Author Topic: Migraines and children  (Read 1619 times)

Offline SallyM

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Migraines and children
« on: May 18, 2009, 01:33:11 PM »
What is the recommended approach for an 8 year old boy who is having migraine headaches?  His mother does not want to put him on medicine.  Thanks, Sally
Sally Miller
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Offline Nori

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Re: Migraines and children
« Reply #1 on: May 18, 2009, 02:47:13 PM »
Food allergies are a common place to look for migraine triggers.  This, as with other stressors, can contribute to vascular aberrations.  And, certainly seeking underlying cause would require examining all the health hazards: malnutrition, addictions, TOXINS, trauma, and stress.  In my practice, a 58 year old man who suffered for 48 years (yep, from 10 years old), removed all the tyramine-containing foods
(• Aged cheese
• Aged or cured meats (e.g., air-dried sausage)
• Any potentially spoiled meat, poultry, or fish
• Broad (fava) bean pods
• Marmite concentrated yeast extract
• Sauerkraut
• Soy sauce and soy bean condiments
• Tap beer);
and still had frequent migraines, although much fewer. But he went one step further: removal of his ancient amalgam fillngs.  Now, he has 1 attack per MONTH, probably due to his work-related need to fly (high altitudes exacerbate as well). 

I think that two herbs work really well for migraine:  butterbur and feverfew. If he will not swallow pills, tinctures may work (glycerine to counter any bitterness). Ginger is also a helpful. 
Nori M. Hudson, BA, MS
Instructor, Bauman College, Berkeley
Board Certified in Holistic Nutrition by and Registered with NANP
Certified Diet Counselor, Nutrition Educator,  Nutrition Consultant, and Nutrition Teacher through Bauman College

Offline SallyM

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Re: Migraines and children
« Reply #2 on: May 18, 2009, 03:00:20 PM »
Thank you for your prompt reply Nori.  I was wondering about sugar and caffeine.  Those were the 2 things that I thought of immediately.  Any studies done on these?  Sally
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Offline MistyH

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Re: Migraines and children
« Reply #3 on: May 19, 2009, 11:15:22 AM »
I have also read a Vitamin D deficiency can contribute to migraines.  Cod Liver Oil added to a clients diet of mine helped tremendously.  He is 8 as well.
Eat Well, Feel Well

Offline AmyL

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Re: Migraines and children
« Reply #4 on: May 19, 2009, 01:30:32 PM »
These are all excellent replies. Two other thoughts:

1. Headaches in children can be serious, and I assume they have thoroughly checked and ruled out any possible organic causes? An 8-year-old friend of ours last year had headaches and vomiting episodes which an MRI revealed to be a non-cancerous brain tumor. The surgery was successful and the child is recovering very well with no expected relapses, but they had been through years of nutritional, occupational, and other kinds of therapies before finally getting to the organic cause of the problem.

2. Presuming that it is a true migraine, removing food triggers etc. can only help. I have also been using EFT (now called Meridian Tapping Therapy) very successfully with migraine clients (about a 95% success rate on eliminating the headache once it begins). I will be offering Headache Clinic Workshops over the summer, and love working with individual clients on migraine. (One recent success story that I love involves an acupuncturist who had been treating her own migraine by "needling" herself for 14 hours overnight. Nevertheless, the pain remained at a level of "5" out "10" for two days. (Presumably, the acupuncture helped prevent it from progressing further.) She was open to trying an EFT session with me, and in about an hour we completely eliminated the headache. Getting at the emotional trigger (a stressful confrontation the day before the headache started) proved to be essential. A few weeks later, she successfully subdued another migraine on her own, and is now a total EFT enthusiast. :-)

You could advise your client's mother to check out the free information at www.emofree.com, or I would be happy to teach her the technique or work with her child directly if desired. It's amazingly effective.

