HeadWise HeadWise: Volume 3, Issue 2 | Page 28

kids’ korner you ask, our physician experts answer. PERIODIC SYNDROMES IN Jack Gladstein, MD Professor, Department of Pediatrics Director, Pediatric and Young Adult Headache Clinic University of Maryland School of Medicine Baltimore, Maryland Childhood O ne of the hallmark characteristics of migraine is its periodic occurrence. Migraine is not described as a daily headache—particularly in children. However, parents may note a pattern to bouts of vomiting, dizziness, fever, and limb pain. The symptoms may hint at migraine, particularly if there is a family history of migraine. However, it is essential that more serious conditions be ruled-out. The periodic syndromes of childhood refer to a group of disorders that are identifiable because of the fixed rhythm of the symptoms. Although these syndromes are rare, they are scary to parents and children alike. Often, the diagnosis may be delayed for months to years. In each, the attacks are intermittent and the youngster returns to normal between attacks. Establishing this diagnosis is very important for treatment options as well as helping parents cope, recognizing the mystery that is making their child sick. Many of these conditions eventually lead to migraine at an older age. In addition to explaining the condition to the parents, the physician must also warn the parents to expect the onset of migraine later in their child’s life. This list of symptoms are often called precursors or predictors of migraine. Children may experience one or a combination of these complaints: • Cyclical vomiting – attacks of repeated vomiting with a pattern. • Recurrent but vague stomach pains. • Dizzy spells. • Recurrent episodes of fever – up to 103 to 104 degrees F, over several days • Periodic attacks of pain and/or stiffness in the limbs and joints Benign paroxysmal torticollis occurs in infants. Babies are happy, wake up from a nap and appear to have their head stuck to one side or the other. The baby looks pale, acts cranky, and is light sensitive (sounds like migraine). The attack can last up to a few days. The work-up should include an MRI, as well as blood tests to rule-out metabolic defects. If this type of attack occurs more than once, and a pattern develops, the diagnosis becomes more obvious. Benign paroxysmal vertigo occurs in toddlers as opposed to infants. Again, the youngster can be active and playing when the attack starts. The toddler will cling to the parent, because the child feels dizzy and unsteady. Other 26 HEAD WISE | Volume 3, Issue 2 • 2013