Conditions We Treat

What is epilepsy?

Epilepsy is a neurological condition involving the brain that makes people more susceptible to having recurrent unprovoked seizures. It is one of the most common disorders of the nervous system and affects people of all ages, races, and ethnic background. Epilepsy happens more often in children than in adults.


When a person has two or more recurrent unprovoked seizures, they are considered to have epilepsy. There are many possible causes of epilepsy, including genetic etiology, structural pathology, tumors, strokes, and brain damage from illness or injury, or some combination of these. In the majority of cases, there may be no detectable cause for epilepsy.


What is an epileptic seizure?

A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupts normal electrical brain function. If someone has seizures, it does not always mean that he or she has epilepsy.

  • Seizure Types

    The type of seizure depends on which part and how much of the brain is affected and what happens during the seizure. The two broad categories of epileptic seizures are generalized seizures (absence, atonic, tonic-clonic, myoclonic) and focal (with and without impaired awareness) seizures. Within these categories, there are several different types of seizures in children, including:



    Focal seizures. Focal seizures take place when abnormal electrical brain function occurs in one or more areas of one side of the brain. With focal seizures, the child may experience an aura before the seizure occurs. The most common aura involves feelings such as deja vu, impending doom, fear, or euphoria. Visual changes, hearing abnormalities, or changes in the sense of smell can also be auras. Two types of partial seizures include:

    1. Focal seizures with intact awareness:  The child may show different symptoms depending upon which area of the brain is involved. If the abnormal electrical brain function is in the occipital lobe (the back part of the brain that is involved with vision), the child's sight may be altered. However, more commonly, a child's muscles are affected. The seizure activity is limited to an isolated muscle group, such as fingers or to larger muscles in the arms and legs. Consciousness is not lost in this type of seizure. The child may also experience sweating, nausea, or become pale.
    2. Focal seizures with impaired awareness: This type of seizure commonly occurs in the temporal lobe of the brain, the area of the brain that controls emotion and memory function. This seizure usually lasts one to two minutes. Consciousness is usually lost during these seizures. Losing consciousness may not mean that a child passes out--sometimes, a child stops being aware of what's going on around him or her. The child may look awake but have a variety of behaviours. These behaviors may range from gagging, lip smacking, running, screaming, crying, and/or laughing. When the child regains consciousness, he or she may complain of being tired or sleepy after the seizure. This is called the postictal period.


    Generalized seizures. Generalized seizures involve both sides of the brain. There is loss of consciousness and a postictal state after the seizure occurs. Types of generalized seizures include the following.


    1. Absence seizures (also called petit mal seizures): These seizures are characterized by a brief altered state of consciousness and staring episodes. Typically, the child's posture is maintained during the seizure. The mouth or face may move, or the eyes may blink. The seizure usually lasts no longer than 30 seconds. When the seizure is over, the child may not recall what just occurred and may go on with his/her activities, acting as though nothing happened. These seizures may occur several times a day. This type of seizure is sometimes mistaken for a learning problem or behavioral problem. Absence seizures almost always start between ages 4 to 12 years.
    2. Atonic (also called drop attacks): With atonic seizures, there is a sudden loss of muscle tone, and the child may fall from a standing position or suddenly drop his/her head. During the seizure, the child is limp and unresponsive.
    3. Generalized tonic-clonic seizures (also called grand mal seizures): Generalized tonic-clonic seizures are bilateral and symmetric generalized motor seizures, that occur in an individual with loss of consciousness. The tonic-clonic seizure consists of a tonic (bilateral increased tone, lasting seconds to minutes) and then a clonic (bilateral sustained rhythmic jerking) phase, typically in this order, however variations such as clonic-tonic-clonic and myoclonic-tonic-clonic can also occur. Not all of these phases may be seen with every one of this type of seizure. During the postictal period, the child may be sleepy, have problems with vision or speech, and may have a bad headache, fatigue, or body aches.
    4. Myoclonic seizures. This type of seizure refers to quick movements or sudden jerking of a group of muscles. These seizures tend to occur in clusters, meaning that they may occur several times a day, or for several days in a row.
    5. Tonic seizure: A generalized tonic seizure involves bilaterally increased tone of the limbs typically lasting seconds to a minute. They often occur out of sleep and in runs of varying intensity of tonic stiffening. The individual is unaware during these events.
    6. Infantile spasms: This rare type of seizure disorder occurs in infants from before six months of age. There is a high occurrence rate of this seizure when the child is awakening, or when they are trying to go to sleep. The infant usually has brief periods of movement of the neck, trunk, or legs that lasts for a few seconds. Infants may have hundreds of these seizures a day. This can be a serious problem and can have long-term complications.
    7. Febrile seizures: This type of seizure is associated with fever and is not epilepsy, although a fever may trigger a seizure in a child who has epilepsy. These seizures are more commonly seen in children between 6 months and 5 years of age and there may be a family history of this type of seizure. Febrile seizures that last less than 15 minutes are called "simple," and typically do not have long-term neurological effects. Seizures lasting more than 15 minutes are called "complex" and there may be long-term neurological changes in the child.