Best,
Amy
amy@nourishingconnection.com (San Francisco)

Offline BrigitteM

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Re: Migraines and children
« Reply #5 on: May 19, 2009, 08:47:19 PM »

Here's something i wrote on headache a while ago. Most migraines are food allergy related. Gluten dairy, taurine rich foods.  Blessings, Brigitte

Headache
    Headaches are one of the most common human afflictions.
There are two main categories. Vascular headaches result from dilation of the blood vessels in the head and non-vascular, or psychogenic  headaches result from stress. Many headaches are caused by neuromuscular skeletal imbalances. Low blood sugar  can also be a cause. Some folks get headaches from being around cool white fluorescent lights.
    Pay attention to how you hold yourself. Do you clench your jaws, hold your neck tight? Breathe into these tense area and do your best to let go. Headaches are considered a heat disease as well as liver centered.  Liver chi rises when it is in the liver is congested. Headaches that feel better with the application of pressure can indicate a deficiency. Biofeedback training can teach a headache prone person to relax more. This can also improve circulation. Many have been helped by hypnosis. Avoid exposure to hot sun which can bring on headaches. Wear a hat when outdoors.
Some find that spraying a cold jet of water directly onto the soles of the feet constricts blood vessels and relieves headache.
     Stay off sugars and fruit juices and eat smaller more frequent meals to keep blood sugar levels on a more even keel. Include more protein and complex carbohydrates in the regime. Foods to eat more of  include black sesame seed, buckwheat, carrots, celery and scallions.  Use radish for headaches in the back of the head. Fish oils or flax seed oil can reduce migraine intensity.
   Caffeine consumption as well as caffeine withdrawal can cause headaches. This happens because caffeine causes blood vessel constriction.  It is best to gradually decrease caffeine rather than all at once. Alcohol is a vasodilator. Nicotine can cause headache by constricting blood vessels.  Other foods that can trigger headaches include chocolate, wheat, citrus, corn, tomatoes, apples, bananas, peaches, peanuts and onions, red meat.  Minimize excess spicy foods, chocolate, fats and fried foods.  Avoid ice cold foods and drink. Foods high in the amino acid, tyrosine such as aged cheese and wine can cause migraine headaches. There is also a class of chemicals known as vasoactive amines that can cause headaches in some people. This includes histamines in aged cheese, eggplant, spinach, tomato, chicken liver and wine. Tyramines in avocados, bananas, cheese, citrus, red wine, peanuts, fermented, pickled and smoked foods, plums, sourdough bread and baker's yeast as well phenylethylamine in chocolate and cheese are all headache contributing culprits.  Avoid chemical food additives such as sulfites, nitrates and nitrites, red and yellow dye. 
   Herbs to help headaches include:
 Angelica helps one feel lighter and happier. Relieves headaches due
to nerves. Anti-inflammatory, astringent, carminative and  nervine.
Blue vervain is for menstrual and  tension headaches, as well as
migraines.  Anti-coagulant, anti-inflammatory, antispasmodic,
astringent, cholagogue, nervine, sedative and vasoconstrictor. 
Catnip helps tension headaches. Anodyne, antispasmodic,
carminative, nervine, refrigerant and sedative.
Cayenne contains capsaicin, which relieves cluster headaches when
applied topically in ointment form inside the nose. Blocks small pain
fibers thus depleting them of neurotransmitters. Stimulates
endorphins and facilitates even blood flow. Anti-inflammatory. 
Chamomile helps  headaches, migraines and  caffeine withdrawal.
Analgesic, anodyne, anti-inflammatory,  antispasmodic, carminative,
nervine and sedative.
Chrysanthemum clears heat and reduces inflammation, For liver
related  headaches and  dizziness. Alterative and  antispasmodic.
Clematis is vasoconstricting on  the brain lining, For migraine and
cluster headaches. Analgesic and antispasmodic.
Coffee constricts blood vessels. Can also cause headaches, but is
helpful if used on occasion at onset of a headache. Cerebral stimulant.
Elder flower is for tension  and congestion related headaches. Anti-
inflammatory, antispasmodic, carminative and  decongestant.
            Feverfew inhibits prostaglandin biosynthesis and  blood platelet
               aggregation. Tonifies blood vessels. Stops the blood platelets from releasing too much serotonin.   Feverfew  helps prevent and
               treat migraines by inhibiting serotonin and histamine release which
               can dilate blood vessels. Feverfew  has anti-inflammatory properties
               and helps to tone the blood vessels. A study done at King's College
               Hospital in London found that 70% of those that used feverfew had
               reduction in  frequency and intensity of  headaches. One third of had
               no headaches. The feverfew was administered by eating feverfew
               leaves on bread and butter sandwiches, although tea, capsule or
               extracts also are helpful. Feverfew works best as a preventative 
               taken on a daily basis rather than when headache is already in
               progress. Anti inflammatory, antispasmodic,  nervine and vasodilator.
Ginger inhibits biochemical pathways associated with inflammation   
and prevents blood platelet aggregation. Analgesic, anti-
inflammatory, anticoagulant,  antispasmodic, carminative.
Ginkgo increases oxygen utilization and blood flow to the brain.
Helps prevent blood platelet aggregation. Anti-inflammatory,
astringent, cerebral tonic, circulatory stimulant, sedative and
vasodilator.
Hawthorn improves  oxygen levels to the brain. Dilates coronary
blood vessels, but relaxes peripheral blood vessels. Astringent,
carminative and vasodilator.
Hops helps tension headaches. Anodyne, antispasmodic, astringent,   
hypnotic, muscle relaxant, nervine, sedative and soporific.
Kava kava is calming and relaxing. Can helps people shut out
excessive "mental chatter." Antispasmodic and sedative.
Lavender is a nerve restorative that relieves pain. Analgesic,
antispasmodic, carminative, cholagogue, nervine and sedative.
Meadowsweet contains salicin and  is the source from which
Aspirin was first synthesized. Milder than aspirin and  naturally
buffered. For headaches accompanied by digestive disorders.
Analgesic, anti-inflammatory, antispasmodic, astringent and sedative.
Peppermint helps migraines and  headaches. Analgesic, anodyne,
