Scholar athlete Anna Rosenthal will begin her freshman year at Copley High School this week with a plan in her pocket to combat the severe migraines that caused her to miss about 10 percent of 8th grade last year.
The 14 year old’s migraines began as chronic daily headaches at age 13. These headaches occurred about 15 days out of the month, and in half of them she saw a blue light and smelled wheat and raisins prior to onset.
“I remember being at a volleyball tournament and I started seeing blue dots in one eye,” Anna said. “I didn’t say anything and ended up playing the whole game without seeing out of my right eye.”
From February to April 2015, Anna began having severe headache pain that radiated around the front half of her head. Her headaches lasted 1 to 3 days with nausea, loss of appetite, sensitivity to light and sound, and occasionally slurred speech.
By the time she arrived at Akron Children’s headache clinic, she had missed 15 days of school in the previous 3 months.
Her mother, Heidi Rosenthal, a local dentist, took her to several doctors who thought Anna’s headaches might be related to her menstrual cycle. She continued taking over-the-counter medications, which didn’t help and may have even exacerbated her symptoms.
Dr. Victorio examined Anna in April, taking a medical and family history, identifying her triggers and suggesting a treatment plan, which has helped Anna be migraine-free this summer.
Dr. Victorio emphasized preventive treatment with lifestyle changes, diminished doses of over-the-counter painkillers, and resting in a cool, dark, quiet room.
Children’s headache clinic nurse helped prepare paperwork for Anna’s school so she has a plan to be excused and a place to lie down when migraine symptoms arise. The goal is to have Anna only miss a few classes versus entire days.
“Before the visit, some of my teachers were getting fed up with my absences,” said Anna, a straight-A student. “Dr. Victorio broke things down so clearly and her staff helped write up a detailed plan for my teachers.”
Preventing and treating pediatric migraines
One recommendation from the visit was a headache diary. Anna now uses a mobile app to record triggers and features of the attacks including time of the attack, type of pain, prior symptoms, food and drink consumed, sleep patterns, activities prior to headache and her medications.
“Once triggers are identified we can attempt preventive treatment,” said Dr. Victorio at a recent Akron Children’s grand rounds. “Treatment is very individualized and involves an interdisciplinary approach.”
Migraines occur in 1 in 11 children in the U.S. and is more common than diabetes and asthma combined, according to Dr. Victorio.
For these children, management has 3 facets. First, educate patients and parents concerning migraine triggers. Second, formulate a plan of treatment for the acute attacks. Third, consider preventive medication for patients with frequent migraines.
For Anna, Dr. Victorio prescribed Topiramate, one of the few FDA-approved medications for prevention of pediatric migraines.
Part of that approach includes a complete family history because migraines have a genetic component. In Anna’s case, her mother, maternal grandmother, maternal aunt and several relatives on her father’s side suffer from migraines.
“I didn’t realize and Anna didn’t reveal how bad her headaches were,” Heidi said. “My migraines didn’t start until my late 40s and my mother’s in her early 40s.”
Migraine symptoms can differ from person to person. They can include depression, anxiety, chronic back and abdominal pain, fibromyalgia and chronic fatigue syndrome.
Recently, Anna was one of 3 freshmen to make Copley High School’s JV volleyball team. She’s already put in a few weeks of practice and is excited to start the season. Her mother is so relieved to have their questions answered.
“Before the headache clinic, I felt like we were winging it,” Anna said. “Now I’m much less anxious about starting school because I have a plan.”