When Pain Runs In The Family

When Anthony Stall got his first piercing headache at the age of 4, his mother, Karyn, recognized his pain, nausea and aversion to light and sound--she's had migraines since she was 7. But their family doctor didn't buy it. He put Anthony on antibiotics, then Tylenol, then different strengths of ibuprofen. Nothing helped. So after Anthony missed 23 days of school last year due to headaches, Karyn switched doctors. Anthony, now 13, got the right diagnosis and a part in a study of the triptan drug Imitrex in children. He's better, though he still misses some classes--the drug treats headaches but doesn't prevent them. Recently, Karyn went into his school to explain. ""Until a person gets [a migraine],'' she says, ""they don't understand.''

For many parents, that lack of understanding only compounds their children's suffering. Even when they wave genetic red flags as the Stalls did, a long lag between a child's first stab of pain and an accurate diagnosis is not unusual. Doctors familiar with adult migraine can be led astray by subtle differences in the pediatric version. And a child's migraine pain tends to radiate out through the rest of the family, straining everyday life.

Still, the disease is treatable, and more families than ever are getting relief. Less than a decade ago the childhood migraine was all but ignored, and the drugs available barely worked. Some parents and doctors think relief may come from eliminating ""triggers'' in the child's diet. Increasingly, though, they're turning to a suite of new migraine drugs. They're meant for adults, but some doctors have begun prescribing child-size doses, the best news yet for these families.

No one knows how many kids actually get migraines; estimates for prepubescents range between 3 and 10 percent. Before puberty, boys and girls get migraines in roughly equal proportions; afterward they settle into the adult ratio of three females to every male sufferer. Some doctors think childhood migraine is on the rise, and a Finnish study that compared 7-year-olds in 1974 with 7-year-olds in 1992 did find that the migraine rate had risen from 1.9 percent to 5.7 percent. But doctors aren't sure if perceived increases reflect higher prevalence or just better awareness and diagnosis.

Childhood migraines are especially tricky because the pediatric version has different symptoms--though researchers aren't sure why. Headaches are shorter-lived, sometimes lasting only 30 minutes compared with up to three days for adults. Kids often say their pain is worse in the front of the head, instead of on one side. And children tend to have more stomach problems, such as nausea and vomiting, than adults do. To recognize those differences, doctors have proposed a children's version of the standard diagnostic criteria for migraines. ""Those slight changes would dramatically improve the ability to make a diagnosis,'' says Paul Winner, a pediatric neurologist in Palm Beach, Fla.

Kids' migraines are just like adults' in one way: they can shut a life down cold. Shayna Weinstein, a Dallas 15-year-old, was auditioning for a lead part in a school play when ""I started to feel the pain in my stomach and tiny pains in my head,'' she says. ""It's like a pulse, like boom! boom!'' She blew the scene, lost the part and spent the rest of the day at home crying from the pain. Often, parents end up caring for the sick child, dealing with ruined family outings and coping with their own migraines, as well. At the Stall house, Anthony's migraines make everyone tense. ""I yell at everybody for everything they do,'' he says. They can also spark rebellion. Martha McMillen of Louisville, Texas, wonders why her son Daniel doesn't always take his Imitrex. ""He's 16. He knows where the medicine is. I'm not going to force it down him.''

It can be disheartening, but children with migraines can be helped. The most common first step is also the most controversial: restricting diet to eliminate potential trigger foods. Some foods--chocolate, cheese, monosodium glutamate (MSG), NutraSweet--may set off headaches. But many researchers doubt triggers are as important as popular self-help books tend to suggest. ""If there are 20 of us that have migraine, maybe three of us are sensitive to the same thing,'' says David Rothner, director of child neurology for the Cleveland Clinic Foundation. ""Anti-migraine'' diets that forbid lots of foods generally don't work, and they often ban things kids love, like hot dogs (which contain nitrites) and pizza (because of the cheese). A doctor told Jennifer Shain, a 15-year-old from Manalapan, N.J., to stop eating cheese, nuts, MSG, chocolate, caffeine and NutraSweet. She still got four headaches a week. ""It was kind of frustrating,'' she says. ""Now I just eat whatever.'' (Jennifer's father, Harold Shain, is president and chief operating officer of NEWSWEEK.) A new doctor switched her to drug therapy, and her migraines are down to three a month.

That's an increasingly common tack. Full studies of traditional migraine drugs, especially the triptans--like Imitrex and Zomig--are just getting underway, but anecdotal evidence suggests they are as effective on kids as on adults. Until those tests are completed, the government won't approve the drug for pediatric use, but that doesn't mean they're not available. Some kids participate in a study in return for triptans. More often, doctors will simply prescribe them (or preventive drugs) ""off-label.'' Kids also seem to respond to biofeedback and relaxation training about as well as adults; both can reduce the frequency of migraines.

A small number of children get better on their own. One European study showed that of 73 kids with migraine ranging from 7 to 15 years old, 41 percent were in remission 15 years later. Overall, the odds probably aren't that good, and migraines can return after years of remission. But when one of your children is confining herself to a darkened room with an excruciating headache, it's nice to think that this pain might someday stop running in the family.

THE DIFFERENCE YOUTH MAKES

Doctors often miss migraines in kids because the symptoms differ. A list of the telling details:

Duration: Kids' migraines tend to be shorter, some lasting only half an hour.

Location: Adult migraines are confined to one side of the head; kids' heads hurt at the front.

Symptoms: Kids may be sensitive to light or sound, not both, and their stomach problems may be worse.