Heading off Migraines

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Greg Raver-Lampman

A book that physicians all over the country turn to for facts on headaches in children and teenagers was written by CHKD pediatric neurologist Donald Lewis.

MaxyRiddickMaxilove “Maxy” Riddick, 13, excels at every sport she plays. A dozen trophies for baseball, basketball, soccer and volleyball crowd a display shelf in her family’s living room in Norfolk.

But one afternoon in November 2006, after volleyball practice at Lafayette-Winona Middle School, a powerful headache stopped her in her tracks. For a moment, she went completely blind. With her heartbeat thudding in her head, she collapsed.

Her mother, Marie, thought it might be a virus, but pain relievers didn’t help. The next day, Maxy passed out from a similar attack.

“I rushed to her, but she wasn’t moving,” Marie said.

After a frantic 911 call and transport to CHKD, tests ruled out dire conditions such as meningitis and brain tumors. The specialists instead zeroed in on a diagnosis of a severe migraine.

That surprised Marie. “I didn’t think young people got migraines,” she said.

Migraines are not new to medicine. They’ve been described in medical literature since well before the Roman era. Until recently, though, doctors had only a vague understanding of the causes and had few effective weapons to fight them.

In both children and adults, severe migraines can be absolutely crippling.

“These are terribly disabling attacks of pain,” said CHKD pediatric neurologist Donald Lewis, a nationally-recognized expert on migraines in children and adolescents. “Until recently, there weren’t many effective treatments. The only thing that made these headaches better was to lie down in a dark room, and maybe throw up as well.”

To make matters worse, migraines are often mis-diagnosed.

KatherineEberweinThat happened with 13-year-old Katherine Eberwein of Virginia Beach, who was just 10 when she suffered her first migraine in Phoenix, Arizona, where her family lived at the time.

“Katherine woke up with a horrible headache and a sore neck,” recalls her mom, Anne.

At an adult emergency room in Phoenix, doctors mistakenly diagnosed meningitis and placed Katherine in an air-controlled isolation room.

“We were terrified,” Anne recalls. “When Katherine’s headache didn’t go away, they gave her some really heavy narcotics.”

Despite common misconceptions, migraines commonly strike children and adolescents. Recent research has uncovered the startling fact that migraines afflict 11 percent of children between the ages of five and 15, with the percentage peaking when children are 12 years old. While boys tend to outgrow the migraines, girls more often continue to suffer through adolescence into adulthood, often prompted by changes in hormone levels.

“I’ve seen migraines in children as young as 4 years old,” Dr. Lewis said. “Many times, those children are referred to eye doctors because the migraines start in the lobe of the brain that controls vision.”

Over the years, the sheer number of children and adolescents with migraines prompted Dr. Lewis to conduct research on causes and treatments. His book, Headaches in Children and Adolescents, recently published in a second edition, serves as a resource for doctors nationwide on the latest research and treatment.

“We’ve discovered a genetic disorder that causes some cells of the brain to be hyper-irritable,” Dr. Lewis said. The migraines “start with an unusual electrical charge in the occipital lobe, which controls sight. This often causes the odd, altered vision, a kind of aura that comes before the full headache hits. That electrical charge creates a cascade of chemical changes throughout the brain, including in the brain stem, that causes not only a crushing headache but also nausea and vomiting.”

By understanding how a migraine works, researchers have been able to develop a new class of drugs – dubbed triptans – that disrupt the sequence of chemical changes that cause migraines, at least in adults.

Proving the effectiveness of medications in children, however, can be tough because children have an unusually strong response to placebos.

In an effort to determine whether these triptans worked in children, Dr. Lewis recently devised an innovative study using the adult migraine drug Zolmitriptan. During the first round of the study, Dr. Lewis gave placebos to all the children in the study. Those whose headaches went away after taking the placebos were eliminated from the study. Those who didn’t respond to the placebos were selected for the clinical trials.

Thanks to that kind of research, pediatric neurologists today have far more tools available to eliminate migraines in patients like Maxy and Katherine.

Today, medications prescribed by Dr. Lewis stop Katherine’s migraines before they really get started.

In Maxy’s case, thanks to similar medications, migraines no longer limit her activity. She is now getting back into sports, big time, hoping to bring home a few more trophies.

Dr. Lewis is vice president of academic affairs at CHKD and chairman of the EVMS department of pediatrics. He practices with Children’s Specialty Group PLLC at CHKD.

This story was featured in the fourth quarter 2007 issue of KidStuff, a publication of Children's Hospital of The King's Daughters.

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