Thinking About Kids

Parents, kids, and the way we live together

Withdrawn, Irritable Teen? Is It A Migraine?

Pubertal migraines can look like nausea, irritability, or ADD

I've heard of migraines my whole life, but always as a kind of running joke featuring a stereotypical middle aged housewife.  Then my son got them and I realized how devastating they can be.  And that I had suffered from them as a teen as well  

Migraines often begin and are most intense at puberty.  They disguise themselves as many different illnesses, making them hard to diagnose, and even more difficult to treat.  

They are brought on by common conditions that are experienced by many teens - hormone changes, stress, loud sounds, and lack of sleep.

Many people suffer migraines without headaches, and some of the symptoms look like our stereotype of teenagers: irritability, depressed mood, the desire to hang out in a quiet bedroom and just be left alone, being scatterbrained and having a hard time getting homework done, and just wanting to sleep.

Signs and symptoms

The classic migraine is an intense, throbbing, pulsing headache localized on one part of the head - often the temple.  But migraines are much broader than that.  Symptoms include:

  • Headaches
  • Nausea and vomiting
  • Auras: floating spots of dots of lights or glowing auras around bright lights.  Some people lose all or part of their vision.
  • Painful sensitivity to sound, light and touch that makes being around people unbearable.
  • A feeling of disorientation, lack of concentration, and 'spaciness'.
  • Some people tend to exercise particularly poor judgment just before or after a migraine.
  • Severe migraines can be associated with hallucinations.

10% of people worldwide have migraines.  They are three times more likely to strike females than males.  They tend to spike at times of hormonal changes - puberty in both sexes and menopause in women.  

Migraines usually last at least 3-4 hours and can last weeks.  Most people with migraines have relatives with migraines or other related disorders.

Four phases of migraines:

The migraine cycle usually lasts for several days.  It encompasses four phases: prodrome, aura, attack, and postdrome.  The single most important thing to know about migraines is that the earlier you recognize them and take steps to prevent them, the better.

Prodrome:

Many migraine sufferers can tell a migraine is coming on a few days ahead of time.  They experience:

  • uncontrolled yawning
  • depression
  • food cravings
  • hyperactivity
  • irritability
  • stiff neck
  • constipation

Often, prevention at this phase can stop a migraine from developing.  Most critical is quiet, low light, and sleep. 

Aura:

Just before a migraine sets in, approximately one in three people experience auras.  In additional to visual auras, these can also include feeling pins and needles, vision loss (often a blotting of the center of vision) or aphasia (difficulty with speech).  Again, withdrawing from triggers at this phase (retreating to a quiet, dark room) can be critical in avoiding onset of a full attack.  

Attack:

Migraine onset is often marked by nausea, loss of balance, extreme sensitivty to light or sound, as well as with a sharp throbbing headache.  People often feel dizzy and experience blurred vision.  They can be snappish because the world seems an overwhelming buzz of sensation (think drunk and dizzy at a midnight carnival midway).   Quiet and dark help.  

The first 20 minutes appear to be critical.  If a doctor has prescribed medication TAKE IT NOW.  Once the migraine is established, it sets up a reinforcing cycle of pain that is difficult to break. Pain begets pain.

Postdrome:

After the attack, most people feel wiped out and spacey.  Some people suffer from poor judgment during this period.  Others experience  mild euphoria.

Causes:  

Like most headaches, the causes of migraines are poorly understood.  They may be associated with changes in the brainstem interacting with the trigeminal nerve, a major pain pathway.  They seem to be associated with serotonin imbalances - levels that are either too high or too low.  According to the Mayo Clinic, the drop in serotonin levels during migraine attacks can trigger the release of neuropeptides which can irritate your meninges and lead to headache pain.  Ironically, one of the drugs often prescribed to temper the vomiting of severe migraines is a serotonin suppressor.  

Migraines can be triggered by growth spurts, by stress, lack of sleep, loud sounds and bright lights, physical activity, and changes in weather.  They can also be triggered by foods, including nitrates found in hot dogs and pepperoni, food additives common in snack foods, and cheese.  A pepperoni pizza can be a migraine sufferer's worst nightmare.

Migraines at Puberty

A lot of migraine factors - especially changes in hormones, stress, and lack of sleep - are common characteristics of adolescence.  We have just arrived at headache central.

One thing that makes migraines so sneaky is that often look like something else.  Migraines often begin with feeling spacey, absentminded, and disassociated.  Because migraine sufferers tend to be intensely sensitive to stimuli, they can be very irritable.  They isolate themselves in their rooms to stay away from bright lights and sounds.  This can be a good thing, because it can prevent the onset of a full bore attack.  But it can also mask the fact that the problem is physical - a migraine - and not just a stereotypical teenage funk. 

A migraine can also manifest itself as nausea.  People with a migraine coming on can often feel a little - or a lot - sick to their stomachs.  They may have little energy and be unable to concentrate.  Younger adolescents will often experience migraine nausea without ever getting a headache, never realizing the underlying cause.  Because nausea can be fairly regular - and migraines tend to be most intense in September (the beginning of school) and March (spring fever), it can look like a kid just trying to play hookey.  They can't possibly feel sick to their stomach that often, right?  This can seem especially suspicious to parents because migraines are often associated with tiredness and being unable to concentrate, so homework goes slow or doesn't get done.  

For many girls, migraines come and go with their menstrual cycle, and are dismissed.  

See a doctor - and things you can do for yourself

The NIH suggests that every migraine makes it more likely to have another migraine, so prevention is key.  See a doctor early to get good advice on pain medication.  Teens should also:

  • Keep a migraine diary.  Keeping a diary of activities that may trigger migraines can be the very best thing to avoid future attacks.  It is also useful to bring to a doctor to discuss.
  • Maintain a regular sleep schedule.
  • Recognize the signs of an oncoming atttack.  Often withdrawal to a quiet place for even 20 minutes can stave off a full bore attack.  Schools will often accommodate the need to leave class and lie down - there is often a sympathetic migraine sufferer in the main office.  A doctor's note will help.
  • Learn relaxation techniques.  Relaxing jaws and shoulders can help relieve some of the stress that feeds into the nerves that trigger pain.  Massaging temples and the joint joining jaw to skull also triggers pain relief in many migraine sufferers.  And pain hurts less when you are relaxed.
  • Think good thoughts.  Surprisingly, research suggests that projecting strong positive emotions can also relieve migraine symptoms.  

The good news

Although migraines often come on with puberty, for many people they also often recede in late adolescence.  

Nancy Darling, Ph.D., is a Professor at Oberlin College.

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