Selected Podcast
Managing Pediatric Headaches Do's and Dont's
Dr. Susy Jeng shares tips on managing pediatric headaches.
Featured Speaker:
Susy Jeng, MD
Dr. Susy Jeng is Clinical Associate Professor of Neurology at Stanford Children’s Hospital at Stanford University. Dr. Jeng received her A.B. at Harvard College and M.D. at the University of California, San Diego. She completed her pediatrics residency at University of California, San Francisco and is board-certified in pediatrics. After practicing general pediatrics for two years, she returned to UCSF for neurology residency. Upon completion of her residencies, she joined the faculty at Stanford as a general child neurologist with a special interest in medical education. She is the site director for the Stanford medical student neurology clerkship and the pediatric neurology liaison to the Stanford pediatrics residency program. Transcription:
Managing Pediatric Headaches Do's and Dont's
Scott Webb; (Host): Sometimes dealing with a headache is as easy as taking a few over the counter pain relievers. And sometimes we need to see a specialist. And since none of us wants our kids to suffer, it's good that pediatric neurologists are available to help diagnose and treat headaches in our kids. And joining me today is Dr.
Susie Jeng. She's a Pediatric Neurologist with Stanford Children's Health.
This is Health Talks with Stanford Children's Health. I'm Scott Webb. So, Dr. Jeng, thanks so much for joining me today. We're talking about pediatric headaches, do's and don'ts. So, how do I know if my child's headache is ordinary or dangerous? And then how do I know further if it's a migraine?
Dr. Jeng: So, in general, I tend to think of headaches as what we call primary headaches. So, those would-be headaches like migraine type headaches or tension headaches. Those kinds of headaches are not dangerous, but they can be debilitating if it causes your child to miss activities or school. So, those are primary headaches and then secondary headaches are the ones that are caused by other things.
So, some of the red flag symptoms would be things like fever, having headaches that are worse at night, or waking you up from sleep, vomiting or progressive vomiting, vision changes, balance problems, or other neurologic symptoms like weakness or numbness. Any of those kinds of red flags symptoms with a headache would be concerning for a secondary headache and a dangerous headache. Okay? But if we're talking about migraines, which is the most common type of primary headache for kid s, actually 11% of kids ages five to 15 have migraines and up to a third of teenagers will have migraine as well. So, it's actually one of the top five childhood health problems. So, really common. And the thing about migraines is there's actually no blood test or brain scan or anything to diagnose them, because people with migraines are normal, they have normal brains. And so, we can't do that kind of testing. The way you diagnose a migraine is actually, by the type of symptoms they have.
So, it can get a little technical, but in general, the way we diagnose childhood migraines are that they have to have had at least five headaches that have been similar in nature. The pain has to be at least 30 minutes, at a time. If it's less than that, then it doesn't quite qualify for what we call a migraine. And then the headache has to have some characteristic of either moderate pain, throbbing or pounding nature to the headache I’m having is worsening by exercise. So, if you exercise during the headache, it gets worse. And then it also has to have a characteristic of either nausea or vomiting, loss of appetite, or sensitivity to light or sensitivity to noise. So, as I'm talking about this, I think probably a lot of people recognize that these are features for adult migraine and they're similarly features for pediatric migraine as well.
Host: Yeah, absolutely. And so, when we're talking about our kiddos and they've got headaches or possibly migraines, when should we take them to the doctor and what sort of doctor, what kind of doctor should we go to?
Dr. Jeng: Well, I think you could start with either a pediatrician or a pediatric neurologist. I'm always happy to see kids with a new onset. If your child's headaches are new, if they're severe or they're increasingly bothersome, I think there's no reason not to see either your pediatrician to start or directly to a pediatric neurologist, either way would be fine.
Okay. And, one of the things I'm sure whether it's the pediatrician or stepping up to a neurologist, one of the things I'm sure that you will do, or they will do for our kids is develop an action plan. So, let's talk about that. What is an action plan and what should we do and how do we help our children who are suffering from headaches?
Because migraines and headaches are very multifactorial, and so there's many steps to take when we're addressing headache. So, I try to break it down for families. I try to break it down into three parts and the first part is lifestyle management. The second part is having a rescue plan for what to do when you have a headache. And then the third part is what preventative treatments can we do to make kids less sensitive to having headaches.
