Children as young as six-years-old who get frequent headaches may be using over-the-counter (OTC) pain relievers far more than they should, and often without their parents' knowledge, suggests a study being presented this week at the 46th Annual Scientific Meeting of the American Headache Society (AHS).*
Not only is the overuse of those medications potentially harmful, the practice may lead to rebound-chronic daily headache, according to researchers from the Cleveland Clinic. The study's lead investigator, A. David Rothner, M.D., director emeritus of child neurology and director of the Pediatric/Adolescent Headache Clinic at The Children's Hospital at The Cleveland Clinic, Cleveland, Ohio, said:
"I've been astounded by the large numbers of kids using over-the-counter medications five or six times a week - sometimes 15 to 20 times a week. A few of them even went into kidney failure or developed gastrointestinal bleeding because of all of the medicine they were taking ... Even more frightening was that a lot of them were taking medication without telling their parents. Physicians need to specifically ask children and adolescents who get headaches how much over-the-counter medicine they are using."
One popular medication being used by children and teens and marketed as a Migraine remedy contains aspirin, which children shouldn't have until they are at least 19 years old, because it has been linked to potentially deadly Reye's Syndrome. Children and adolescents most often use and non-steroidal anti-inflammatory (NSAID) drugs such as ibuprofen and naproxen. All of these medications are available without a prescription.
Headache and Migraine experts define overuse of OTCr medications - in children and adults - as taking more than three doses a week for more than six weeks. About 1 in 7 children and adolescents used the medications without telling their parents. They just didn't realize that their parents should be consulted before they took medications, said Dr. Rothner.
The study involved 680 children and adolescents, ages 6 to 18, who had been referred to The Cleveland Clinic's Pediatric/Adolescent Headache Clinic: 41% had Migraine disease; 28% had tension-type headaches; 22% had a mixture of Migraines and tension-type headaches; 5% had headaches due to a disease or physical problem (such as an infection or brain tumor), and 4% had other forms of headaches. Overuse of over-the-counter pain relievers occurred in 22% of study participants, and was more common in girls who had chronic tension-type headaches or a mix of Migraines and tension-type headaches.
Additionally, 14% of patients had missed more than 15 days of school in a school year. Most of those who missed school had chronic tension-type headaches or a mix of Migraines and tension-type headaches. Nearly 1 in 5 (19%) of the kids in the study had headaches every day or nearly every day; 80% were girls and 85% were straight A or A/B students.
"If you have a child or teen with frequent headaches who is missing a lot of school, you need to be forceful in getting an accurate diagnosis," said Dr. Rothner.
Most of the children and adolescents in the study named school as a major cause of stress. Many of them unconsciously were attempting to avoid stress by insisting that they were in pain and needed to stay home from school, and their empathetic parents kept them home, said Dr. Rothner. "Part of the cure is that they must go back to school," said Dr. Rothner. "They need tough love. Staying home doesn't cure the headaches. They often benefit from professional help to learn how to deal with the stress and pain. If needed, a doctor can prescribe medication to prevent the headaches."
In addition, parents should monitor their children's use of over-the-counter medications, and limit it to two doses per week, he said. If the headaches are frequent, a doctor can prescribe daily preventive medication. Children seem to get the most benefit from the combination of counseling, medication and daily school attendance, said Dr. Rothner.
Unfortunately, no headache or Migraine medications have been approved by the FDA for use in children or adolescents, although many physicians will prescribe them because there has been limited research showing some are safe. Another study being presented at the AHS meeting suggests one of the triptans is safe and effective in children. Triptans are one of the most effective acute or symptomatic Migraine medications available, Dr. Rothner said. The pediatric neurology community is focused on conducting more studies to determine safety and effectiveness of headache medications in children and adolescents, said Dr. Rothner.
* Please watch for a follow-up to this article coming soon as I have an interview scheduled with Dr. Rothner.
For a more detailed version of this article, click HERE.
