Management of pediatric headache at Mayo Clinic

Kenneth J. Mack, M.D., Ph.D., a pediatric neurologist at Mayo Clinic in Rochester, Minn., estimates that 80 percent of his practice is devoted to patients with headache. He explains that the high volume is not surprising, given that the prevalence of migraine is estimated to be 3 percent in children ages 3 to 7 years and as high as 23 percent in 15-year-olds. Chronic daily headache is estimated to affect 1 percent of boys and 3 percent of girls in middle school. Migraine and chronic headache can have a profoundly negative impact on a young person's academic performance and participation in social and school activities.

At Mayo Clinic, headache specialists collaborate with colleagues throughout the pediatric practice. Depending on the age of the child, the diagnostic tests for migraine or chronic headache are similar to those conducted in adults and may include blood tests, imaging studies, autonomic tests and, rarely, a lumbar puncture to rule out structural abnormalities or disease.

Dr. Mack notes that two-thirds of patients with chronic headache have sleep impairments. Patients can be referred to Mayo Clinic's Center for Sleep Medicine for tests that may include a nocturnal polysomnogram and a multiple sleep latency test. Often, management of sleep problems can improve headache frequency and severity.

As is true for adults with chronic headache or migraine, treatment is highly individualized for children. "We use the same medications as we do in adults," Dr. Mack explains, "with adjustments for the weight of the child. The challenge is that medications have been less well studied in children than in adults, and children may respond differently to them."

Additional sources of therapy at Mayo include the multidisciplinary Pain Rehabilitation Center, staffed by anesthesiologists, psychologists, physical medicine and rehabilitation physicians, and physical therapists with specific training in the treatment of pediatric patients. Alternative treatments may include:

  • Lifestyle changes
  • Biofeedback
  • Trigger point injections
  • Botulinum toxin type A injections

Explaining Mayo's practice for patients who are not local to Rochester, Dr. Mack says, "Having examined the patients' history prior to their visit, our main goal is to rule out other causes of headache, provide a comprehensive evaluation, help patients feel comfortable with the diagnosis, and make sure they are aware of all the treatment options open to them. For patients with more complicated symptoms who are unlikely to be able to return to Mayo, our goal is to make specific-enough treatment recommendations that physicians less familiar with headaches will feel comfortable carrying them out."