anti-inflammatory, antispasmodic, carminative, cholagogue, nervine
and  mild vasodilator.
Periwinkle increases cerebral blood and oxygen flow. Astringent,
cerebral vasodilator and sedative. Not for people with low blood
pressure
Rosemary eases anxiety. For headaches and  migraines.  Anodyne, 
anti-inflammatory, antispasmodic, astringent, carminative,
cholagogue, circulatory stimulant, decongestant, smooth muscle
relaxant and nervine.
Scullcap stimulates endorphin production.  Relieves heat and 
tension headaches. Alterative, anodyne, anti-inflammatory, 
antispasmodic, cerebral tonic,  nervine, sedative and spinal tonic.   
Valerian lessens nerve excitability. Smooth muscle and skeletal
relaxant.  Anodyne, antispasmodic, astringent, carminative, hypnotic,
nervine and  sedative.
White Willow inhibits prostaglandin production and thereby
reduces inflammation. Contains salicin, a forerunner of aspirin.
Alterative, analgesic, anodyne,  anti-inflammatory, astringent and 
bitter tonic.
Wild  Yam is a muscle and nervous system relaxant.  Moves
congested chi. Anti-inflammatory, antispasmodic and  cholagogue.
Wood betony was once used as a smoke and snuff to remedy
headaches. Alterative, analgesic, antispasmodic, astringent,
bitter tonic, cerebral tonic, circulatory stimulant, liver tonic, nervine
and sedative.
   Some patent formulas to consider include Lung Tan Xie Gan Pill for headaches due to liver and gallbladder congestion. Headaches with stiffness and sore muscles  in the lower back may be helped by Xiao Huo Luo Dan.
   Magnesium relaxes muscles and can help migraine and tension type headaches.  B Complex and  Vitamin B2 supplementation has also been found helpful. Essential fatty acids such as found in fish, flax and hemp seed oil  can help by reducing the inflammation associated with headaches. . Some have found relief from using the amino acids DLPA, L-Glutamine and GABA. 5HTP is a precursor to serotonin and those with low levels of this brain chemical are more susceptible to pain.
   Homeopathic remedies  for headaches include the following:
Aconitum napellus: Skull feels constricted. Comes on suddenly and violently. Often occurs from feelings of anxiety and apprehension. Argentum nitricum : For emotionally caused headaches. Pain is worse in the left front and may be described as "boring." Skull may feel as if separating or head may feel huge. Bandaging the head tightly seems to help. Vomiting bile or sour substances may occur.
Belladonna: For throbbing blood congested right sided headaches. There may be a red face and  pounding pulse. Noise and light aggravate. More likely to occur prior to  menses,  in afternoon or evening. Lying in bed in a dark room feels best.
Byronia: Violent sudden headache, either side.  Pain often above the forehead on left side and described as splitting or bursting. Steady ache. Aggravated by motion and bending over. Irritable and wants to be left alone, still with cold drinks.  Lips and mouth are dry. Firm pressure and lying on painful part of head brings some relief.
Chamomilla Bursting, severe pain. Oversensitive to pain, Nothing pleases. Worse from warmth.
Coffea  cruda :  Headaches in restless, hyperactive type people. May have insomnia. Very sensitive to noise, touch and smell. May feel as if nail has been driven into head.
Gelsenium :  Often begins at the back of the head, feels like a band around the head. Person may feel weak, dizzy and barely  be able to open their eyes. For the person who feels relief after urinating.
Ignatia :  For headaches occurring after emotional experiences such as disappointment in love, embarrassment or sadness. They may sigh often, get lumps in their throat and have a hard time swallowing.
Iris versicolor :  Migraines preceded by visual aura. Pain along dental nerves, often along right side, below eye or in temple. May have watery sour vomit. Worse in the evening. Motion in moderation improves. May reoccur in a pattern.
Kali bichromicum : Migraine accompanied by sticky yellowish vomit. Pain is concentrated on right side, under eye.
Kali phosphoricum : Headaches that occur in nervous people dealing with stress and mental strain.  Often a remedy for intellectuals and students.
Lac caninum :  Migraine made worse by noise or vibration. Headache may begin on a different side or extend from base of skull to one eye.
Lac defloratum : Migraine where pain starts in forehead and extends to back of head. May occur with constipation.
Lachesis :  Left sided headaches. Pain is worse in morning upon arising and before menses, affecting root of nose. Made worse by sun and warmth. Better from open air and pressure.
Melilotus :  For frontal headaches that are intense. Hot flushed face in the beginning. Worse in morning. Reoccurs every few days. Nosebleed or menstrual onset brings relief.
Natrum muriaticum :  Menstrual headaches and  migraines.  May start in morning and worsen in evening. Better from sleep or lying with eyes closed.  Hammering headache preceded by visions that look misty or zigzagging lights and may feel like knocking on the brain with pain over eyes. Headache may be brought on by grief, loss or disappointment. Cold  wet cloth while lying in a dark room may bring relief.
Nux vomica :   Often occurs in back of eyes as if a nail had been driven in. For type "A" personalities. Overall sick feeling. Headache due to overindulgence in food, drugs or drink. Chilly, sensitive to drafts, aromas and light. For irritable people that suffer from insomnia.  Often called the "hangover remedy."
Pulsatilla:  Chills, scanty menses, throbbing or stitching pains on one side. May come on after a fatty meal or from  stress or overwork.
Nausea and vomiting may occur. Cold helps. Worse in evenings.
Ruta graveolens   : For headaches  resulting from eye strain.
Sanguinaria :  Migraine .  Intense pain, vomiting bile. For women with excessive menses. Headaches come on in morning and worsen as day progresses. May reoccur in pattern, like every week. Right sided headaches that begin in the back of the head. Can occur from sun exposure. May feel better after vomiting.
Sepia : Throbbing pain over one eye. Pain feels as if shooting upward or outward. Hot flashes, nausea and stiff neck. Noise, light and motion make it worse.
Silicea :  Head feels engorged. Hair is sensitive. Pain runs up the neck or may be one side of top of head, forehead or occiput. Stress, motion, sound, light and  bending make it worse. Heat and lying in the dark improve.
Spigelia :  Headaches over left eye and frontal region, from exposure to cold. Sometimes described as if hot poker is in or above left eye. Relieved by cold compresses, steady pressure and lying on left side with head erect.


