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, adolescent migraine is a serious problem, as this overview shows...
For a long time, 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 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 remaining 40% will have persistent migraine. Note that 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 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 overview of adolescent headache assessment and treatment is here.
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