Pediatric Migraines

Pediatric Migraines

Migraine headaches often start before adolescence. It’s estimated that 11% of children between the ages of 7 and 15 experience recurring headaches, and contrary to popular belief, the majority of children with severe migraine are still suffering more than twenty years later. A significant number of these children come from families in which other members have had the disease for decades, relying on a poupouri of antihypertensives, antihistamine, antiseizure or abortive medications with varying success.

Historically, treatment for pediatric migraine has leaned heavily on medications, such as analgesics and antiemetics. Preventative medications can include antidepressants such as amitriptyline, anti-seizure medications such as dilatin, and beta blockers such as propranolol. It’s only recently, however, that any of the abortive medications used to treat adults have become accepted for pediatric migraines, as many children have experienced benefits after bravely taking them off-label.

Unfortunately, for severe pediatric migraines, this treatment can mean a decades-long regimen of multiple medications. Many of these drugs have not been studied for long term side-effects, a great risk to the developing child taking them for possibly 30+ years. What’s more, even with medication, the consequences of long-term pediatric migraine are far-reaching, as the disease interrupts the development of social, scholastic and physical wellness. This can lead to a withdrawn adolescent, unable to participate in sports or other after school activities. As with nearly all migraine sufferers, isolation ensues as the family support system habituates to hearing about the continual invisible suffering that saps family time and understanding.

However, over the last 15 years, the growing field of migraine surgery has reliably demonstrated a 33-51% complete resolution of headaches one year after the procedure, with over 90% of moderate to severe migraine patients showing improvement. The surgery also proves to have few long-term side effects (apart from those implied from a general anesthetic as an outpatient). The effects appear to be maintained in five-year follow up studies. The surgery is shown to dramatically decrease the cost of care for this disease whose numbers exceed that of diabetes and asthma combined.

 

Migraine Surgery consists of one to four procedures that deactivate migraine trigger sites (sensory nerve decompressions in three potential sites on the head, and nasal airway surgery in the fourth site). On average, patients require three sites to be treated. The majority of migraine surgery patients receive Botox injection testing before the surgery, as well as pre-operative CT scan evaluation of the paranasal anatomy.

After surgery, most patients are able to eliminate or greatly reduce their dependence on their abortive and preventative medications. This is a tremendous benefit to children and adolescents, who would otherwise depend on these medications for many years, with frequent, sometimes unpredictable side effects. In fact, under-treatment of pediatric migraines stands to have the profound consequences, since a “normal” childhood is simply unattainable in the face of chronic pain.

Over the last 15 years, Dr David Branch has successfully performed 32 pediatric migraine trigger deactivations (ages 11 to 19) at Northeastern Migraine, with an average follow-up time of 31 months. These patients were under the care of a neurologist before surgery, and had shown no improvements with outpatient or inpatient medical therapy at well-known headache centers. All of these patients had a favorable response to Botox testing and/or significant findings on CT scan indicating rhinogenic migraine.

Few surgeons in the world have any experience treating pediatric migraine. Dr. Branch is comfortable treating children, and feels that this population stands to gain the most from this new treatment option. Find out if your child is a candidate for migraine surgery! Set up your 30-minute consultation by filling out the form on this page.