   
   When dealing with a headache, lie down, do deep slow breathing and practice tensing then relaxing each part of your body. Some people find that if they can have a bowel movement at the onset of a headache,  the headache will diminish.
   The acupuncture point hoku can be stimulated with the fingers to give headache relief. It is located in the fleshy mound in the hand just above where the thumb and forefinger bones come together.
    A Chinese folk remedy for headache is called Li-Shou. It is done by standing with your feet apart 20 inches or so. Rub the hands together to warm them and gently stroke the face 30 times from the forehead to chin in the same direction. While doing this, partially close eyes and look down at the toes. The extend arms in front at waist level with fingers touching and swing them back and forth 100 times. This helps to divert blood from the head to the hands as well as stimulate endorphin production.
   A simple folk remedy is to sit with the feet in hot water Add one teaspoon of ginger or mustard powder to a gallon).  While  doing this apply a cold compress to the back of the neck at the base of the skull for five minutes.
   Another hydrotherapy technique is to sit on a waterproof stool in the shower with legs apart, bending forward with hands clasped in back of the neck. Allow the elbows to fall between the knees so the upper back muscles get stretched. Have a spray of warm/hot water aimed towards the back of the head for five minutes. Turn off the water. Dry off. Soak a face towel in very cold water. Apply it to the same area you were spraying with hot water. Leave in place for half a minute.  Another folk remedy is to dunk  both hands into hot water (within reason)  for one minute.  Try making a  compress of tea of lavender, peppermint or rosemary. Soak a cloth in the hot tea and apply to the forehead and back of neck. Chilling the tea and making a cold application may feel even better. You be the judge of which temperature would feel better.
   Unwind in an aromatherapy bath of lavender, peppermint or rosemary.   An aromatherapy headache pillow can be made by stuffing a sachet full of aromatic headache herbs like peppermint, rosemary and lavender. Take it to bed with you. Breathe deep the comforting aromas.
    An Irish folk remedy for headaches is to loosely tie a bandanna around the head and then slip some slices of raw sliced potato between the head and scarf. Place the potatoes strategically where the pain is throbbing, over temples or over eyes. Lie down in a quiet room. After an hour the potato slices should be very warm and the headache relieved.
    One teaspoon gomasio,  simply eaten is a helpful remedy from Japan. A teaspoon of umeboshi plum paste stirred into a cup of hot water and slowly sipped is one of my favorite headache remedies.
    Electro-magnetic pollution can be a factor in headaches. Do you live near major power lines? Is your bed near an excessive amount of clocks, TV, stereo equipment and computer ware? Do what you can to minimize any of these factors, such as moving the bed or electric paraphernalia.
    Visualize breathing in the colors  violet, blue or green which are cooling to inflammation. Remember to verbalize your feelings.
 
