Transcription:
At-Home Treatment Options for Children With Headaches

Introduction: Another informational resource from UK Healthcare. This is UK HealthCast. Featuring conversations with our physicians and other healthcare providers. Here's Melanie Cole.

Melanie Cole: Nearly everyone has had a headache at one time or another, but how do we know what to do about them? And sometimes they cause us unnecessary worry. Welcome to UK HealthCast with the University of Kentucky Healthcare, I'm Melanie Cole. And today we're talking about at-home treatment options for children with headaches. Joining me is Dr. Sharoon Qaiser. He's the Director of the Children and Young Adult Headache and Research Program at UK Healthcare. Dr. Qaiser, I'm so glad to have you on with us today. We've done a previous podcast on the program at UK Healthcare, and now we'd like for you to give parents listening some really great advice about how best to treat headaches in our children. So before we get into that, do we even know what headaches are?

Dr. Qaiser: Thank you so much for letting me talk again. I love these sessions and my philosophy is to teach. So thank you. So first question, do we even know what headaches are? It's very difficult to describe something that's so subjective in any objective way. So what headaches are, anything that bothers us and has something to do with our head? That's how I say headache, but really, I mean, in most of the children, much younger children, which I see headaches have some non headache competent to that as well. Whether it's a tummy pain or it's loss of appetite, or it's just being light sensitive, or now with the online learning kids can't focus on a screen. So to me, that's all headaches. So headache is more than the pain, which is inside head. So that's how I look at headache.

Host: That was an excellent analogy and explanation. So how do we, if it's so subjective and we're just having our children tell us how bad their headache is, how do we diagnose it? Whether it's, you know, a tooth ache and as you mentioned, there's computer screens, our kids are staring at their phones or their online school. How do we know what's causing it? Do we care what's causing it? And then we're going to talk about what to do about it.

Dr. Qaiser: Yeah. During the last talk, I touched on the basis of genetics, of headaches, that it has a very strong genetic component. So really we don't know what causes it, but there are internal and environmental factors being up late, messing up the bedtime routines, not drinking enough water, too much caffeine and you have headache then because of the light sensitivity to the headache, which makes headache worse. During that time, screen exposures and screen exposures messing the time you go to bed and then blue light coming from the screen. So there are like so many things that can trigger. A few people think that a change in temperature and pressure are very common triggers for them. So thunder storms, lightning, all these things can trigger headaches. So it's very different for individual patients. Everyone has their own triggers, but the common one are which we just discussed.

Host: Well, that's a great point. And that people who do get many headaches tend to know what sets them off, or they feel them coming on. And they know those triggers. If we've got kids and teens specifically to doctor, because they seem to get a lot of headaches, what do we do about it? We look at Motrin, there's Tylenol, there's ice packs. There's so many home treatments. What do you recommend as a headache expert that we do for our kids?

Dr. Qaiser: Yeah. This is a great question. So a wise man once said, hit it early, hit it hard. So that's our mantra of what to do when we have a headache. So, or what we call acute headache plan. So I interviewed many of my patients and I found out they were common pitfall or barriers. And the most common one was that we were not hitting early on. So thinking about like a wildfire, if it's easy to control it when it's a little bit and after that nothing works. So the most important thing in treating headache is to catching it early on in its course, because generally, I mean, young kids, they don't tell anyone if their head hurts until to the point that they just can't function. And most of the time when they're telling us that their head hurts, we're already way behind in the ballgame. So educating our patients, even young ones, four or five-year-old age, educating them that to let someone know at the beginning of their headache is the most important step in treating acute headaches.

The next thing is picking the right medicine. So the nature of these headaches is what we call inflammatory headaches, which means we need medicines that act at reducing inflammation. So all type of NSAID, which is just a fancy name for Motrin or ibuprofen or Aleve or Naproxen, or based on how old you are, asperin and diclofenac, and some other NSAIDs as well, which means one of the most common medicine used in kids per headache may not be the ideal medicine for headache, which is Tylenol. Tylenol is a very good fever medicine. It's a very good pain medicine, but when it comes to headaches, especially the primary headaches, then NSAID work better. They have a sustained response. And when we really dose adjust them, they may have actually less side effects. So first thing is hit it early, second thing is hit it with the right medicine. So ibuprofen, Naproxen, whichever you're comfortable, whichever you have in the home.

And the third thing is the right dose. So that's the mantra of hit it hard part. The problem is most of my patients when they come in and cleaning come and ask them that why their treatment plan is not working. And almost every time I see that everyone is under-dosing. And why is that? So over the counter medicines, most of the time, they come with some kind of a dosing suggestion on the label or a back of a bottle, and problem is kids. All the medicines are weight-based. So when we go by age range, we are actually not dosing them correctly. And as a matter of fact, we are under-dosing them. So under-dosing has two problems. A, under-dosing leads to ineffective or less effective medication effect. But the second problem is we still get a lot of other side effects, which are not dose dependent. And if you're, under-dosing more likely you are using medicine more frequently, and that increased the risk of medicine, overuse headache as well. So hit it early, hit it hard, and hit it with the right medicine.

