With 28% of adolescents between 15-19 years suffering with migraines, there is a risk of them missing out on school, sports, work, or other important activities to recover. Equally as disruptive, drug-based migraine treatments can raise concerns due to unwanted side effects, overuse of medication, inconsistent relief, or general drug aversion.
Dr. Alex Feoktistov, MD and PhD, and Director of the Synergy Integrative Headache Center, is available to discuss the common symptoms of teen migraines, the importance of a holistic approach to treatment plans, and the effective non-pharmacological treatments that can be safely used throughout the school day.
“For children and teens, you don’t want to use heavy duty medication unless you have tried a holistic approach first. There is plenty of growing evidence showing that non-drug treatments applied and integrated into a patient’s lifestyle can help reduce headache frequency and headache severity while improving overall quality of life,” says Dr. Alex.
I had a chance to interview Dr. Feoktistov to learn more.
What are some common symptoms of migraines in teens – and does it differ from migraine symptoms for adults?
First of all I would like to mention that migraine is a very common headache disorder (affecting 13% of the US population) and typically starts in childhood. It tends to occur in boys at a younger age than in girls. What is interesting is that migraine symptoms change with age. For example, in childhood migraine can present as abdominal pain, that may last for a few hours or even days and resolve. In most cases the diagnostic GI workup is unrevealing. This is a so-called abdominal migraine. Gradually, usually over the years, the abdominal symptoms improve and "transform" into a more typical migraine presentation where the actual head pain prevails. In children and teenagers, migraine frequently presents as frontal pain that affects both sides of the forehead at the same time (as opposed to unilateral headache more commonly seen in adults). Headache may frequently be described as a severe ache or pressure-like pain as opposed to usually throbbing pain in adults. Just like adult patients, teenagers may experience photophobia and nausea (and occasionally even vomiting) during, especially severe headaches attacks. The headache usually lasts for few hours, but may last as long as a couple of days, especially if untreated or unsuccessfully treated. It certainly can be quite disabling, impacting both academic and athletic performance. Therefore, it is critical to recognize these symptoms early and develop an effective treatment strategy.
What are the benefits of using a holistic approach to migraine treatment?
There are a number of effective treatment options available, including pharmacological and non-pharmacological choices. I usually recommend starting treatment with a more natural, holistic approach. It is important to understand what is causing or starting migraine attacks. In many cases, we are able to identify a number of triggers that bring on migraine. Therefore, avoiding some of the triggers may help reduce overall migraine frequency without any medications. In younger patients, at the beginning of their migraine history, it is critical to establish a migraine-specific treatment approach and use effective treatment options. At this point, there are multiple preventative and acute treatment choices available for teenagers with migraine. Some may involve prophylactic medications (they may help reduce migraine frequency) and acute or rescue medications (that may help stop an ongoing migraine attack). These options can be very effective yet may cause certain side effects such as fatigue and drowsiness, weight gain or weight loss, constipation or chest tightness. We also need to consider presence of certain migraine-associated symptoms such as nausea and vomiting (may occur in up to 60-70% of patients) which may make taking medications by oral route challenging or simply ineffective. For these patients we may offer proven safe and effective non-oral options such as non-invasive neuromodulation devices approved for use in adolescents and adults. For example FDA cleared non-invasive vagus nerve stimulation (gammaCore) or remote electrical neuromodulation devices (Nerivio). These are effective, well tolerated, drug-free and migraine specific treatment options.
What are some school-friendly options that teens have for controlling and treating migraines?
First of all we need to consider options that would be well tolerated, that would work fast and help our adolescent patients to return back to their activities as fast as possible. We may consider adding one of the medications from the triptans family (such as rizatriptan, zolmitriptan, eletriptan or sumatriptan). If non-steroidal anti-inflammatory options (such as ibuprofen, naproxen, etc) are effective we certainly can utilize them. As mentioned above, we may consider non-invasive vagus nerve stimulation (gammaCore) or remote electrical neuromodulation devices (Nerivio) which had demonstrated good efficacy and low side effect profile. Both of these devices are quite small and portable and can be easily used at school. No matter which option we choose, it is important for patients to recognize migraine symptoms early and initiate therapy as soon as possible to achieve best results. For that purpose, we prepare a letter or a school note allowing patients to carry their abortive treatments with them to school. Patients may also benefit from resting in a comfortable environment, free from bright light and loud noises and while applying these treatments and allowing enough time for them to work. It is also important to keep in mind that maintaining regular meals and adequate hydration during the school day is very important.