  • Signs & Symptoms

    The child may have varying degrees of symptoms depending on the type of seizure. The following are general symptoms of a seizure or warning signs that your child may be experiencing seizures. Symptoms or warning signs may include:


    • Staring
    • Jerking movements of the arms and legs
    • Stiffening of the body
    • Loss of consciousness
    • Breathing problems or breathing stops
    • Loss of bowel or bladder control
    • Falling suddenly for no apparent reason, especially when associated with loss of consciousness
    • Not responding to noise or words for brief periods
    • Appearing confused or in a haze
    • Nodding the head rhythmically, when associated with loss of awareness or even loss of consciousness
    • Periods of rapid eye blinking and staring

    During the seizure, the child's lips may become bluish, and breathing may not be normal. The movements are often followed by a period of sleep or disorientation.


  • Management

    How Are Seizures Diagnosed?


    The full extent of the seizure may not be completely understood immediately after onset of symptoms but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a seizure is made with a physical examination and diagnostic tests. During the examination, the physician obtains a complete medical history of the child and family and asks when the seizures occurred. Seizures may be due to neurological problems and require further medical follow up.


    Diagnostic tests may include:


    1. Blood tests
    2. Electroencephalogram (EEG) - a procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp.
    3. Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
    4. Lumbar puncture (spinal tap) - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems.
    5. Other advance test such as PET scan, SPECT scan Functional MRI are reserved for rare refractory patients. 


    How Are Seizures Treated?


    For almost all children with epilepsy, the first and most effective treatment is medicine. More than 20 medicines treat epilepsy. Different medicines are more effective for different types of seizures. These medicines are called anticonvulsants, anti-epileptics or antiseizure medicines.


    Medicine helps about 2 out of 3 children with epilepsy stop having seizures. Most children and teens can control their seizures with just 1 kind of medicine.


    Specific treatment for a seizure will be determined by your child's doctor based on:

    • Your child's age, overall health, and medical history
    • Extent of the condition
    • Type of seizure
    • Your child's tolerance for specific medications, procedures, or therapies
    • Expectations for the course of the condition
    • Your opinion or preference

    The goal of seizure management is to control, stop, or decrease the frequency of the seizures without interfering with the child's normal growth and development. The major goals of seizure management include the following:

    • Proper identification of the type of seizure
    • Using medication specific to the type of seizure
    • Using the least amount of medication to achieve adequate control
    • Maintaining good medicating levels


    Medications


    There are many types of medications used to treat seizures and epilepsy. Medications are selected based on the type of seizure, age of the child, side effects, the cost of the medication, and the adherence with the use of the medication.


    It is important to give your child his/her medication on time and as prescribed by your child's physician. Different people use up the medication in their body differently, so adjustments (schedule and dosage) may need to be made for good control of seizures.


