Tyler Stewart was 5 when he had his first migraine. He stepped out of class to get a drink of water, got a headache and vomited. His mom, Kelly Stewart, got a call from the school. The nurse suspected Tyler had a migraine.
Tyler, now 15, says chronic pediatric migraines affected his entire childhood experience, from school to sports.
“The day I had my test to qualify for my black belt in tae kwon do, I had a migraine,” he said. “I got the black belt, but I had to push through a migraine to do it.”
This past summer, Tyler began to see Dr. Emily Law, a psychologist in Seattle Children’s Pain Medicine program and a researcher at Seattle Children’s Research Institute. She studies the use of behavioral interventions and screening tools in treating pediatric migraines, and recently received a grant from the National Institutes of Health to support her research.
“A lot of kids with migraines don’t get behavioral treatment soon enough,” Law said. “Pediatric migraines are debilitating not only physically, but also socially and developmentally because these kids frequently miss out on school and activities.”
Over the years, many of Tyler’s school days ended early with mom Kelly picking him up and bringing him home.
“He missed 56 days of school in 9th grade and started falling back in his studies,” Kelly Stewart said. “He’d turn off the lights in his room, curl up in a tight ball and turn on a fan because he’d get hot during migraines. This would happen three, sometimes four times a week.”
Kelly Stewart also spent a lot of time advocating for her son at school in Maple Valley, Wash. She says teachers didn’t always understand how debilitating migraines could be, so they worked with his school to develop a plan for how to handle his migraines.
Harnessing the mind to fight migraines
Tyler takes medication for his migraines and uses Law’s behavioral intervention approach. Their progress in reducing and managing his migraines has been remarkable.
“One of the most important things I learned from Dr. Law is that I could teach my mind and body that not every pain is an emergency,” he said.
Law worked with Tyler and his parents on a plan that would help Tyler achieve his goal to stay in school when he had a migraine. For Tyler, this included using relaxation methods in the classroom, taking breaks during the school day to increase stamina and working with his teachers and other school staff.
Tyler completed the Biofeedback Program at Seattle Children’s Hospital, where he learned to use relaxation methods with sensors that showed him his vital signs like heart rate and temperature. The patient observes in real-time how relaxation methods affect their bodies and takes the focus away from the pain. Law has enhanced Tyler’s biofeedback training by helping him use these skills at school so that he doesn’t have to go home when he has a migraine.
“Biofeedback was one of the coolest things I have ever done,” Tyler said. “Dr. Law has me think about a favorite memory, like the feeling of the wind when I longboard. She will prompt me to think of the smell and taste of the memory. The deeper I am into the relaxation session, the calmer my mind is.”
Tyler’s mom was apprehensive about the new techniques, but then she saw how they helped Tyler get past his migraines.
“Dr. Law also recommended Tyler try acupuncture,” she said. “He dislikes needles, but said he was willing to try anything. Sure enough, the acupuncture was effective in reducing his migraines.”
Researching pediatric migraines
The $140,000 grant that Law received from the National Institute of Neurological Disorders and Stroke supports her work in researching behavioral interventions for chronic migraines, developing a screening tool and designing potential web-based interventions for pediatric chronic migraines.
“One out of 60 kids that comes to a neurology clinic has chronic migraines, so it’s a common condition and one that can isolate kids academically and socially at critical developmental stages,” she said. “My goal is to find new ways to help patients and families manage chronic pain so they can lead normal lives.”
Law also helps parents understand how to manage their child’s pain.
“Often a parent’s first reaction when a child says they have pain is to keep them home from school or allow them to get out of other daily activities like chores or sports practice,” Law said. “The danger in doing that when a child has a chronic pain problem is that over time this can create a cycle where pain signaling increases and disability from pain worsens. I work with kids and parents to disrupt this cycle, re-train the child’s pain signaling and support parents in helping their kids return to school, sports and other activities.”
A turning point in treatment
Tyler says the team approach with his parents and Law to develop an individualized plan was a turning point. He adds it’s important to be open to treatment options because you never know what might work.
“It’s been a frustrating and stressful part of my life for a long time, but now I have the right techniques to not let migraines take over,” he said.
Kelly Stewart has been with Tyler every step of the way. Her advice to parents who have a child with a chronic condition is to see the many appointments as more than just a medical visit and use them as one-on-one time. Most of all, she is glad to see her son improving and understanding how he handles migraines.
“The last year has been so different for us because of Seattle Children’s,” she said. “His grades are good, he’s learning and he’s happier. It’s such a relief.”