Cluster Headaches
   Cluster headaches are considered vascular and sometimes referred to as "histamine reaction headaches." These are intensely painful, localized, often beginning in the evening and sometimes awakening one from sleep.  Adult men are most  affected. Severe pain can last 30 to 90 minutes or up to several hours. They occur as a group that can last for a few days to months and may not reoccur for several months or even years. Some people experience them more in the spring and fall which leads some health professionals to feel they may be allergy or hormonally related. If  related to allergies, panothenic acid supplementation may help. Also do your best to avoid any allergens. Cluster headache sufferers can be heavily goal oriented. Think  calm  thoughts.
Migraines
   Migraines are also considered a vascular condition.  Often preceded by auras where objects appear surrounded in light. Strange smells, numbness and difficulty with speech may also occur.  Blood vessels can constrict then over dilate, which causes the pain. The pain can be general or local, but is usually on one side in the frontal or temporal region. Migraines may also manifest as  numbness, tingling, nausea, vomiting and  diarrhea. The pain may shift from one side to the other.  Attacks may last less than a day, up to three days and in some cases weeks.
    Migraines may occur cyclically or from a particular food.  Menstrual cycles and birth control pills may be a factor.
    Food allergy is common with migraine sufferers. Dairy products, eggs, wheat and food additives, such as MSG, aspartame and nitrates may all be culprits. A sensitivity to the amino acid tyramine commonly triggers migraines.  Chocolate contains phenylethalamine which has a similar effect.  Yeasted breads,  gluten rich foods, citrus fruits and processed meats  can also bring on migraines. It may be helpful to eliminate all of these foods for several weeks and add them back one at a time to see if any bring on a reaction. Yeast overgrowth can also be a contributing factor. Bed rest may be needed if the migraine is severe.
    Throbbing in the eye area (caused by vasoconstriction) initially can be opened by a vasodilating 100 mg. of niacin. Don't be afraid of the ten minute hot prickly rash . It will not last and it will not harm you.
 If you're in the kitchen, you could try inhaling deeply from a jar of mustard.
    Migraine sufferers need to feel in control of their situations. Those with migraines are likely to be ambitious, eager to please and sensitive to criticism. Those that suffer frequent migraines may have experienced sexual abuse. Interestingly enough migraine sometimes are known to have long lives. Perhaps due to enforced rest?
Sinus Headaches
   If one feels worse when bending , it may be a sinus headache. Minimize dairy products, flour and sugar all of which can contribute to mucous congestion. Try sniffing some horseradish or mustard from a jar.  An herbal steam  inhalation of peppermint or lavender can be  sinus opening. Dilute some chlorophyll and put one drop in each nostril.
Tension Headaches
   Stress , poor posture, lack of sleep  can all contribute to tension headaches.  Tension headaches are more likely to occur as one's day becomes increasingly stressful. Neck pain  often goes along with tension headaches. The pain may be on one or both sides.
Consider getting body alignments if you can't put help yourself with yoga. Exercises that can relieve headaches are pranayama, meditation and neck rolls are all excellent. Avoid excessive forward bends and backbends.
    Sometimes headaches require medical attention. See your health practitioner if the headache is 1) caused by a blow to the head 2) coughing, sneezing or vomiting worsens the headache 3) Headache is accompanied by fever, memory loss, double vision, speech and hearing difficulties 4) Sexual, bladder or menstrual problems accompany headaches 5) Headache appears suddenly, patient is elderly, arteries on the side of the head are engorged 6) Sweating and fever accompany the headache. 7) If a headache begins after taking some kind of medicine.
 Rather than simply blocking out the pain of a headache, it is important to determine the cause and change it.



