Some people never get headaches. My father — a physician — lived eighty years and told me he didn’t know what a headache felt like! Other people complain of headaches from time to time, but they don’t seem to bother them very much. Pain medicine is usually not needed for these minor headaches, which don’t seem to interfere with everyday chores and activities. A lot of people, however, get migraine headaches. While the symptoms can vary in onset, severity, and duration, the one thing that is pretty uniform is a sufferer’s inability to perform at their usual level. Whether at school or at work, at rest or at play, these headaches hurt.
Headaches are a common complaint among children. Often parents are not sure whether or not they should be worried about them. My general rule of thumb is if your child complains of pain one minute, and then the next minute they seem perfectly fine — running around like a nut, jumping up and down happily, eating and sleeping normally, getting to school and getting all their work done well — I tend not to worry too much about their complaint. If a child who complains of a headache looks and acts sick — doesn’t want to do much, if any, running or jumping, has a drop-off in eating or new problems with sleeping, has difficulty getting to school and staying there without visits to the school nurse or has new academic struggles — then I worry about their headache symptoms and want to see them in the office for an extended visit.
Most of the time these kids who need to be seen are having migraine headaches. Migraines are vascular headaches. For people who get migraines, something triggers blood vessels in the brain to initially constrict and, after a few minutes, dilate, causing pain. These sufferers seem to be sensitive to certain triggers. Lack of sleep is probably the number one trigger, but there are definitely others, including hormonal triggers (think puberty, menstruation, pregnancy), stress (final exams, social disruption, illness), weather changes (sudden changes in temperature, humidity, and barometric pressure), and foods:
Certain foods, including some aged cheeses, pickled products and nuts, have relatively high levels of tyramine, which is formed from the normal breakdown of an amino acid. Tyramine can accumulate in foods that are aged, fermented or stored for long periods, experts say. Other potential headache triggers include some foods with nitrites, such as processed meats; citrus foods and juices; freshly baked goods with yeast; soy products; and caffeine and alcohol, even in very small amounts. The most commonly reported dietary headache trigger is monosodium glutamate, or MSG, a flavor enhancer that may be added to canned vegetables and soups and processed meats. The time interval between consuming a trigger food and contracting a headache can be a few hours to 48 hours.
Sumathi Reddy provides a list of foods to be avoided in the Wall Street Journal:
The National Headache Foundation suggests patients might want to limit their intake of tyramine, a chemical that occurs naturally in certain foods, to help control headaches. Here are some foods containing tyramine or other substances believed to be headache triggers:
- Aged, dried, and fermented meats and fishes, such as pepperoni and salami
- Aged cheeses, such as blue, Brie, Cheddar, provolone and others
- Fermented soy products, like miso, soy sauce and teriyaki sauce
- Beans, sauerkraut, pickles and olives
- Alcoholic beverages such as Chianti, sherry, burgundy, vermouth, ale and beer
- Foods containing as ingredients monosodium glutamate, nitrites and sulfites
There is one other cause of headaches that we see too much of: concussions. Usually we get the history of a pretty obvious head trauma during a sport or activity. But I believe there are other times when a child or teenager suffers a significant head-bang which is either not witnessed by a responsible adult or not reported by the child. The PediaBlog has covered concussions here and here.
Read WSJ.com article here.