So, I think addressing the first part, lifestyle management. So, the very first thing, I get in the history when I'm talking to the parents and to the child are if there are any triggers that they've identified to their headache. So, for example, common triggers are things like dehydration, poor sleep, warm weather, and stress and anxiety, which, we don't think of kids necessarily having, but they do. They have a lot of school stress and other stressors as well. So, those are some of the triggers and then other triggers can be foods. I talk about processed meats, MSG, caffeine, and unfortunately, sometimes chocolate. So, those are, factors to really get into, because if we can identify triggers to the, to your child's headache, then just eliminating the triggers will help quite a lot. And then the other part of lifestyle management is really talking about hydration. Making sure that they're drinking enough, that their diet is a healthy diet, not skipping meals, not having caffeine, they're getting at least eight to 10 hours of sleep, exercise, ideally, about 120 minutes of aerobic exercise a week, and that their stress level is okay or that they know how to manage that stress. So, lifestyle, management is so important because if we can optimize all of those things, we can really help with headaches and control headaches long-term and I also wanted to emphasize the importance of keeping a daily diary. So, it's a bit onerous, but I think it's really important in trying to hone, to get down into why your child might be having headaches. So, keeping a daily diary means that every time your child has a headache, you note the time and the day, and try and think of any triggers that might be involved. And also maybe the intensity of the headache, and what kind of treatment you use, during that headache.
So, because we can then look over a month's time or two months’ time, that really helps us see the different patterns, possible triggers and also look at progress if things are getting better or things are getting worse. So, that is the homework that I do give families, is to keep a daily headache diary. And there are some different apps, iPhone apps and things like that can make it easier or more fun for kids. Another place that you can look for a customized headache diary is a website called www.Headachereliefguide.com and kids can make their own headache diary off of that as well. So, that's really, the first step is lifestyle management.
Host: Yeah. So, that's the first step. And then the second step or the second part would be the rescue plan. So, what is a rescue plan and what kinds of over-the-counter, OTC medicines or prescribed pills should we give our kids if they're having headaches?
Dr. Jeng: Part two rescue plan is actually what you do when your child comes to you and says, I'm having a headache, or you look at your child and they are hunched over pale and you figure they probably have a headache and so the key with a rescue plan is to give the treatment right away. The over-the-counter medications we often talk about are things like Tylenol, Advil, which are the first line and then other ones including Excedrin and Aleve. Those are other over the counter medications. But I think what parents often try and do is wait to see if the headache gets worse or give just a half dose of the medication, not understanding that the way to stop a headache cycle from perpetuating is to really hit it right away and to hit it hard. Because the longer a headache persists, the more those pain pathways between your brain and your brainstem, all those sort of sensory pain pathways get inflamed. And so it's harder to break the headache with the medication. So, again, we want to hit the, hit right away with a full dose of the over-the-counter medication. And then talking about if those aren't doing the trick, because, over the counter medications are usually first-line. We do have medicines that were devised just for migraine and have been shown to be safe for children as well.
And those are a category called triptans. So, that's T-R-I -P-T-A -N -S and the common ones we use are sumatriptan and rizatriptan. So, those are actually prescription medications, that are designed to work right at the beginning of a migraine to keep it from progressing. And you can use both that and the over-the-counter medications in concert, you can use them together. They work in different ways to try and stop that headache.
Now, the key about rescue medications and I always warn families about this, is that they shouldn't be used more than three days a week. So, if you take, if you take those over-the-counter medicines, or if you take the triptans more than that, you can actually get rebound or medication overuse headaches. So, your body gets used to it, it gets dependent on it. And then, if you get overuse headache, the only treatment is to stop taking that medicine. And because of that, because of not being able to take those medicines more than two or three times a week, that's why we have our third part of the plan, which is the preventative treatments.
Host: Yeah, let's talk about that. I was just going to say, it's good to know that you can take OTC's and triptans together. I didn't know that. So, let's talk about preventative treatments.
Dr. Jeng: So, in general, if you have episodic headaches, which means they're happening less than twice a week in general, you can treat with just medication, rescue medications. But if headaches are happening more than 15 days a month, we actually call those chronic headaches and then you need a preventative treatment because you would be overusing rescue medications otherwise. So, we do have non-medication preventative treatments that are effective and they can work actually as well or better than prevention medications.