Offline Nori

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Re: Migraines and children
« Reply #6 on: May 27, 2009, 12:00:45 PM »
Brigitte, I think you meant tyramine rich foods

Most migraines are food allergy related. Gluten dairy, taurine rich foods.

Do you have references for these suggestions?
Nori M. Hudson, BA, MS
Instructor, Bauman College, Berkeley
Board Certified in Holistic Nutrition by and Registered with NANP
Certified Diet Counselor, Nutrition Educator,  Nutrition Consultant, and Nutrition Teacher through Bauman College

Offline SuzanneAz

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Re: Migraines and children
« Reply #7 on: May 28, 2009, 06:37:48 AM »
My son use to get migraines when he was a young boy. We took him to our homeopathic Dr he found some foods that were contributing. That was a big help for us. They were hot dogs ,dairy,and artificial sweeteners in gum and mints.Good luck and good health to you and your family. :D Suzanne

Offline KatieH

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Re: Migraines and children
« Reply #8 on: May 30, 2009, 09:03:33 PM »
My son (age 12) recently experienced his first migraine after running a 5K race.  The next time he did one, (3 weeks later) the same thing happened.  After speaking with a nurse at his pediatrician's office, we came to the conclusion that he may have been dehydrated.  In preparation for a 10K that he wanted to do, I had him hydrate a lot the day before, morning of and during the race.  Thankfully, he did not get a migraine.  There are great ideas listed in many of the posts, but you may want to also consider if your son is well hydrated.  Keeping more hydrated seems to be working for my son, although his migraines so far seem to be exercise induced.   He does get regular headaches at school sometimes which also seem to be related to lack of hydration.  Hope you're having some luck.  I grew up having them and they're no fun. 

Offline MiraD

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Re: Migraines and children
« Reply #9 on: May 31, 2009, 08:52:04 AM »
Although migraines can be triggered by food or other substances, according to a doctor I know, there is sometimes a biological reason as well, some people have a kink in the blood vessels at the base of the skull, this can sometimes be helped by adjustments to the area by a chiropractor. 

There are also some people who suffer from abdominal migraine.  I've been told that as many as 15% of childhood migraine sufferers have abdominal migraines.  Many of these children become adults with typical migraine features.



Offline SallyM

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Re: Migraines and children
« Reply #10 on: May 31, 2009, 07:20:19 PM »
Thank you to everyone for all the great information that I can pass along.  Mira - what is an abdominal migraine? 
Sally Miller
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Offline MiraD

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Re: Migraines and children
« Reply #11 on: May 31, 2009, 07:32:59 PM »
Hi Sally,

Abdominal migraine is a migraine that has a lot of the classic symptoms, pain, nausea, vomiting.  But the pain is in the stomach and there is no aura.  The pain does not go away easily.  One of my children suffered from this and she used to drape herself over the arm of the sofa to put pressure on her stomach to try to make the pain go away. 

The abdominal pain can last for a couple of days (this is one of the "symptoms" that doctors use to diagnose, along with a family history, if there is one, of migraine).  My daughter also used to get very pale and drawn looking when she was experiencing this.

HTH.

Best,
Mira


 

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