Updated 27 February 2017

Headaches may precede strokes in kids

Parents should think twice before dismissing their children's headaches since a new study suggest that migraines may be the forerunner of strokes in children.

Most of us are familiar with the term "stroke" and are aware of the damage it can cause to the body.

A stroke happens when the blood supply to parts of the brain is blocked or reduced. This can lead to the death of brain cells and the subsequent physical impairment. 

Children are much more likely than adults to have a headache before an ischaemic stroke, new research suggests.

Strokes do happen in children, and according to Jo Wilmhurst, head of paediatric neurology at the Red Cross Children's Hospital they see many children with stroke and "it isn't a rare complication". 

An ischaemic stroke is caused by a blocked blood vessel in the brain.

Symptoms of a stroke

"Stroke should be considered as a possible diagnosis in any child with a headache," study author Dr Lori Billinghurst said in an American Stroke Association news release. Dr Billinghurst added that symptoms of a child stroke include:

  • Weakness or numbness in the face
  • Numbness of the arm or leg
  • Changes in walking
  • Difficulty or changes in talking
  • Alterations in vision 

Migraine vs. stroke

"Urgent brain imaging may be required to distinguish a migraine with aura from a stroke," Billinghurst added. She is a clinical assistant professor of neurology at the University of Pennsylvania and the Children's Hospital of Philadelphia.

But stroke is extremely rare in children, affecting far less than 1% of kids from birth to age 18 each year, according to the stroke association.

The current study included 355 paediatric stroke patients. The children in the study were as young as less than one month up to 18 years of age.

Forty-six percent of the children over age three when they had a stroke said they'd had a headache before the stroke. In children under three, about six percent of youngsters reported a headache before their stroke. The researchers noted that kids under three may not have been able to report having a headache.

Headache incidence records were based on physician and patient reports of headache. No information on headache onset, length and treatment was available.

Blood vessel related problems

According to a press release by the Heart and Stroke Foundation South Africa, up to 50% of strokes in children are caused by bleeding (haemorrhage) in the brain.

The study team noted that among those over the age of three, when they had a stroke, half also had a headache, whether or not their stroke was related to a blood vessel problem.

However, among those with a blood vessel problem – such as a tear or narrowing – the rate of headache before stroke rose to seven in 10 patients, the study found.

The rate of headache was lower in kids whose stroke was related to blood vessel wall inflammation following a pre-stroke infection, cancer or serious medical condition. Roughly four in 10 of such children experienced a headache leading up to their stroke.

"It is possible that younger brains have blood vessels that are more easily distended and more likely to activate pain sensors that trigger headache," Billinghurst suggested.

There are many other causes of headaches in children. Examples are headaches cause by stress, diet and bad posture.

Inflammation may be underlying factor

"It is also possible that inflammation – a powerful activator of pain sensors – may be more important in the processes underlying stroke in children than in adults," she said.

 But more research is needed before doctors could use headache incidence to help figure out the cause of a stroke after the fact, she said.

Read More:

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Ask the Expert

Headache expert

Dr Elliot Shevel is a South African migraine surgery pioneer and the founder and medical director of The Headache Clinic in Johannesburg, Durban and Cape Town, South Africa. The Headache Clinic is a multidisciplinary practice dedicated to the diagnosis and treatment of Primary Headaches and Migraines. Dr Shevel is also the main author of all scientific publications generated by his team. He recently won a high level science debate in which he was able to prove that the current migraine diagnosis and classification is not based on data. Tertiary Education - Dr Shevel holds both Dental and Medical degrees, and practises as a specialist Maxillo-facial and Oral Surgeon. Follow the Headache Clinic on Twitter@HeadacheClinic.

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