So, a lot of our alternative treatments for headache address the triggers such as things like stress or muscle tension. So, for example, physical therapy to stretch and strengthen the neck and shoulders is often very helpful, especially now with the kids having hunched postures from looking on screens all that, all the time and so forth.
Physical therapy can be helpful. Also acupuncture, muscle relaxation therapy and biofeedback. Those all kind of address that type of stress, anxiety type, muscle trigger. In addition to non-medication treatments, there's also, a handful of vitamins and supplements that have been studied and actually been shown to be effective in preventing headaches, both adult and pediatric studies. And so, those include, vitamins and supplements such as magnesium, riboflavin, which is vitamin B2 and then coenzyme Q10. So, all of those have been studied, safe in children and if taken regularly can decrease the number of headaches that they're getting. Those are two categories. We talked about non-medication treatments. We talked about vitamins and supplements.
And then if we're not making headway with those, or if headaches are very severe, we will turn to prescription medications that are preventative medications. So, that means rather than the rescue medications, these are medications that you take every day, regardless of whether you have a headache or not. And they build up in your system over time, they don't cause medication overuse headache, but you take them every day and within about hopefully six weeks to two months, you'll have a reduction in your headaches. And so, those kinds of medications include amitriptyline, topiramate and propranolol. Those are the three most common ones that we use, and those are all prescription medications.
Host: I was just thinking as I was listening to you, if I could possibly talk my daughter into acupuncture, I think, I think that she would think that's really cool, but I'm just not sure. I'll ask her when we're done here. And speaking of my daughter and everyone else's kids, you know, during COVID, our kids have had increased screen time and more stress probably than ever over online school. Are these factors in pediatric headaches? What should we do? Whether it's blue light glasses and more? How do we tackle all this?
Dr. Jeng: Yeah, I think these are certainly factors in worsening our kiddos headaches. The COVID time, the social isolation, the amount of time that you're spending glued to screens, staring at a screen, having less activity; those are all reasons for having increased headaches.
So, as far as things I've been working on with, with patients currently; the increased screen time, in some cases is a necessity because that's how they're learning, but I do advise taking short, vision breaks. So, what I've been told by ophthalmologist to advise my patients to do is every 20 minutes of looking at a screen, to look 20 feet away, look at something 20 feet away for 20 seconds. So that 20, 20, 20 rule is very easy to remember. And that helps your eyes from having to converge, focus on something close all the time to looking at something far away and taking a little break there. Talking about the blue light glasses, those can be helpful.
Also there's blue light screen covers, that you can also purchase to put over the monitor. So, to block out some of that light, and that can be helpful too. And then if those two are not enough, I think it's always important to touch base with the school and see if there are ways that you can limit screen time, such as providing written material, or, learning things, using listening rather than reading. So, I think those are some of the things we can do. I think with this sort of sense of isolation and the stress from that, it's important to think of other ways to have your child connect with others and also it's a good time to learn stress reduction techniques, because this is a very stressful time. And if your children can learn those techniques, they will help them through their whole lives.
Host: Definitely. And of course, today we're speaking specifically about pediatric headaches, but of course, just the stress, the isolation, trying to all stay physically and mentally well, and especially keep our kids physically and mentally well and focused. And Doctor, what is Stanford Children's approach to pediatric headaches? What's unique about the Stanford Children's approach?
Dr. Jeng: Oh, I love being at Stanford Children's being a headache doctor because we have so many resources. It's really multidisciplinary. And so, I work very closely with my colleagues. For example, I do have a colleague who offers Botox injections for chronic headache, and that has been approved in teenagers and can be quite effective.
From the pain side of things, we do have an amazing, Stanford Pediatric Pain Department. And they've got an anesthesiologist, who can do things such as nerve blocks and also, they are trained in acupuncture if needed. And along with seeing the Pain Anesthesiologist, there's always an evaluation by one of their Pain Psychologists who really help to address the psychological aspects of pain.
And in addition to that, we have wonderful physical therapists that have regimens to help with tight muscles and posture. And then we also have occupational therapists that are trained in biofeedback and relaxation therapy. So, I do think under our Stanford roof, we've got all the modalities that can really try and treat headache from many different aspects.