So, these are the three basic principles. The next thing is, as I mentioned, that inflammation is an important part of headaches, which means we have to use something that helps with cooling down the inflammation and replenish the [inaudible06:55], which we are losing during the inflammation process. And something as simple as a sports drink can help. So always I tell my patients, whenever you're taking your medicine and you have to take your sports drinks. So based on age or weight, somewhere between like 12 ounces to 36 ounces of a sports drink of their choice, and truly it is medicine. So we consider as a part of a treatment plan and the most of our adolescents are perpetually dehydrated anyway. So it helps them to get those salts and then that required hydration. The other thing is whenever we take medicine, we need to get a very clear objective plan, how often we can take it and how often we can repeat it. So I always tell my patients, whenever you take the medicine, if the headache doesn't go away in four hours repeated once and that's for maximum allowance.

The reason is all of these mechanisms that cause the headache, they change over time, over like four or six hours, which means there may not be a lot role of oral medicines. Once you are past four or five hour bracket, which means your best chances of dressing your headache is within the first four hours. So that's why repeating your medicine within the first four hours. If you're not back to your previous state, is your best chance. And that's maximum, after that the home therapies may or may not help much. And then I always give them the objective dosing that how many treatments you can treat in a week. So up to two to three times a week is the maximum treatments they can take with acute medicine because anyone who's requiring that much acute medicine, they need to be on what we call daily preventive plan in which you take something every day in hopes that you have less frequent headaches. So hit it early. If four hours you're still in headache or headache doesn't go away, hit it again with the same plan. And that's your maximum for that day. And you're allowed to treat up to three headaches a week.

Host: Wow, Dr. Qaiser, that was outstanding. And I don't know about the listeners, but I did not know that headaches were an inflammatory situation. And so thank you for pointing that out. And under-dosing is something that probably so many of us didn't realize that we were doing before we wrap up relaxation techniques, dark rooms. Do any of these kinds of things, even meditation or exercise, are there some lifestyles that you can recommend that might help us? If we are seeing that our teens or our younger children are suffering headaches or more headaches than we think, or even just one occasionally, is there anything we can do lifestyle wise to help stave these off?

Dr. Qaiser: Absolutely. Absolutely. So lifestyle changes or healthy lifestyle has the most evidence when it comes to prevention. So number one thing is the hydration. I always give my patient hydration goals. Two reasons, A, it helps with headache and B, only 14, one, four, 14% of our adolescents actually meet the hydration goals. So we have to give them objective numbers. So based on age or weight, I give them somewhere between 60 to 80 ounces a day and ask them to bring their water bottle. The next time they come for a follow-up. And so far everyone brings it. So that's first thing hydration. The second thing is the exercise part. There are few studies that suggest that those who have different chronic painful conditions, they may be low in endorphins, which are like our natural painkillers. So our recommendation is 40 minutes each three times a week. Any activity that counts toward exercise, like it makes you breathe fast and make you sweaty. Even jumping jacks, running around everything counts.

So, 40 minutes each, three times a week helps you to have increased sustain amount of your endorphins. And that really helps. And then the third thing is the sleeping part. It's just not the amount of sleep. It's the quality of sleep. And then whether you have different schedules over the weekend, so we always recommend don't lose what you gained over the weekdays. So have at least eight to 10 hours of sleep and try to have the same schedules over the weekend as well. And then we help many of our patients with better sleep hygiene. And the last thing is the eating part, dark green vegetables have some evidence that it helps to reduce headaches, animal product, because they have coenzyme Q10 has some evidence that it reduced headaches, especially in adolescents and then dairy products. It has Vitamin D3. There was some evidence that it helps reduce headaches. So a balanced, healthy diet with dark green, with some animal products, with dairy products, all these things that they contribute. And at the time in decreasing the frequency of headache. And if we don't address this part medicines may or may not work.

Host: Thank you so much Dr. Qaiser for joining us again, what an excellent guest you are. Thank you so much for sharing your incredible expertise with something that's so many of us see in our children and ourselves for that matter. So thank you so much. And to learn more about our pediatric headache program, please visit the website@ukhealthcare.uky.edu. That concludes another episode of UK HealthCast with the University of Kentucky Healthcare. Please remember to subscribe, rate, and review this podcast and all the other University of Kentucky Healthcare podcasts and share this show with your family and friends. I'm sure you know, people whose kids get headaches. And we learned so much in this episode and we're learning from the experts at the University of Kentucky Healthcare. I'm Melanie Cole.