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Chapter 1: What You Can Do to Help Children Get Relief
Headaches: Why Everyone Needs to Learn More About Them
With painstaking attention to detail, Jonathan carefully places his miniature toy soldiers one by one on the floor of his bedroom. Almost as if afraid the slightest movement or even the gentle force of his breath may knock them down, he sits rigidly still with only his eyes following his tiny hand as it picks up each soldier from the toy box and places it in line. His eyes move back and forth from the box to the floor without stopping until all the soldiers have been arranged. When he is finished, he has created a triangle of twenty-one soldiers standing in six precise rows: six soldiers in the back row, five in the next, four, three, two, and one in the front row. Remarkably, each soldier and each row are one inch apart, as if following to the exact tolerances of an architect's blueprint. He is young to be exhibiting the migraine sufferer's compulsive neatness.
As he worked, four-and-a-half-year-old Jonathan has become less and less responsive to anything in his external environment. He doesn't move or say a word when the clock in the family room begins chiming, a sound that would normally alert him to the hour of his favorite television program. He remains motionless when his sister, Jessica, calls him repeatedly, in louder and louder tones, to come out and watch the show. He does not react to his father's presence at the door to his room or when he enters and tells Jonathan that his friend Daniel has come by to watch TV.
By this point, little Jonathan has grown very pale and tears have begun to well up in his eyes. He rises slowly from the floor and lies down on his bed, clutching his head with one hand and his stomach with the other. Seconds later, as his father kneels by his bedside to stroke his hair, Jonathan throws up in a basin his father has pulled out from under the bed. Just at that moment, Daniel walks into the bedroom.
Jonathan's father quickly covers his son with a blanket, kisses his forehead, shuts off the light, and whisks Daniel and the basin out of his son's room, shutting the door behind him. He informs Daniel that Jonathan is having another one of his "headache attacks" and needs to "sleep it off." He apologizes for his son's condition, and tells Daniel to come back another day when Jonathan is feeling better.
Daniel leaves feeling rejected. After cleaning the basin, Jonathan's father is concerned as he joins his daughter in the family room, sighing and shaking his head as he sits down to watch TV. Seven-year-old Jessica complains to her father about Jonathan's being sick again and her having to do his chores as well as her own. In short, Jonathan is ill, his friend is hurt, his father is worried, and his sister is annoyed.
Jonathan suffers from his headaches, but so do many of the people around him. He is hurting in ways that he may not yet have the vocabulary to describe adequately. Without proper explanation or understanding of his headache, the others in his life are suffering as well, and they may not be able to express what they are feeling any better than Jonathan can.
Education is a powerful tool in the fight against headache disorders. The more knowledge we can acquire, the greater capacity we will have to understand and help those affected. We will return to Jonathan's story in chapter 2 for a discussion of his particular headache disorder and the role of education in his successful treatment.
Attitudes About Headaches
From the beginning of civilization, various social, cultural, and family attitudes have developed regarding the appropriate way to act when in pain. Many of us have learned that we have to be brave in the face of pain -- "take it like a man" and not talk about it. As a result, we have seen many adults who have suffered in silence for years before seeking medical attention for their headaches. Some of these patients have been told by friends, family members, or even doctors that their headaches are "no big deal" or that they "just have to learn to live with them." Others have been told, "It's just a headache. Get over it!" Patients tend to internalize these harmful messages and, in turn, develop the fear that if they speak about their pain, they will appear weak or fragile. Many have waited to get help until the headache pain is so bad that it has affected every part of their lives. Sadly, others never get help at all.
Because of the attitudes that many adults hold about pain, and specifically about headaches, children's headaches may be ignored by their families -- and sometimes even their doctors -- as passing phases of childhood or attention-getting behavior. Too often misdiagnosed, their headache disorders are undertreated, incorrectly treated, or not treated at all. These children suffer needlessly. As we have seen in Jonathan's case, everyone suffers -- not just the child.
An adult who suffers from chronic pain probably finds that it interferes with normal activities, such as socializing, working, eating, sleeping, and having sex. When life is so restricted, the sufferer often also feels anxious and depressed.
Chronic pain in children could have far-reaching effects on their personality and skill development. Young children may cry, rock, or hide when they experience pain. As they get older, they may experience anxiety and depression, as well as have difficulties eating, sleeping, and playing. They may have trouble focusing their attention on learning at home or in school, and this may result in behavior problems.
Headache is a widespread problem not to be taken lightly whether in adults or in children. Reports have estimated 68 percent of patients seen by neurologists complain of headache. As previously mentioned, according to the latest conservative estimates, at least forty-five million Americans experience some form of headache on a recurrent basis. Just as severe and/or frequent headaches in adults can often be disabling -- interfering with family, social, and work activities and relationships -- headaches in children can similarly affect a child's family and social interactions, and his or her capacity for attendance and performance in school.
The following table illustrates the results of a 1997 to 1999 survey of three hundred children with headache being treated at the Cleveland Clinic by Dr. David Rothner. The large proportion of children experiencing migraine headaches is typical of what is seen in private practice.
The good news is that most headache patients -- adults and children -- can be helped if we do the following three things:
Adopting Healthy Attitudes About Pain
Before we can expect to find ways to manage pain, we need to acknowledge that it exists. We must recognize that pain is part of the human experience and, like any other human experience, is accompanied by an array of emotions. Both the sufferer and the observer will have feelings about the pain and how it has affected their daily lives. These feelings -- such as fear, anger, sadness, frustration, guilt, and resentment -- need to be expressed in order for healing to occur.
While we encourage discussions among patients, family members, friends, teachers, and so on, it is important for everyone to remember that descriptions and feelings about pain are difficult even for adults to express.
Since most adults seek approval from those around them, negative comments from others may prevent them fro