    All medications can have side effects, although some children may not experience side effects. Discuss your child's medication side effects with his/her physician.



    Ketogenic Diet


    The ketogenic diet is sometimes offered to those children who continue to have seizures while on seizure medication. When the medications do not work, a ketogenic diet may be considered. No one knows exactly how the diet works, but some children do become seizure-free when put on the diet. However, the diet does not work for everyone.



    Additional Treatment Options


    • Vagus nerve stimulation (VNS): Some children, whose seizures are not being well-controlled with seizure medications, may benefit from a procedure called vagus nerve stimulation (VNS). 
    • Surgery: Another treatment option for seizures is surgery. Surgery may be considered in a child who has seizures that are unable to be controlled with medications; or has seizures that always start in one area of the brain; or has a seizure in a part of the brain that can be removed without disrupting important behaviours such as speech, memory, or vision.

Developmental Coordination Disorder

About Developmental Coordination Disorder

Developmental coordination disorder or dyspraxia is a common neuromotor condition, affecting 5%–6% of school-aged children.


Child with developmental coordination disorder have motor coordination below expectations for his or her chronologic age, may have been described as “clumsy” and may have had delays in early motor milestones, such as walking and crawling. Difficulties with coordination of either gross or fine motor movements, or both, interfere with academic achievement or activities of daily living.


Developmental coordination disorder could be present in a child whose parents, caregiver or schoolteacher expresses concerns that he or she is unusually clumsy and is showing persistent delays in gross or fine motor milestones. Children who have developmental coordination disorder frequently have other childhood disorders (e.g., attention-deficit/hyperactivity disorder [ADHD], autism spectrum disorder or specific learning disabilities).


Evidence suggests that children do not “grow out” of DCD and difficulties may extend into adolescence and sometimes into adult life. Consequently, early diagnosis and intervention is important for both child and family.

About Developmental Delay

Developmental delay occurs when a child does not achieve developmental milestones in comparison to peers of the same age range. The estimated incidence of GDD is 1–3% of children aged 5 years or younger. The degree of developmental delay can be further classified as mild (functional age < 33% below chronological age), moderate (functional age 34%–66% of chronological age) and severe (functional age < 66% of chronological age).

 

The delay can be in a single domain (i.e., isolated developmental delay) or more than one domain. A significant delay in two or more developmental domains affecting children under the age of five years is termed global developmental delay (GDD). Developmental domains include gross or fine motor skills, speech and language, cognition, personal-social and activities of daily living.

 

Multiple causes or illnesses can contribute to developmental delay. This could be acquired, genetic or metabolic disorder. Early identification of developmental delays and appropriate management can positively alter the child’s developmental trajectory.

 

It is very important to see a doctor if you feel like your child has features of developmental delay. A systematic diagnostic approach is needed in patients with GDD to identify a specific underlying cause.

Functional Neurological Disorder

What is FND?

Functional neurologic disorders are common set of neurological disorders seen in paediatric population. It has been known by various terminology before. However, FND is a newer and broader term that includes feature nervous system (neurological) symptoms that can't be explained by a neurological disease or other medical condition. However, the symptoms are real and cause significant distress or problems functioning. We encountered these patients in significant numbers in our clinic. Interestingly, this disorder can coexist with organic pathology. For example, epilepsy and non-epileptic events.


Children and adolescent’s presentation could vary and may have specific patterns. The symptom presentation may be very complex sometimes and hard to explain by neurological localization. These disorders can affect our thinking, movements, strength, gait, and special senses. 