Host: Yeah, it definitely sounds like it. And we hope that this was helpful for everybody because we don't want as adults, to be suffering from headaches and we definitely don't want our kids suffering from headaches. And it does sound, as you say that Stanford Children's has all the modalities to come at this from a variety of different ways, from simple OTC's, to acupuncture and Botox and more. So, it's all great to know. Thank you so much for being on and you stay well.
Dr. Jeng: You too. Thank you.
For more information on Pediatric Headache Services at Stanford Children's Health, visit Stanfordchildren's.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you.
This is Health Talks from Stanford Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.
Managing Pediatric Headaches Do's and Dont's
Scott Webb; (Host): Sometimes dealing with a headache is as easy as taking a few over the counter pain relievers. And sometimes we need to see a specialist. And since none of us wants our kids to suffer, it's good that pediatric neurologists are available to help diagnose and treat headaches in our kids. And joining me today is Dr.
Susie Jeng. She's a Pediatric Neurologist with Stanford Children's Health.
This is Health Talks with Stanford Children's Health. I'm Scott Webb. So, Dr. Jeng, thanks so much for joining me today. We're talking about pediatric headaches, do's and don'ts. So, how do I know if my child's headache is ordinary or dangerous? And then how do I know further if it's a migraine?
Dr. Jeng: So, in general, I tend to think of headaches as what we call primary headaches. So, those would-be headaches like migraine type headaches or tension headaches. Those kinds of headaches are not dangerous, but they can be debilitating if it causes your child to miss activities or school. So, those are primary headaches and then secondary headaches are the ones that are caused by other things.
So, some of the red flag symptoms would be things like fever, having headaches that are worse at night, or waking you up from sleep, vomiting or progressive vomiting, vision changes, balance problems, or other neurologic symptoms like weakness or numbness. Any of those kinds of red flags symptoms with a headache would be concerning for a secondary headache and a dangerous headache. Okay? But if we're talking about migraines, which is the most common type of primary headache for kid s, actually 11% of kids ages five to 15 have migraines and up to a third of teenagers will have migraine as well. So, it's actually one of the top five childhood health problems. So, really common. And the thing about migraines is there's actually no blood test or brain scan or anything to diagnose them, because people with migraines are normal, they have normal brains. And so, we can't do that kind of testing. The way you diagnose a migraine is actually, by the type of symptoms they have.
So, it can get a little technical, but in general, the way we diagnose childhood migraines are that they have to have had at least five headaches that have been similar in nature. The pain has to be at least 30 minutes, at a time. If it's less than that, then it doesn't quite qualify for what we call a migraine. And then the headache has to have some characteristic of either moderate pain, throbbing or pounding nature to the headache I’m having is worsening by exercise. So, if you exercise during the headache, it gets worse. And then it also has to have a characteristic of either nausea or vomiting, loss of appetite, or sensitivity to light or sensitivity to noise. So, as I'm talking about this, I think probably a lot of people recognize that these are features for adult migraine and they're similarly features for pediatric migraine as well.
Host: Yeah, absolutely. And so, when we're talking about our kiddos and they've got headaches or possibly migraines, when should we take them to the doctor and what sort of doctor, what kind of doctor should we go to?
Dr. Jeng: Well, I think you could start with either a pediatrician or a pediatric neurologist. I'm always happy to see kids with a new onset. If your child's headaches are new, if they're severe or they're increasingly bothersome, I think there's no reason not to see either your pediatrician to start or directly to a pediatric neurologist, either way would be fine.
Okay. And, one of the things I'm sure whether it's the pediatrician or stepping up to a neurologist, one of the things I'm sure that you will do, or they will do for our kids is develop an action plan. So, let's talk about that. What is an action plan and what should we do and how do we help our children who are suffering from headaches?
Because migraines and headaches are very multifactorial, and so there's many steps to take when we're addressing headache. So, I try to break it down for families. I try to break it down into three parts and the first part is lifestyle management. The second part is having a rescue plan for what to do when you have a headache. And then the third part is what preventative treatments can we do to make kids less sensitive to having headaches.
