Managing migraines in children

Researchers taught children deep breathing and muscle relaxation techniques and had them imagine fun or peaceful settings. Then, after five months, "the headaches got better," says Scott W. Powers, a paediatric psychologist at the Cincinnati Children's Medical Center, USA, and an author of the study.

The children had fewer and less severe headaches, he says. Finding a new way to help children with crippling headaches is particularly important, Powers says, because so often these kids don't get much attention. "I don't know if adults take them as seriously as they should," he says.

Dr. David Rothner, director of the Pediatric Headache Center at the Cleveland Clinic Foundation and author of Headaches in Children and Adolescents, agrees that biofeedback techniques can be useful in treating migraines in children as well as adults, but he says the study doesn't prove its effectiveness.

The improvements cited -- which Rothner thought were not large -- could have come from medications or other preventative measures, he says. In addition to the relaxation therapy, the children were treated with other techniques and medications when needed, the researchers say.

"It gives us a taste that biofeedback could be helpful -- and maybe could have an effect," Rothner says. But he thinks that's as far as it goes. "I wasn't very impressed," he says.

Experts estimate that by the age of 7, up to 3 percent of kids suffer from migraines, which are severe headaches characterized by pain, nausea and sensitivity to light, sound and smell. As many as 11 percent of kids between 7 and 15 have these headaches.

The 20 children in Powers' study were, on average, between 11 and 12 years old. They missed roughly five days of school a semester. On a scale of one to 10, with 10 being the most severe, the children assessed their headaches at five. They reported migraines 12.9 days a month and said the migraines lasted an average of 6.9 hours.

At the Cincinnati clinic, the children learned "biobehavioral" techniques believed to reduce the likelihood and severity of migraines. They learned to drink more non-caffeinated water, to get more regular sleep, to exercise regularly and to eat healthily, including plenty of foods with riboflavin, which may be important in reducing migraines. They learned to use appropriate medications when necessary.

Relaxation techniques
They also were taught relaxation techniques in a simple, one-hour session, Powers says. They learned to breathe deeply and slowly, reducing the number of breaths a minute from 15 or 16 to about half that, he says. They also learned to gradually relax each muscle group.

For example, they might begin by clenching a fist and pushing down on an elbow -- and then relaxing completely. Finally, they were led through imagery that was appropriate for their age. A teen-ager might recall a recent trip to a beach, while a younger adolescent might imagine a visit to an amusement park.

Relaxation strategies are thought to improve blood flow, and opening up blood vessels is believed to reduce the probability of migraines.

To find out whether the relaxation techniques were working, Powers and his colleagues measured the children's temperatures at their fingertips, which indicates whether blood flow has moved from intensively clumping around organs to the periphery of the body, a classic response to reducing stress.

When the children were asked to relax before they'd been given relaxation training, the researchers found no differences in temperature, the study says. But after the first training session, the children's temperatures rose 3.3 degrees, the study says.

The children were sent home with directions to listen to an individualized tape on the techniques every night for two weeks and, after that, to practice the techniques three to five times a week and every time they felt a migraine approaching.

When retested about five months later, the children were able to raise their peripheral temperatures an average of 3.7 degrees, the researchers say, and 95 percent showed a positive change.

Also, the severity of headaches had dropped to an average of 4.5 on the 1-10 scale, the study says. And, they were occurring less frequently -- down to 9.7 times a month for about 5.2 hours at a time.

The children best able to raise their temperatures saw the greatest relief in headaches, Powers says. Findings appear in this month's issue of Neurology.

It's impossible to say exactly which of the various strategies helped the children the most, he says. But, he adds, the study reported a statistical correlation between raised temperature and reduced headache frequency.

However, Rothner, of the Cleveland Clinic Foundation, questions whether the children, being children, really practiced the techniques consistently during the 150-day time span. And, he points out, the children simply may have wanted improvement so much that they believed it was there even if it was not.

At the same time, he says, the researchers are well respected in the field, and biofeedback has been shown to be effective in other studies. The latest study, he says, "is a suggestion in that direction and worthy of note."