  • Signs & Symptoms

    Signs and symptoms that affect body movement and function may include:


    • Limb weakness
    • Fainting episodes/dizziness/ drops attacks
    • Headache 
    • Seizure like events – non epileptic events 
    • Sensory symptoms 
    • Swallowing problems
    • Tremor/ dystonia
    • Abnormal gait
    • Post-concussion syndrome 
    • Jerks and twitches
    • Slurred speech/Word finding difficulty 
    • Other symptoms 
    • Poor memory/concentration
    • Tiredness/fatigue/
    • Chronic pain/complex regional pain 
    • Low mood/ panic/anxiety  
    • Visual symptoms - double vision/blurred vision/blindness
    • Seizures or episodes of shaking and apparent loss of consciousness (nonepileptic seizures)
    • Episodes of unresponsiveness
    • Hearing problems – tinnitus/hearing loss 

  • Causes

    The condition may be triggered by a neurological disorder or by a reaction to stress or psychological or physical trauma, but that's not always the case. Functional neurologic disorders are related to how the brain functions, rather than damage to the brain's structure (such as from a stroke, multiple sclerosis, infection or injury).


    Many different predisposing factors likely make patients more susceptible to functional symptoms, and at the time of illness onset, these precipitating factors may likely trigger or exacerbate FND symptoms which then cultivate on-going functional symptoms. Perpetuating factors likely begin to create new neuropathways, which could eventually cause changes in the brain. These neuropathways can be retrained with proper treatment and care.


    Patients with functional symptoms do not have damage to their nervous systems so it’s not surprising you can't see it on a scan. Instead, the nervous system is not functioning properly.


    If you were a computer, it’s like having a software problem rather than a hardware problem. If you have a software bug on your computer, it might keep crashing or work really slowly. You wouldn't solve that problem by opening up the computer and looking at the components.  You wouldn't see anything if you did an x-ray of that computer. In the most recent fMRI studies, patients with FND showed decreased functional connectivity in some parts of the brain compared to their healthy counterparts.


    There are significant number of research going on across the world to understand the complexities of abnormal brain networking in these conditions. 


  • Management

    The most important first step toward a successful treatment for Functional Neurological Disorder comes from clear and effective communication in a mutually respectable environment. Your doctor will explain the diagnosis and educate the patient is of critical importance to the subsequent likelihood of successful treatment. The diagnosis is made on the clinical grounds. No investigations are required in majority of the cases. Sometimes, the doctor may ask for the test if there is some confusion in the diagnosis.  The role of multidisciplinary team approach is paramount in many cases. Recovery may be slow and may take weeks to months. 


    Early diagnosis and treatment, especially education about the condition, can help with recovery.


What is Cerebral Palsy?

Cerebral palsy describes a group of permanent disorders of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing foetal or immature brain. The motor disorders of CP are often accompanied by disturbances of sensation, perception, cognition, communication, and behaviour, by epilepsy, and by secondary musculoskeletal problems.

 

Intellectual impairment occurs in about two thirds of patients with cerebral palsy. About one half of paediatric patients have seizures. Growth problems are common, as well as neurologic abnormalities such as impaired vision or hearing.


The prevalence of CP for all live births’ ranges from 1.5 to 3 per 1,000 live births. It is the most common motor and movement disability of childhood.

  • Types

    Based on clinical findings, CP is generally classified as spastic, dyskinetic, and hypotonic/ataxic or mixed.


    Spastic type: Seventy to 80 percent of patients with cerebral palsy have spastic clinical features. Affected limbs may demonstrate increased deep tendon reflexes, tremors, muscular hypertonicity, weakness, and a characteristic scissors gait with toe-walking.


    Dyskinetic type: The athetoid or dyskinetic type of cerebral palsy, affecting 10 to 20 percent of patients, is characterized by abnormally slow, writhing movements of the hands, feet, arms, or legs that are exacerbated during periods of stress and absent during sleep.


    Hypotonic or ataxic type: hypotonic or ataxic cerebral palsy affects 5 to 10 percent of patients and predominately impairs balance and coordination. These patients walk with a wide-based gait and have intention tremors that complicate performance of daily activities requiring fine-motor function.


