Management of migraine

Article Abstract:

Migraine headaches in children are hard to diagnose because children have difficulty recounting new or previous symptoms, and because many of the features of classic adult migraine may be missing. Alternatively, prostration and vomiting may eclipse the headache in children. It is simplest and safest to designate as migraine those recurrent headaches which are periodic. In addition, the child should return to full health between attacks, and other causes of headache, including brain tumors, must be excluded. A relatively long term of observation, six months or more, may be needed before diagnosis can be made. This is best done by a general practitioner or community health service. Treatment of migraine should not be influenced by parental anxiety concerning the condition, but should be based strictly on evaluation of the child. Similar provoking factors may result in migraines or tension headaches, both of which may be present. Psychogenic headaches may also coexist with migraine. Thus stress, such as adjustment problems in school, neglect and abuse at home, fasting, fatigue, light, and minor head trauma may play a role. Much attention has been given to the relationship between diet and migraine, but little real improvement has followed dietary intervention. Drug treatment should be avoided if possible, and removal of causes of stress should be considered first. If needed, medication should be given at the earliest sign of attack, should be easily available in school, and should offer pain relief and thus, diminish anxiety. Acetaminophen has been used, as has aspirin. If these drug are insufficient, other drugs have been used with some success. No preventive treatment has been found. Most children respond within months to reassurance, advice, and modest treatment. Response failure may indicate a need to reappraise the diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Migraine, Migraine in children

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Chronic inflammatory bowel disease

Article Abstract:

Chronic inflammatory bowel diseases involve inflammation and impairment of the normal function of the intestines. Ulcerative colitis and Crohn's disease are two examples of inflammatory bowel disease. Crohn's disease causes inflammation, ulcers, and the growth of dense tissue similar to scar tissue in the gastrointestinal tract (esophagus, stomach and intestines). It is estimated that 5 to 6 out of every 100,000 people develop Crohn's disease and 5 to 10 out of every 100,000 people develop ulcerative colitis each year. It is not uncommon for Crohn's disease to affect parts of the body other than the gastrointestinal tract. Approximately one third of the children with this disease have growth retardation caused by slow bone development. In some cases the pancreas, skin and lungs may be affected. When the disease affects the face it causes the lips and face to swell and ulcers to appear in the mouth. The disease is diagnosed using a procedure called colonoscopy that allows the inside of the intestines to be visualized. Drugs used to treat this disease include sulphasalazine, mesalazine and steroids. Also, restricted diets have been shown to effective in reducing gastrointestinal symptoms. In some cases surgery (proctocolectomy, removal of a portion of the colon) can be effective, but it can cause other problems to develop in 10 to 20 percent of the cases. Allergic colitis (inflammation caused by an allergic reaction) is a relatively new form of inflammatory bowel disease. Cow's milk, soya and beef are the most common causes of allergic colitis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Development and progression, Inflammatory bowel diseases

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Anorexia nervosa complicating inflammatory bowel disease

Article Abstract:

Inflammatory bowel disease seems to be increasing among children and adolescents. The incidence of anorexia nervosa in children is not known, but in the young adolescent population its occurrence among males is higher than among females. This report considers two cases where both diseases were present simultaneously: a boy with ulcerative colitis who developed anorexia, and a girl with Crohn's disease who became anorectic after cessation of drug therapy. Corticosteroid treatment was administered to both patients as part of the therapy. In the first case, the boy stopped taking prednisolone because of real and imagined physical changes in his appearance, with life-threatening consequences. In the girl's case, her parents stopped her from taking medication to treat Crohn's disease, inflammation of the lower small intestine (ileum), because they had heard steroids induced weight gain, and this precipitated the anorexia. In both instances the children began to express inordinate concerns about their physical appearance. Medications including prednisolone are indicated in the treatment of both bowel diseases, but the risks of the use of the drug, other than the physiological ones, have to be dealt with. The use of alternative dietary regimens should be considered. More important, perhaps, is the urgent need to provide patient counselling about the drug reactions. Each patient undergoing these treatments should be carefully observed for sudden dietary and behavioral changes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies, Causes of, Complications and side effects, Anorexia nervosa, Adrenocortical hormones, Crohn's disease in children

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