The Corpus Callosum

Muggle’s view of Migraine

There
is a refreshingly whimsical article, on a very serious subject, in this
month’s edition of Headache: The Journal of Head and Face Pain.

rev="review"
href="http://www.blackwell-synergy.com/doi/abs/10.1111/j.1526-4610.2007.00665.x">Harry
Potter and the Curse of Headache
Fred Sheftell MD, Timothy J Steiner MB, PhD, Hallie Thomas
Headache: The Journal of Head and Face Pain 47 (6), 911–916.
doi:10.1111/j.1526-4610.2007.00665.x

Headache disorders are common in children and adolescents. Even young
male Wizards are disabled by them. In this article we review Harry
Potter’s headaches as described in the biographical series by JK
Rowling. Moreover, we attempt to classify them. Regrettably we are not
privy to the Wizard system of classifying headache disorders and are
therefore limited to the Muggle method, the International
Classification of Headache Disorders
, 2nd edition (ICHD-II).
Harry’s headaches are recurrent. Although conforming to a basic
stereotype, and constant in location, throughout the 6 years of his
adolescence so far described they have shown a tendency to progression.
Later descriptions include a range of accompanying symptoms. Despite
some quite unusual features, they meet all but one of the ICHD-II
criteria for migraine, so allowing the diagnosis of 1.6 Probable
migraine
.


Despite the whimsical style of the article, href="http://www.emedicine.com/neuro/topic529.htm">adolescent
migraine is a serious problem, as this overview shows…


For a
long time, href="http://www.medicinenet.com/script/main/art.asp?articlekey=60915">it
was thought that children and adolescents did not have serious headaches,
just as it was thought that they were not susceptible to serious mood
disorders.  It is now recognized that href="http://www.clevelandclinic.org/health/health-info/docs/2500/2555.asp?index=9637&src=news">migraine
afflicts as many as 7 to 10 percent of adolescents.
 About 40% will experience remission by adulthood, 20% will
convert to having episodic tension headaches, but the href="http://www.medscape.com/viewarticle/546556">remaining
40% will have persistent migraine.  Note that href="http://www.medscape.com/viewarticle/555844">migraine
increases the risk of suicide in adolescents.  

Keeping a headache diary may help identify triggers, such as certain
foods.  Over-the-counter analgesics may help, but using them
too often can lead to a really nasty problem with rebound headaches.
 I’ve heard differing advice on this; some say OTC analgesics
should not be used more than twice weekly, others say three times is
the maximum.  Certainly, daily use is a bad idea, as it could
contribute to the development of href="http://www.aafp.org/afp/20041215/editorials.html">chronic
daily headache.  (Note that rebound headache can
occur with prescription migraine medication, too.)

In adolescents with severe head pain, it may be necessary to do some
diagnostic testing.  This is particularly true if there are
abnormal findings on the neurological exam, or if there is a pattern of
gradual increase in the severity of the headache.  The
combination of headache, fever, and neck stiffness is a very serious
presentation that could be caused by meningitis.  A decent href="http://www.aafp.org/afp/20020215/625.html">overview of
adolescent headache assessment and treatment is here.