  • Signs & Symptoms

    Kindly consider contacting us for an appointment if your child has any of the below mentioned symptoms:


    • Stiffness of muscles
    • Posturing of limbs 
    • Hypotonia 
    • Incoordination
    • Asymmetrical motor development
    • Seizures 
    • Language delay and swallowing issues
    • Hearing/ vision issues 
    • Cognitive issues

  • Management

    The goal of management of cerebral palsy is not to cure or to achieve normalcy but to increase functionality, improve capabilities, and sustain health in terms of locomotion, cognitive development, social interaction, and independence. The best clinical outcomes result from early, intensive management. Optimal treatment in children requires a team approach.


    An approach focuses on total patient development, not just on improvement of a single symptom. Treatment programs encompass physical and behavioural therapy, pharmacologic and surgical treatments, mechanical aids, and management of associated medical conditions. In physical, occupational, speech, and behavioural therapies, the goals include enhancing patient and caregiver inter-actions while providing family support.


Neuromuscular Disorders

What are NMDs?

The brain controls the movements of skeletal (voluntary) muscles via specialised nerves. The combination of the nervous system and muscles, working together to permit movement, is known as the neuromuscular system.

 

Neuromuscular disorders are common causes of weakness and hypotonia in the infantile period and in childhood. These conditions impact the peripheral nervous system, which includes the muscles, neuromuscular (nerve-muscle) junction, peripheral nerves in the limbs and motor-nerve cells in the spinal cord.


Earlier diagnosis and treatment of neuromuscular disorders optimises long-term function. To diagnose this condition, your doctor may request range of blood test that may be relevant to the condition. This might include metabolic testing, genetic testing, MRI imaging of different parts of body, nerve conduction studies (to measure the ability of nerves to conduct electricity), electromyography (EMG), muscle and nerve biopsy. 

  • Types

    Classifications of neuromuscular disorders include muscle and nerve disorders, and include muscular dystrophies such as Duchenne and Becker muscular dystrophies, congenital myasthenic syndromes, congenital myopathies and inherited and acquired neuropathies. 


  • Signs & Symptoms

    Kindly consider contacting us for an appointment if your child has any of the below mentioned symptoms:


    1. Delayed development 
    2. Weakness and numbness/tingling of arms and legs
    3. Difficulty walking
    4. Acute onset of weakness or sensory symptoms
    5. Double vision, droopy eyelids, swallowing problems, chewing problems, muscle weakness of arms and/or legs.
    6. High arch feet and hammer toes, weakness of legs and hands, numbness of feet, painful feet.
    7. Muscle weakness, dark-coloured urine myoglobinuria, elevated CK or CPK, muscle fatigue, muscle cramps

  • Causes

    The majority of neuromuscular causes in paediatric age group are inherited or genetic in origin. Few of them might have diverse reasons including metabolic, inflammatory, acquired and others.


  • Management

    The management depends on which part of the neuromuscular system is involved. Most often, there is no cure and medications are directed to ameliorate the symptoms.


    Physical and occupational therapies, braces and other orthopaedic devices, and orthopaedic surgery can help children cope with the disabling symptoms of the disease.

    The doctors at our clinic will make a comprehensive plan based on individual cases so that maximum benefit could be utilized early in the disease process. 


About Movement Disorders

Many children make slightly unusual, repetitive, and predictable movements—also called paediatric movement disorders.


Some movement disorders are set off by stressful events, while others occur in tandem with psychological disorders. Still others are primarily physiological in nature. Although the vast majority of cases disappear with time and require no treatment, if the movements become disruptive and affect the ability of a child to function well at home or at school, parents may decide to seek advice and treatment from a paediatric neurologist.


What are Movement Disorders?

Movement disorders are defined by a heterogeneous constellation of signs and symptoms and are challenging to diagnose in children.


Paediatric movement disorders are neurological conditions that affect the speed, fluency, quality, and ease of movement in children. These comprise of a large group of disorders (tics, myoclonus, tremor, dystonia, chorea, Parkinsonism, ataxia), often with mixed phenotypes.


