children in pain: headaches

CHILDREN IN PAIN
(HEADACHES)

Children and their parents should understand that there are no miracle cures for headaches.”  Dr Lawrence Robbins from the article discussed today.

I just received the May issue of Practical Pain Management, and was immediately drawn to the cover’s title — Children In Pain: From Headaches to Growing Pains.  Most of all I was interested in the article by Dr. Lawrence Robbins (Managing Headaches in Children and Adolescents).  Although Robbins is undoubtedly a brilliant doctor with world-wide credentials (he is a Neurologist, and his website states that he is, “considered to be one of the top 10 experts in the country on management of headache medication. He started the American Headache Society section on refractory headaches, and has written as much on the topic as anyone in the world“), this article not only shows how differently MD’s think, but reveals OLD PREJUDICES as well.  

Robbins gets the ball rolling by telling us that, “Headache is a common complaint among children and adolescents.”  Because he doesn’t tell us just how prevalent HEADACHES are in this population, I looked at the science.  The December, 2013 issue of Pediatrics in Review (Pediatric Headache: A Review) stated that, “Headaches are common in children and adolescents and are a frequent chief complaint in office and emergency department visits.  Depending on the study definition of headache, population involved, and time periods studied, 17% to 90% of children report headaches, with an overall prevalence of 58% reporting some form of headache in the past year.”  How many of these Headaches are MIGRAINE HEADACHES?  In a brand new article for Medscape (Migraine in Children), Dr. William C. Robertson reveals that, “Migraine is a common disorder in children. Estimates indicate that 3.5-5% of all children will experience recurrent headaches consistent with migraine.

We learn that in similar fashion to adults, “the vast majority of headaches in children and adolescents are…. migraine, tension-type headache, and chronic daily headache.”  He goes on to tell us how said headaches should be diagnosed — via a “thorough history and physical examination.”  What’s interesting is that regardless of anything that Dr. Robbins is doing in his clinic, what should be and what is, are two very different things.  For instance, for years I have been increasingly hearing the same thing from people visiting specialists for all sorts of musculoskeletal complaints — I went to yet another doctor and he didn’t examine me either.  In fact, I find it particularly ridiculous that despite the huge amounts of peer-reviewed literature linking abnormal ranges of motion of the cervical spine to Headaches, THESE RANGES OF MOTION are rarely if ever checked — particularly in children, and particularly if there is no history of trauma (HERE).

Instead, even though Dr. Robbins lets us know that the guidelines clearly state that most diagnostic tests are completely, “unnecessary” (laboratory investigation usually is not warranted….  Neuroimaging studies usually are not indicated in children with a normal neurologic examination…., especially migraine or tension-type headache. These children usually will not have significantly abnormal findings on head CT scans or MRI), the first thing that most physicians immediately order is some sort of advanced imaging — HERE (especially CT) and blood work — just to make sure that we’re not dealing with a brain tumor.

After talking about “collaboration” and before mentioning his belief that, “a multidisciplinary approach is the most successful for patients with severe headaches,” Dr. Robbins discusses “Nonpharmacologic Treatments“.  Behavioral Specialists and PTs are the practitioners he mentions by name.  As far as “lifestyle strategies” are concerned, he suggests that, “It helps to say [to patients] that migraines are a genetic medical condition, just as asthma or diabetes are,and suggests things like, relaxation techniques, such as biofeedback, deep breathing, and imaging.”   I’ll deal with the rest of his statement later, but just remember that in most cases — probably the vast majority of cases — blaming ‘bad genes’ on your health problems (Genetics) is being discarded in favor of something called EPIGENEICTICS

So, when Robbins says that, “Nonpharmacologic treatments are particularly important because they typically are more effective in children and help to minimize the use of medications and their related side effects,” I’m not fully convinced that he is being completely sincere.  Even though he mentions things like diet, food, allergies, missed meals, perfume or other smells, stress, hormones, cigarette smoke, exercise — to much or lack of (he recommends a half hour per day and specifically mentions swimming, walking, biking, and yoga by name), there is little time spent in discussion of any of these —- despite having just spoken so highly of their collective benefits.  When you get down to it, the focus of this paper is the drugs used most often to treat these kids. 

