ROANOKE TIMES

                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: MONDAY, March 19, 1990                   TAG: 9003172239
SECTION: EXTRA                    PAGE: E1   EDITION: METRO 
SOURCE: Jane Brody
DATELINE:                                 LENGTH: Medium


PARENTS CAN PLAY ROLE IN DIAGNOSING CHILD'S HEADACHES

Adults often complain that doctors do not take their headaches seriously.

Instead of distinguishing between types of headaches and trying to ferret out the factors responsible for them, many physicians automatically attribute headaches to emotional factors and prescribe drugs to relieve pain and anxiety.

The problem can be worse when headaches af-

Headache is a symptom, not a disease or disorder, and rooting out its cause often requires a fair amount of both the physician's and the patient's or parents' time and attention.

The causes of chronic headaches in children are many and varied, from problems in school to tumors in the brain, and careful detective work may be needed to reach an accurate diagnosis and devise an effective treatment.

Determining a cause may be complicated by the limited information a young patient can provide.

In some cases, too, parents are unwilling or unable to recognize when their attitudes or actions contribute to a child's headaches.

Still, experts say young headache sufferers as well as their parents can provide important clues, especially if the physician interviews them separately.

Diagnostic difficulties may be further compounded because headaches in children can masquerade as something else.

By paying attention to the nature of the child's symptoms and when they occur, parents can play a central role in the diagnostic work-up.

And just as parents know how to respond quickly when a child's fever soars, they should know how to recognize potentially serious headaches that require immediate medical attention.

Young children can suffer from headaches long before they are able to tell their parents why they are miserable.

Very young children may rub or hold their heads and cry when they have a headache.

In young children with migraine, the auras - strange symptoms that precede the headache - can be severe even if they are followed by only a mild or brief headache.

During an aura a child may have visual distortions, confusion or difficulty walking. Unexplained episodes of vomiting followed by sleepiness can be symptoms of migraine in a very young child.

A major clue to migraine is whether a parent is also afflicted and whether the headache is relieved by sleep.

Tension headaches also differ in the young.

Adults tend to experience them as a tight band of pain circling the head or a feeling that the top of the head is about to blow off. With children, the pain is in the forehead or temples.

It often gets worse as the day wears on, is aggravated by exercise and in adolescents does not respond to simple painkillers.

A headache that persists for weeks without accompanying neurological symptoms is most likely caused by emotional problems.

Such headaches commonly afflict children with chronic anxieties. Dr. Arthur L. Prensky, writing in Patient Care magazine, lists these signs of anxiety to look for: unusual fears, excessive preoccupation with future events, constant need for reassurance, clinging behavior, inability to relax, insomnia, irritability, excessive sweating, flushing and jitteriness.

Dr. A. David Rothner, a pediatric neurologist at the Cleveland Clinic, notes that headaches may be a sign of depression in children who also undergo mood change, perform poorly in school, behave aggressively and experience withdrawal, lack of energy or weight loss.

But don't be fooled by the absence of behavioral abnormalities. Older children with stress-induced tension headaches may continue to pursue their usual activities and schoolwork as if nothing were wrong.

If after suffering a blow to the head, a child develops any kind of neurological abnormality, from sleepiness or irritability to numbness on one side of the body, an immediate examination by computerized X-ray (CT scan) is needed to check for brain injury even if no headache occurs.

Ordinary X-rays can be useful in diagnosing headaches caused by chronically inflamed sinuses.

These front-of-the-head or facial headaches may follow a respiratory infection and are often accompanied by postnasal drip, infected ears and swollen nasal passages, but fever is not common.

While eye abnormalities are not frequent causes of headaches in children, those caused by refractive errors or astigmatism may result in headaches after prolonged close work.

Eyeglasses or contact lenses can solve the problem.

Prensky warns that increasingly severe pain in the orbit of the eye should be considered an ophthalmologic emergency.

It can result from increased pressure caused by a tumor or fluid buildup. Again, a CT scan is the first step in diagnosis.

Rothner insists that taking a careful history, directing questions at both the parents and the child, is the most important part of headache diagnosis.



 by CNB