Your doctor will diagnose whether the movement is normal, physiological developmental motor patterns and pathological movement disorders. Sometimes, it may be difficult to distinguish physiological developmental motor patterns from pathological movement disorders. Children should be monitored to evaluate how the movement pattern develops. In general, physiological patterns will subside with typical psychomotor development. Besides developmental features, other neurological diseases (such as epilepsy) may resemble movement disorders.

  • Types

    Movement disorders are classified into three major groups: hyperkinetic and hypokinetic movement disorders and ataxia. In children, hyperkinetic movement disorders are more prevalent and include tics, dystonia, chorea, myoclonus, stereotypies, and tremor. Hypokinetic movement disorders, including Parkinsonism, are rare in children. Ataxia is not a hypo- or hyperkinetic movement disorder, but includes disorganized and poorly executed movements, and is relatively common in children.



    What are tics?


    Tics are defined as sudden, rapid, recurrent, non- rhythmic movements or vocalizations. A distinction is made between motor and phonic tics, and each is subdivided as simple or complex. Simple motor tics comprise a single muscle or localized muscle group, such as eye blinking. Complex motor tics involve either a cluster of simple actions or a coordinated sequence of movements. Simple phonic tics include sounds and noises such as humming or sniffing, whereas complex phonic tics comprise the repetition of words, syllables, or phrases. Positive clues are a waxing and waning course, worsening by stress or excitement, the report of a premonitory sensation, and brief voluntary suppressibility followed by a rebound.



    What are motor stereotypies?


    Stereotypies are repetitive movements or sounds. These may include simple movements such as body-rocking, head-nodding, finger-tapping, or more complex movements such as arm and hand- flapping, waving, or pacing. Stereotypies form a normal part of development (especially between the ages of 2-5), but for some children they continue into adolescence (teenage years). Stereotypies are often present on their own but may also be seen with other medical conditions to do with brain development, such as autism spectrum disorder, dyspraxia and Tourette’s syndrome.


    Stereotypies do not cause any damage to the brain, but it is not yet known exactly what causes them or why some children perform these movements/sounds and others do not. It is thought that stereotypies may reflect learned patterns of behaviour, soothing or stimulating themselves, differential brain maturation, genes or may be a combination of these factors.


    Most children respond well to self-help strategies and do not require specific treatments, as stereotypies typically reduce with age and over time. However, if the stereotypies do interfere with school, friendships, or everyday life then treatment may be needed. A form of behavioural therapy called habit reversal therapy (HRT) has been shown to be effective for the management of stereotypies. Cognitive behavioural therapy (CBT) may also be useful to help manage thoughts and emotional feelings that may trigger the stereotypies. Medications are also available, although these are rarely used.



    What is dystonia? 


    Dystonia causes the body muscles to twist into abnormal postures. The aetiology of dystonia can be divided into acquired or genetic. Acquired causes can be divided in structural lesions, vascular insults, and infectious or auto-immune disorders. For genetic dystonia, the list of causes is extensive. Classification of the clinical characteristics of dystonia is important, because of the implications for diagnostic testing and treatment.


  • Management

    We perform a thorough evaluation, collect a complete medical and family history and create an individualized treatment plan that meets the needs of both the child and the family. Diagnostic testing may also be ordered, including a brain MRI, lumbar puncture for metabolic studies, genetic testing, metabolic testing, gait evaluation, EEG (to test the electrical activity of the brain), or an ophthalmology evaluation.


    Some children with movement disorders such as tics may also have anxiety, attention deficit hyperactivity disorder (ADHD) and/or obsessive-compulsive behaviours. If a doctor determines that a child also has one of these disorders, the child may require additional treatments or medications. The need for treatment generally depends on how severe the problem is and should always balance potential risks and benefits.


    Some children with movement disorders benefit from Cognitive Behavioral Treatment (CBT), a form of talk therapy that increases awareness of habitual thoughts and behaviours and how those are linked.


About Headaches

A headache is an ache or pain that occurs in any region of the head. There are many different types of headaches, migraine, tension type, cluster headaches, sinus headache, and rarely due to serious underlying condition. Headaches are common in children and teenagers. Most often, these are easily managed at home. However, if symptoms are frequent or/ and intense, it would be worthwhile to see a doctor. 


