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Tuesday, April 22, 2008

Headaches and kids: More common — and complicated — than you think

Kids are always getting stomachaches and rashes. But headaches? Strictly for grown-ups, right?

Wrong. The majority of school-age children get headaches, and many have headaches on a recurrent basis. Even before entering school, roughly one-third of children experience a headache at some point.

You know the pain is real, but what can you do? Find out what's triggering your child's head pain and identify measures you can take to help.

What causes children's headaches?

A number of factors, singly or in combination, can make your child headache-prone. These factors include:

* Genetic predisposition. Headaches, particularly migraines, tend to run in families. If you have a family history of bad headaches, your child will have a higher risk of getting them too.
* Head trauma. Accidental bumps and bruises can cause headaches. Although most head injuries are minor, seek medical attention right away if your child falls hard on his or her head. Also contact a doctor if your child has a steadily worsening headache after a bang on the head.
* Illness and infection. Headache is a frequent symptom of many common childhood illnesses. Ear infections, sinus infections, colds and flu are often accompanied by headache.
* Environmental factors. Conditions in the environment, including weather changes, odors, loud noises and bright light all can cause headaches.
* Emotional factors. Peer pressure, school problems and parental expectations can lead to high levels of stress and anxiety. Children with depression may complain of headaches, particularly if they have trouble recognizing feelings of sadness and loneliness.
* Certain foods and beverages. The food additive monosodium glutamate (MSG), found in such foods as bacon, bologna and hot dogs, has been known to trigger headaches. Also, caffeine, which is in soda, chocolate, coffee and tea, can cause headaches.
* Sleep deprivation. Overtiredness may cause headaches in children.
* Inadequate hydration. Lack of fluids can also cause headaches.

What kind of headache does your child have?

Headaches are typically hard to describe, especially for children. Some headaches are related to stress, while others are the result of an illness or injury. All headaches, though, are classified into two main categories — primary and secondary.

Primary headaches

Primary headaches develop by themselves rather than as a result of illness or injury. Headaches in this category include:

* Tension-type headache. Often stress related, this type accounts for many children's headaches. If your child has this type of headache, he or she may complain of a tightening or pressure in the head, neck and skull muscles.
* Migraine. Approximately 10 percent of school-age children experience migraines. Before children reach puberty, migraines affect about the same number of boys as girls, but in the teen years, girls tend to have migraines more often than boys do. While a migraine lasts, it may be disabling, causing not just pain but nausea, vomiting and extreme sensitivity to light and sound. Unlike tension-type headaches, migraines often occur during nonstressful or recreational times.
* Cluster headache. This is the least common type of headache in children. It's usually disabling and involves a sharp, stabbing pain on one side of the head.

Secondary headaches

Secondary headaches result from some underlying condition such as:

* Fever
* Head trauma
* Cold
* Sinus infection
* Strep throat
* Ear infection
* Meningitis
* Temporomandibular joint disorders (TMJ) and other jaw-related problems
* Medication side effects

Is your child's headache chronic?

Because children's headaches have many possible causes, each child needs a personal evaluation. As a rule of thumb, though, your child should see a doctor if he or she starts having headaches on a weekly basis or has any episode of head pain bad enough to keep him or her out of school or other activities. Children who are too young to tell you what's wrong may cry and hold their heads to indicate severe pain.

Two common types of chronic headache are:

* Transformed migraines. This happens when an occasional migraine occurrence turns into a daily occurrence.
* Rebound headaches. This can result from overusing certain over-the-counter and prescription medications for chronic tension-type headaches.

How do doctors diagnose chronic headaches?

Doctors diagnose most chronic headaches after taking a detailed medical history and performing a neurological exam.

Occasionally, this work-up suggests that an abnormality in the brain or skull may be responsible for a child's headaches. In these instances, imaging tests, usually performed in hospital radiology departments, can pinpoint the problem. The most common imaging techniques are:

* Computerized tomography (CT). A CT scan is a diagnostic imaging procedure that uses a series of computer-directed X-rays to provide a comprehensive view of the brain.
* Magnetic resonance imaging (MRI). An MRI doesn't use X-rays. Instead, it combines magnetism, radio waves and computer technology to produce detailed images of the brain.

Preventing children's headaches

A few simple measures will prevent all but the occasional headache in a child:

* Insist on adequate rest. Young children and adolescents need plenty of sleep — eight to 10 hours minimum. On the flip side, too much sleep can cause headaches, so don't let your child sleep the day away.
* Provide a healthy diet. Make sure your child eats breakfast, lunch and dinner and has healthy snacks to choose from throughout the day. Also, make sure your child drinks enough water, particularly in hot weather and after strenuous activity.
* Take steps at the first sign of a headache. If you think your child is developing a headache, encourage him or her to take a nap — if possible, in a dark, quiet room.
* Keep a headache diary. Note times and places that headaches occur. Also describe any thoughts, behaviors or events that occur with headaches. Use information from the diary to help your child avoid possible headache triggers. Wait for the child to volunteer that he or she has a headache rather than soliciting the symptom.
* Avoid stressors. Be alert for things that may be causing stress in your child's life, such as difficulty doing schoolwork or strained relationships with peers. If your child's headaches are linked to anxiety or depression, consider talking to a counselor.

Baseline prevention consists of a predictable daily routine, adequate rest, and healthy meals and snacks. Over time, the items you note in the headache diary should help you understand your child's symptoms and take specific preventive measures.

Treating children's headaches

Treatment depends on the type of headache. It may include:

* Behavior therapy. Stress- and anxiety-related headaches are often the culmination of several physical and emotional factors. If your child shows signs of stress — behavioral changes, eating and sleep disturbances, lack of interest in favorite activities — he or she may benefit from professional and peer counseling.
* Over-the-counter medications. Pain relievers such as acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin IB, others) relieve the immediate symptoms of mild headaches. Both ibuprofen and acetaminophen reduce fever too. Don't give aspirin to children under age 16 unless instructed to do so. Aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition in children.
* Prescription medications. Ergotamine and the triptan medications, such as sumatriptan, zolmitriptan and rizatriptan, relieve migraines already in progress. Other prescription drugs, including tricyclic antidepressants, beta blockers, calcium channel blockers and anticonvulsants, are taken regularly to prevent frequent and disabling migraines.

Remember, the medication strategy differs from child to child. Ask your doctor or pharmacist if you have questions. Keep these points in mind:

* Read labels carefully. Use only the dosages recommended for children, not adults. Some products come in infant, child and adult strengths but may look the same.
* Don't give doses more frequently than recommended.
* Ask about possible side effects of any medication.

Bottom line: If your child has chronic headaches, you can do more than simply surrender to the condition. Get help to find out how you can make a difference.
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