Unfortunately, when you talk to the average person who struggles with severe headaches (child or adult), you’ll find that while drugs can certainly provide some relief in some instances, drugs are not a great therapy for most people, and the results are always short-lived.  There are several tables in the article and all but one concern the two classes of drugs used for treating children with headaches.

  • PREVENTATIVE: These are headache meds that are taken daily with the hope that they will keep the child from getting a headache in the first place.   Because these meds tend towards the harsh side, I appreciate Dr. Robbins mentioning that it is important to, “attempt to avoid daily preventive medication.”  If they see a 30% improvement with this class of drug, it is considered successful.
  • ABORTIVE:  Once the child has a headache, the goal is to catch it early enough that the medication(s) can head the brunt of it off at the pass.

Some of the drugs that are specifically mentioned include NSAIDS, various forms of ACETAMINOPHEN & IBUPROFEN, Caffeine (which also acts as a trigger for many people), NEURONTIN, ANTIDEPRESSANTS (children are the new frontier for this class of drug), BETA BLOCKERS, CALCIUM CHANNEL BLOCKERS, BOTOX, Topomax, Imatrex, and an array of others. In his defense, he does mention Magnesium as well as several herbs as showing benefit against Headaches.

But what do we already know happens to these kids once their Headaches are severe enough they are seeing doctors for them?  They end up being prescribed NARCOTICS.  In case you think I am being harsh or simply making this up, HERE are the studies.  And if we are honest with each other (and regardless of what Dr. Robbins is doing in his clinic), we already know that not one doctor in 100 is giving any sort of meaningful dietary advice to the families of children with Headaches, other than possibly the sort given here; “eat a proper diet” (HERE’S WHY).  In light of the science, I’m almost not sure how an article like this could be written without at least taking a few sentences to discuss the GLUTEN / MIGRAINE CONNECTION or mention the premise of fellow Neurologist, David Perlmutter’s #1 best selling book, Grain Brain

And in this age of EVIDENCE-BASED MEDICINE, how can an overview of Childhood Headaches fail to spend at least a paragraph on one of the hottest topics in Headache Research today (not to mention for the past decade); REBOUND HEADACHES (the headaches that are both relieved and caused by the same medications)?  And what about manipulation?  He fails to as much as mention it in any capacity.  When a combination of CHIROPRACTIC ADJUSTMENTS and SCAR TISSUE REMODELING are used for patients with Chronic Headaches, the results are frequently nothing short of miraculous (HERE).  And when this approach doesn’t work, it’s time to find the source of the INFLAMMATION that’s driving the problem.

There are any number of Inflammatory drivers that children (or adults) can potentially be dealing with that are causing their Chronic Headaches.  One of the chiefest of these has to do with GUT HEALTH.  When you look at the research linking Chronic Migraine to the combination of messed up MICROBIOMES and LEAKY GUT SYNDROME, you should already be thinking along these lines —- particularly when Dr. Robbins specifically mentions that DEPRESSION (heavily linked to Gut issues — HERE or HERE) and GI PROBLEMS are both common “comorbidities of Chronic Headaches.  There’s nothing in his article about MOLD.  There’s nothing said about YEAST.  There’s nothing mentioned about DYSBIOSIS or the various drugs that cause it (HERE).  The silence on some of these issues is deafening.

Maybe this was just an issue of space (not enough of it), and Dr. Robbins did not have enough time to deal with some of these issues.  But methinks not.  I would contend that if Dr. Robbins combined what he already knows about Headaches, with some of DR. CARRICK’S FUNCTIONAL NEUROLOGY (or just hire a Functional Neurologist) and a took a “Functional Medicine” approach, his results would go through the ceiling.  Naturally, there would be much less time spent discussing medication in his articles.   If you are looking for a starting point as far as getting your child off their Headache Medications, or preventing some time on the MEDICAL MERRY-GO-ROUND, why not at least take a quick gander at THIS POST.

As always, the information in this post and on my site is just that — information.  It is not meant to diagnose or treat any sort of disease.  THE FDA has declared that drugs and surgery are the only “cures” for diseases.  If you feel you or your child has a disease, make an appointment with your doctor immediately, as this post is not meant to take the place of medical advice. 

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