Making a correct diagnosis in young children may be difficult as they are too young to describe their complaints. On many occasions, your doctor may have to see the child few times or wait for symptoms to fully develop in order to give parents a diagnosis.


Sometimes, other symptoms could complicate the picture. It is worthwhile to discuss all symptoms with your doctor and wait for all investigations are over before reaching the correct diagnosis. 

  • Types

    There are different reasons a child can have headache. Common types are migraine and tension type headache. Sometimes, headaches are precipitated by dental problems, infections, eye problems, ENT problems, medication side effects and head injuries. Sometimes, depending upon the symptoms, a doctor may be concerned and request an MRI scan or blood test. 


    Most are not serious and can be easily treated with simple measures such as Paracetamol and/or Ibuprofen. 



    What is migraine?

    Migraines are recognised by the World Health Organisation as the third most disabling condition in the world.

    Migraines are common in the paediatric age group especially among teenagers. It could significantly affect quality of life if not adequately treated. Children often miss school, and they may sometimes have a great impact on family and friends.


    Migraines usually involves a combination of symptoms that typically include headache, nausea, vomiting, sensitivity to noise, light or smell. These symptoms may or may not present in all children. Sometimes, headache is not prominent at all and other symptoms such as dizziness, vertigo, abdominal pain, weakness are the presenting symptoms.


    There are certain triggers such as poor sleep, menstrual cycle, missing meals, dehydration, and some foods such as include chocolate, cheese, caffeinated drinks, additives such as monosodium glutamate (MSG) and aspartame (an artificial sweetener) and fatty or salty foods Sometimes, painkillers themselves may be a trigger.


  • Signs & Symptoms

    Kindly consider contacting us for an appointment if your child experiences symptoms such as new onset headache, progressive pain, repeated vomiting, focal weakness, double/blurry vision, pain in night hours. These children need to be assessed urgently.


    Also, if headaches are frequent and interrupting your child’s sleep or school attendance, no repones of common drugs should also prompt parents to visit a doctor.


  • Causes

    There are number of causes which could trigger head pain. It is pertinent to look for source of headache by means of detailed medical history and physical examination.  Your child’s past medical history is also important to try to identify any previous illnesses or current medical conditions that might trigger headache. In some disorders such as migraine, a detailed family history is helpful in making a current diagnosis. Based on these factors, your doctor may ask for investigations to reach a proper diagnosis. 


    Other aspects of your child’s everyday life will be considered too, such as stress or problems at school or home. This will help in identify the triggers for headaches. The doctor will ask which headache treatments to have been tried previously and to what degree they were helpful. 


  • Management

    Pharmacological management:

    Treatment of headache depends on underlying cause and type of headache. Management of headache in children is multifaceted and involves a combination of approaches - making an accurate diagnosis, helping understand the condition, support at home and school, psychological help, identifying and avoiding triggers and medication.


    Medications are given during acute phase and/or continue regularly as part of preventive strategy to avoid headache to happen frequently. 


    Your doctor will discuss the right approach based on frequency and intensity of these episodes. There are different types of medications available for managing headache. Efficacy and side effects of medications may play a major role in deciding which drug is best for your child.



    Non pharmacological management:

    Lifestyle changes such as having a regular sleep pattern, drinking plenty of fluid, having downtime from screens, eating regular meals, avoiding taking too many painkillers or avoid caffeinated soft drinks. It is important to establish good lifestyle as this may make it more difficult for an attack to be triggered and it may make other preventative treatments more effective if they are still needed. 


    Some type of headache requires relaxation techniques, exercise, cognitive behaviour therapy to manage pain. In children with stress and depression, psychology sessions may be required. 



    Other sources of information and support: 

    headacheaustralia.org.au 

    www.migrainetrust.org 

    http://www.migraine.org.uk 

    www.thebraincharity.org.uk