So, I think addressing the first part, lifestyle management. So, the very first thing, I get in the history when I'm talking to the parents and to the child are if there are any triggers that they've identified to their headache. So, for example, common triggers are things like dehydration, poor sleep, warm weather, and stress and anxiety, which, we don't think of kids necessarily having, but they do. They have a lot of school stress and other stressors as well. So, those are some of the triggers and then other triggers can be foods. I talk about processed meats, MSG, caffeine, and unfortunately, sometimes chocolate. So, those are, factors to really get into, because if we can identify triggers to the, to your child's headache, then just eliminating the triggers will help quite a lot. And then the other part of lifestyle management is really talking about hydration. Making sure that they're drinking enough, that their diet is a healthy diet, not skipping meals, not having caffeine, they're getting at least eight to 10 hours of sleep, exercise, ideally, about 120 minutes of aerobic exercise a week, and that their stress level is okay or that they know how to manage that stress. So, lifestyle, management is so important because if we can optimize all of those things, we can really help with headaches and control headaches long-term and I also wanted to emphasize the importance of keeping a daily diary. So, it's a bit onerous, but I think it's really important in trying to hone, to get down into why your child might be having headaches. So, keeping a daily diary means that every time your child has a headache, you note the time and the day, and try and think of any triggers that might be involved. And also maybe the intensity of the headache, and what kind of treatment you use, during that headache.
So, because we can then look over a month's time or two months’ time, that really helps us see the different patterns, possible triggers and also look at progress if things are getting better or things are getting worse. So, that is the homework that I do give families, is to keep a daily headache diary. And there are some different apps, iPhone apps and things like that can make it easier or more fun for kids. Another place that you can look for a customized headache diary is a website called www.Headachereliefguide.com and kids can make their own headache diary off of that as well. So, that's really, the first step is lifestyle management.
Host: Yeah. So, that's the first step. And then the second step or the second part would be the rescue plan. So, what is a rescue plan and what kinds of over-the-counter, OTC medicines or prescribed pills should we give our kids if they're having headaches?
Dr. Jeng: Part two rescue plan is actually what you do when your child comes to you and says, I'm having a headache, or you look at your child and they are hunched over pale and you figure they probably have a headache and so the key with a rescue plan is to give the treatment right away. The over-the-counter medications we often talk about are things like Tylenol, Advil, which are the first line and then other ones including Excedrin and Aleve. Those are other over the counter medications. But I think what parents often try and do is wait to see if the headache gets worse or give just a half dose of the medication, not understanding that the way to stop a headache cycle from perpetuating is to really hit it right away and to hit it hard. Because the longer a headache persists, the more those pain pathways between your brain and your brainstem, all those sort of sensory pain pathways get inflamed. And so it's harder to break the headache with the medication. So, again, we want to hit the, hit right away with a full dose of the over-the-counter medication. And then talking about if those aren't doing the trick, because, over the counter medications are usually first-line. We do have medicines that were devised just for migraine and have been shown to be safe for children as well.
And those are a category called triptans. So, that's T-R-I -P-T-A -N -S and the common ones we use are sumatriptan and rizatriptan. So, those are actually prescription medications, that are designed to work right at the beginning of a migraine to keep it from progressing. And you can use both that and the over-the-counter medications in concert, you can use them together. They work in different ways to try and stop that headache.
Now, the key about rescue medications and I always warn families about this, is that they shouldn't be used more than three days a week. So, if you take, if you take those over-the-counter medicines, or if you take the triptans more than that, you can actually get rebound or medication overuse headaches. So, your body gets used to it, it gets dependent on it. And then, if you get overuse headache, the only treatment is to stop taking that medicine. And because of that, because of not being able to take those medicines more than two or three times a week, that's why we have our third part of the plan, which is the preventative treatments.
Host: Yeah, let's talk about that. I was just going to say, it's good to know that you can take OTC's and triptans together. I didn't know that. So, let's talk about preventative treatments.
Dr. Jeng: So, in general, if you have episodic headaches, which means they're happening less than twice a week in general, you can treat with just medication, rescue medications. But if headaches are happening more than 15 days a month, we actually call those chronic headaches and then you need a preventative treatment because you would be overusing rescue medications otherwise. So, we do have non-medication preventative treatments that are effective and they can work actually as well or better than prevention medications.
So, a lot of our alternative treatments for headache address the triggers such as things like stress or muscle tension. So, for example, physical therapy to stretch and strengthen the neck and shoulders is often very helpful, especially now with the kids having hunched postures from looking on screens all that, all the time and so forth.
