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Conditions & Treatments

We treat a wide range of headaches and headache symptoms at Arkansas Children’s from common tension headaches to more serious headaches related to brain tumors. Our providers are experts in diagnosing and treating many types of headaches.

Migraine With and Without Aura

Migraines are headaches that cause pulsing and throbbing head pain that lasts for hours or days. Migraines also come with other symptoms, which can include:

  • Sensitivity to light and sound
  • Nausea and vomiting
  • Worsening pain with physical activity

Some patients get a visual, auditory, sensory or speech warning signs that a migraine is about to happen. This is referred to as aura. Auras can last for several minutes up to an hour. Their symptoms include:

  • Visual aura can occur in one of both eyes as an area of brightness or blindness that expands into flashes of light, zigzags, stars of shapes.
  • Auditory aura includes hearing sounds that are not there or a buzzing in the ears.
  • Sensory aura includes a burning sensation, numbness or a pins-and-needles feeling.
  • Speech and language aura happens when a patient cannot recall words, cannot understand language and has problems reading and writing.

Treatments for a migraine include medicines to reduce pain and prevent nausea, medicine to prevent migraines from happening and stress management techniques.

Hemiplegic Migraine

Complicated migraine refers to migraines that cannot be specifically diagnosed. The term also refers to a severe and rare form of the headache called hemiplegic migraine. The symptoms of hemiplegic migraines mimic a stroke and can be serious. Symptoms include:

  • Visual, auditory, sensory or speech auras
  • Throbbing pain on one side of the head
  • Tingling feeling in the hand and up the arm
  • Numbness on one side of the body
  • Weakness or paralysis on one side of the body
  • Loss of balance
  • Dizziness
  • Nausea or vomiting
  • Loss of consciousness or coma

Treatments include the use of anticonvulsant medicines to prevent the headaches and reduce pain and the use of calcium channel blocker heart medicines to relax and widen blood vessels.

Chronic Daily Headache

Chronic daily headache occurs when a child experiences headaches that last 4 or more hours a day every day or nearly every day. The child has at least 15 headaches days a month with no underlying medical condition. Daily headaches can come in different forms, including:

  • Transformed migraine
  • New daily persistent headaches
  • Hemicrania continua

Treatments include education about migraines and how to properly use pain medicine. Too much pain medicine can trigger headaches. Daily preventive medicines also may be prescribed.

Episodic Headache

Episodic headaches are tension headaches that happen less than 15 days a month, or migraine headaches that occur less than 15 days a month. It is important to treat episodic headaches. If left untreated, episodic migraines can become chronic. Treatments include pain medicines and medicines to prevent the headaches and stop them when they start.

Migraine Variant

  • Benign paroxysmal vertigo of childhood
  • Paroxysmal torticollis
  • Cyclical vomiting of childhood are syndromes thought to be migraine related

Headache Related to Chiari 1 Malformation

Headaches are the most common symptom of patients with Chiari 1 malformation (link to Neurophysiology page) and they often mimic migraines. A Chiari 1 malformation happens when the lower part of the brain, called the cerebellum, pushes through into an opening for the spinal cord. The crowding in this space can cause spinal fluid to back up, which can create pressure and headache pain.

Many patients with Chiari 1 malformations have no symptoms and often are diagnosed by coincidence, such as when a provider orders imaging tests to diagnose migraines. Treatments

might include surgery by a neurosurgeon to repair the malformation and medicines to relieve headache symptoms.

Persistent Post-Traumatic Headache

Many patients who experience a traumatic head or brain injury have persistent headaches after their injury, often for many months. These post-traumatic headaches can happen after mild, moderate and severe injuries and most closely resemble migraines. Treatments include:

  • Medicines for pain
  • Preventive medicines such as antidepressants, blood pressure pills and anti-seizure medicines
  • Physical therapy
  • Biofeedback
  • Botulinum toxin (as known as Botox) injections
  • Cognitive behavioral therapy

Headache Related to Idiopathic Intracranial Pressure

Also called pseudotumor cerebri or “false brain tumor” this condition involves the spaces around the brain and spinal cord. These areas are filled with cerebrospinal fluid to cushion and nourish the brain and spinal cord. Sometimes the pressure in these spaces increases. Idiopathic intracranial hypertension refers to a pressure increase with no known cause.

Intracranial hypertension can also be caused by:

  • Certain medicines, such as tetracycline
  • Blood clot in the brain
  • Excessive intake of vitamin A
  • Brain tumor

Headaches and vision loss are the most common symptoms. Chronic intracranial hypertension can lead to swelling and optic nerve damage.

Treatments include:

  • Weight loss
  • Reduced salt intake
  • Medicines to decrease the production of cerebrospinal fluid

If needed, surgery is performed to reduce pressure on the optic nerve or to drain excess cerebrospinal fluid to reduce the pressure.

Pharmacological Management

Headache treatments often involve medicines to reduce pain and to stop the headaches from happening. Mild to moderate headaches can often be addressed with

  • Analgesics
  • Anti-inflammatories

More severe headaches may require medicines used to ease or relieve nausea symptoms associated with the headaches such as anti-emetics, abortive therapies that constrict blood vessels in the brain such as triptans and daily prophylactic medicines which can prevent the headache from occurring.

Non-Pharmacological Management

Headaches can be treated in many ways that do not involve medicines. Some options include:

  • Physical therapy
  • Biofeedback
  • Exercise
  • Stress management
  • Acupuncture
  • Sleep management
  • Massage