Herman Latorre, neurologist: “Migraine can start at any age, and in boys it often starts earlier than in girls” | Experts | Moms and Dads

Headaches are a very common reason for consultation in pediatrics. It is a health problem that not only affects the physical, but can also affect the social and emotional well-being of children who suffer from it. “Migraines can start at any age, but usually in boys they start a little earlier than in girls,” says Germán Latorre (45, Elche), a neurologist at the clinic. Fuenlabrada University Hospital (Madrid). And he adds the fact: “Approximately 20-25% of the world’s population suffers from it, it is the third most common disease and the first reason for visiting neurologists.”

“In minors in general, if migraines don’t affect their functioning, it’s best not to treat them or give them a lot of medication,” he explains. Latorre insists that when faced with migraines, children should not be overmedicated and that parents should trust professional judgment.

ASK. What is meant by childhood migraine?

REPLY. Migraine in children is really the same as in adults: it is a chronic neurological disorder that develops cyclically. It usually occurs in crises, the duration and frequency of which can be variable. Throughout life, there are usually moments of worsening and improvement, which are more or less spontaneous or related to an environmental factor, as well as changes in symptoms. Migraine is a disease of unknown cause. We believe that there are some genetic factors, since most people who suffer from migraine have a history of it. People who suffer from migraine have it from the moment of conception.

TO. How does it differ from migraine in adults?

R. The difference is that when it happens in the developing brain, there are often different symptoms. Young children sometimes don’t have headaches, they have other symptoms that are often harder to recognize as migraines. For example, some will have intermittent abdominal pain, abdominal pain for 24 or 48 hours, and then it goes away. Many of them, when they grow up, have migraines and come to see adults, we see that they have a lot of childhood gastroenteritis or cyclic vomiting syndrome.

TO. How to distinguish migraine from other types of headaches?

R. The diagnosis of migraine is clinical, today we do not have a biological marker, that is, a diagnostic test, something that we can see in an analysis or in a scan. For this, the criteria have been established by consensus. Usually, there is no need for any additional tests for migraine, especially in childhood. The characteristic of the pain is that it is intense, affects one side of the head and is usually associated with sensory intolerance: light, noise, smells and touch cause anxiety, especially in the scalp area. It is associated with nausea and vomiting and worsens with regular physical activity or movement. The criteria do not require all of these characteristics, but combinations may occur that allow us to make a diagnosis. This is based on collecting anamnesis, asking the patient about the symptoms and an adequate physical examination. In children, this anamnesis should be supplemented by data collected by the father or mother, as well as the social, educational or educational circumstances of the minor.

TO. At what age can migraines begin?

R. Migraine can start at any age, but it usually occurs between childhood and adolescence. Boys often have it a little earlier than girls. They may or usually have it a little later, closer to menarche, but that’s not a mathematical rule either. Then it depends on what we consider migraine, because as I mentioned, there are precursor syndromes and syndromes that we know are associated with the risk of developing it. For example, infantile colic is known to be a precursor syndrome to migraine; children who have it are at greater risk of developing migraine as adults. Another very common syndrome in childhood that is also associated with migraine is what we call motion sickness. These are children who get very dizzy in the car, they vomit on very short trips, even extremely short trips.

TO. What are the available treatments?

R. Migraine treatment consists of three parts: hygienic and dietary measures, relief of attacks and preventive treatment. Hygienic and dietary measures consist of explaining to the patient and relatives the diagnosis, prognosis, etc. There is no cure for it, but it is not associated with a serious disease. However, it can lead to disability if not treated properly. The second measure is to inform families about some lifestyle habits that can aggravate migraine so that they avoid them and encourage those who can improve them. Some important measures: sleep hygienetoo little or too much sleep can trigger migraine attacks. Excessive use of painkillers, toxic substance use in adolescents, and obesity or being overweight can make migraines worse. On the contrary, physical exercise practice This can help control it, as well as manage stress and emotional factors. Abortive treatment consists of prescribing analgesics (paracetamol or anti-inflammatory drugs) or other specific drugs to treat crises. In the case of preventive therapy, it is offered only to some patients who have frequent migraines, with high intensity and whose occurrence affects their functionality and quality of life. In this case, oral treatment is usually started with the aim of not curing, but reducing attacks and pain.

TO. What advice would you give to parents whose children suffer from migraines?

R. If you have children who suffer from migraines, first of all, do not blame yourself. The disease is inherited, not the evolution, because it is something specific to the person. They should be explained that sufferers of this disease feel better if they lead a structured life. For minors, a daily routine is very useful, because they have a regular feeding and sleeping schedule. Do not over-medicalize them, relying on professional judgment, unless their functionality is reduced, then you should consider a consultation to see if they need preventive treatment.

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