Physical therapy can be helpful. Also acupuncture, muscle relaxation therapy and biofeedback. Those all kind of address that type of stress, anxiety type, muscle trigger. In addition to non-medication treatments, there's also, a handful of vitamins and supplements that have been studied and actually been shown to be effective in preventing headaches, both adult and pediatric studies. And so, those include, vitamins and supplements such as magnesium, riboflavin, which is vitamin B2 and then coenzyme Q10. So, all of those have been studied, safe in children and if taken regularly can decrease the number of headaches that they're getting. Those are two categories. We talked about non-medication treatments. We talked about vitamins and supplements.
And then if we're not making headway with those, or if headaches are very severe, we will turn to prescription medications that are preventative medications. So, that means rather than the rescue medications, these are medications that you take every day, regardless of whether you have a headache or not. And they build up in your system over time, they don't cause medication overuse headache, but you take them every day and within about hopefully six weeks to two months, you'll have a reduction in your headaches. And so, those kinds of medications include amitriptyline, topiramate and propranolol. Those are the three most common ones that we use, and those are all prescription medications.
Host: I was just thinking as I was listening to you, if I could possibly talk my daughter into acupuncture, I think, I think that she would think that's really cool, but I'm just not sure. I'll ask her when we're done here. And speaking of my daughter and everyone else's kids, you know, during COVID, our kids have had increased screen time and more stress probably than ever over online school. Are these factors in pediatric headaches? What should we do? Whether it's blue light glasses and more? How do we tackle all this?
Dr. Jeng: Yeah, I think these are certainly factors in worsening our kiddos headaches. The COVID time, the social isolation, the amount of time that you're spending glued to screens, staring at a screen, having less activity; those are all reasons for having increased headaches.
So, as far as things I've been working on with, with patients currently; the increased screen time, in some cases is a necessity because that's how they're learning, but I do advise taking short, vision breaks. So, what I've been told by ophthalmologist to advise my patients to do is every 20 minutes of looking at a screen, to look 20 feet away, look at something 20 feet away for 20 seconds. So that 20, 20, 20 rule is very easy to remember. And that helps your eyes from having to converge, focus on something close all the time to looking at something far away and taking a little break there. Talking about the blue light glasses, those can be helpful.
Also there's blue light screen covers, that you can also purchase to put over the monitor. So, to block out some of that light, and that can be helpful too. And then if those two are not enough, I think it's always important to touch base with the school and see if there are ways that you can limit screen time, such as providing written material, or, learning things, using listening rather than reading. So, I think those are some of the things we can do. I think with this sort of sense of isolation and the stress from that, it's important to think of other ways to have your child connect with others and also it's a good time to learn stress reduction techniques, because this is a very stressful time. And if your children can learn those techniques, they will help them through their whole lives.
Host: Definitely. And of course, today we're speaking specifically about pediatric headaches, but of course, just the stress, the isolation, trying to all stay physically and mentally well, and especially keep our kids physically and mentally well and focused. And Doctor, what is Stanford Children's approach to pediatric headaches? What's unique about the Stanford Children's approach?
Dr. Jeng: Oh, I love being at Stanford Children's being a headache doctor because we have so many resources. It's really multidisciplinary. And so, I work very closely with my colleagues. For example, I do have a colleague who offers Botox injections for chronic headache, and that has been approved in teenagers and can be quite effective.
From the pain side of things, we do have an amazing, Stanford Pediatric Pain Department. And they've got an anesthesiologist, who can do things such as nerve blocks and also, they are trained in acupuncture if needed. And along with seeing the Pain Anesthesiologist, there's always an evaluation by one of their Pain Psychologists who really help to address the psychological aspects of pain.
And in addition to that, we have wonderful physical therapists that have regimens to help with tight muscles and posture. And then we also have occupational therapists that are trained in biofeedback and relaxation therapy. So, I do think under our Stanford roof, we've got all the modalities that can really try and treat headache from many different aspects.
Host: Yeah, it definitely sounds like it. And we hope that this was helpful for everybody because we don't want as adults, to be suffering from headaches and we definitely don't want our kids suffering from headaches. And it does sound, as you say that Stanford Children's has all the modalities to come at this from a variety of different ways, from simple OTC's, to acupuncture and Botox and more. So, it's all great to know. Thank you so much for being on and you stay well.
Dr. Jeng: You too. Thank you.
For more information on Pediatric Headache Services at Stanford Children's Health, visit Stanfordchildren's.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you.
This is Health Talks from Stanford Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.