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Like a hammer mashing against your skull. A pounding severe pain on one side of your head (in some cases both) or behind your eyes. That agony, with nausea, vomiting, and a sensitivity to light and sound so acute, that the slightest noise of passing cars outside a closed window or a trickle of light around your bedroom door is still too much, magnifying the pain to a new level.
If the above describes what you go through a few times a year, or for those unlucky few, many times per month, then you are one of approximately 3 million Canadians suffering from recurrent migraines.
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As adults who suffer, we bear it, call in a sick day, maybe with lost wages (not to mention lost productivity for the Canadian economy), take medication, sleep, recover, and get back to the grind. We’re adults. That's what we do.
But as a parent, to watch your child or adolescent go through that agony?
One out of 40 children under six years of age, one out of 15 between 6 and 11 years, and one out of seven teenagers experience recurrent migraine. Statistically, the burden is less so than adults, but that still makes up a lot of our young people.
I should know; I see and manage hundreds of them every year in my clinical practice.
For those young ones who suffer, it’s not only the burden of migraine pain. It’s the day spent in bed away from class, that missed exam, the skipped hockey game or dance recital.
"It’s not fair to her!" A recent exclamation from a parent of a 14-year-old aspiring hockey player whose migraines cause her to miss four days a month of school and hockey practice.
It does not have to be. There are easy-to-administer effective lifestyle changes that can have a significant impact in reducing migraine frequency and intensity.
Relevant changes to reduce migraine burden
Supported by medical data and having personally managed such patients over the years, the most relevant changes to reduce migraine burden include:
- Regular meals. Avoid skipping meals, especially breakfast. Choose breakfast foods relatively higher in protein and fats (eggs, peanut butter, cheeses), and not only carbohydrate-rich products (fruit, jams, refined bread). Encouraging adolescents to grocery shop with the family and asking them to help cook/prepare meals reinforces autonomy for their own healthy dietary choices—for now, and the future.
- Hydration! Especially for the youngest sufferers and high-performing athletes. I recommend carrying a bottle of water wherever they go and having it on their desks during school.
- Frequent exercise (not during a migraine). A wealth of studies report regular aerobic exercise is linked to reduced migraine frequency. Exercise releases ‘feel-good’ chemicals that increase the threshold for pain, and its knock-on effects of improved sleep quality and lifting low mood can secondarily reduce migraine events.
- Management of Stress. Stress is anything that causes physical, emotional or psychological strain. We all feel it, and a certain amount is needed for maturation and development. But too much of it for too long, and it morphs into Anxiety, Depression, sleep difficulties and more. Rates of mental health disorders have been steadily climbing, with stress a strong link. I suggest parents check in with their children, especially if there has been a change in their mood. Trained therapists, counsellors and psychologists are a great resource to help in this regard.
- Start a headache diary. Track migraine events and look for potential triggers. Do they always occur when drinking soda pop? Not enough sleep (see below)? Do they typically happen in the summer months? Maybe not enough water on some days? Your child can modify their behaviour and eliminate those migraine-causing triggers by tracking them and their potential triggers.
One of the most critical contributive factors is sleep quantity and quality. Migraine and sleep have a unique bi-directional relationship as migraineurs suffer from intrinsic sleep difficulties, which translate to greater migraine events.
The biology of this relationship can fill a textbook. Regardless, if your child has frequent migraines, carefully reconsider their sleep routine. The average teenager needs a minimum of eight hours, those between 6 to 12 years at least nine hours and those 3 to 5 years at least ten hours (including nap time).
What about screens? The hours leading up to sleep are as important as the quantity. Ample evidence suggests blue light from screens (phones, tablets) leads to a delay in natural sleep onset and disrupts those sleep stages for optimal learning. Have a ‘screen curfew’ at least one hour before their head hits the pillow with lights off…and here is where I get growls from my teenage patients. But I will stand my ground, and so should their parents. 'Lights out’ includes ‘screens off—at least one hour before.’
That being said, it's not all the fault of their choices. As adolescents mature, their natural internal clock to alert them of sleep delays by a few hours. Ever wonder why teenagers want to stay up late? Yes, it is their hormones.
As a physician and advocate, ensuring that our school system gives teenagers time to accommodate their changing biology is paramount.
A recent study in the U.S. involving hundreds of high schoolers analyzed the sleep patterns of two groups of students. The first was with school start times before 8:30 a.m. and the second after 8:30 a.m. Those with start times after 8:30 a.m. had lower self-reported headache frequency (including migraine).
The authors comment that "shifting to a later high school start time may be an effective strategy for migraine prevention in adolescents." Prospective studies are needed to elucidate this fully, but it's not rocket science.
Of the hundreds of migraine patients I have managed, a large percentage find benefit when dissecting their sleep routine, modifying it to include consistent sleep habits and presto, migraines lessen. It doesn’t have to be rocket science!
To the school boards (especially secondary school boards) across Canada with early start times, I ask that you reconsider. Adequate time spent being taught at the hands of our excellent Ontario teachers is essential, but not at the cost of early wake-up times. Those with migraines need their sleep. It’s inherent in their biology.
The authors of the study above conclude: "If broadly implemented, this could lead to thousands of fewer headache days and missed school days in adolescents annually."
Web Resources:
https://migrainecanada.org/pediatrics-adolescents/
https://www.cdc.gov/healthyschools/features/students-sleep.htm
