migraine, how his sensitivity to light kept him from playing outside with his friends, and how his sound sensitivity was triggered by situations like the unusually large classroom size in the school he was attending.

Matthew confided in Borrero-Mejias that he had been bullied at times in school. The doctor helped him to understand how the emotions from those stressful situations could trigger a migraine response. She helped him by establishing a care plan that addressed coping skills and self-advocacy at school.

As for medications, there are several options that can be effective in either stopping migraine (often within two hours) or preventing an attack from happening. Episodic migraine attacks can often be aborted with NSAIDS (non-steroidal anti-inflammatory medications) or triptans. Chronic migraine may respond better to a daily medication that can work as a preventative.

There are newer calcitonin gene-related peptide (CGRP) medications approved for adults that can be effective in preventing or treating migraine. Clinical trials in children are ongoing and may present more options in the near future.

Matthew was prescribed medications for pain, nausea, and to help regulate his sleep. Armed with those medicines and his lifestyle modification skills, he began a new chapter in his quest to free himself from the grip of debilitating headaches and the constellation of other symptoms he experienced due to migraine.

Real Relief

Matthew got glasses with transition lenses that helped with his sensitivity to light. He paid attention to the weather, as he had observed that a drop in barometric pressure could trigger a migraine. His family helped to ensure that he was eating regular meals and getting enough sleep.

With his new routine, Matthew began to notice some welcome changes.

“I began to notice my headaches became less powerful, less painful than they once were,” Matthew says. “They didn’t last as long; sometimes it seemed only a few minutes.”

Eventually, Matthew was able to taper off most of his medications. He has shown improvements in school, and his social life has changed for the better.

“I can do so much more now,” Matthew says. “I can ride scooters, bikes, and just enjoy time with my friends.”

“Dr. Borrero did so much for us and educated our family as to how we can help make him better,” Diana says. “We are so grateful.”

Borrero-Mejias acknowledges that migraine management takes planning, effort, and discipline. She gives Matthew and his family all of the credit for their commitment.

“I think it’s wonderful that he is so much better,” she says. “Any time I can help impact a child’s well-being, and they can go back to being children, I feel grateful that I can participate in a child’s life in that way.”