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Posts Tagged ‘Colic’

Really? Is Infant Colic Due to Migraine?

Jack Maypole, MD
Contributing Writer and Goddard School Educational Advisory Board Member

For those of you who might be pediatric research wonks, or better yet, for those of you out there who may be parents of young fussy infants, take note: now we have a (another) new theory as to the cause of colic. Now, while you shift that crying baby to your other shoulder and rock gently, let’s dig a little deeper as to what this is all about.

Colic is the unpleasant term for the young infant who follows the Rule of Threes: he or she cries for three or more hours a day for three or more weeks, at least three days out of the week(for anyone who has survived even a flight with a howling babe, we know that is a lot). Colic is common: it happens in about 1 in 5 babies. These so-called colicky infants tend to have a sort of routine, with the onset of a frantic crying pattern— often at around the same time each day(perhaps leading to why some parents call this ‘grandma time!”).  The peak of intensity for colic hits at around 6 weeks of age and can last up to about 2 or 3 months, depending on the child.  As one might expect, colic is a common topic in the first few visits to the primary care clinic.

And, colic is a bit of a medical conundrum. There is no blood test for colic, and nor is there any physical finding that slam dunks the diagnosis.  Sorry, Dr. House. Classically, the diagnosis of colic is one of exclusion, whereby the clinician works with the family to rule out other potential causes of infant crying and fussiness. And, for the record, the comprehensive list of ‘what makes babies cry’ would—no joke—go on for dozens of lines.

For the family members and the health provider, the history is key.  An evaluation best reviews the entirety of a child’s schedule, patterns of eating and sleep and wakefulness, and makes a careful examination of how the crying and fussiness occur (are there triggers? What makes it better? When does it happen? What have you tried so far? And how has it worked?).  Fortunately, a little bit of information, time, and a reassuring exam can go a long way towards making the diagnosis.  Along the way, a discerning clinician will work to rule out the more common or concerning causes of infant distress, such as fever, acid reflux, food or milk protein allergy, a hair in the eye, or a piece of hair tourniqueting on a toe.  When necessary or if other causes are suspected, appropriate lab testing may be considered.  If all else turns up unremarkable, and there is an otherwise thriving, growing child before us  who cries with regularity…colic rises to the top of likely explanations.

So what is the most recent explanation for colic in infancy?  A study published in the Journal of the American Medical Association suggests that colic may be a form of infant migraine. You heard that right:  there may be an association between babies with colic and migraine headaches in older children.   Migraines themselves are incompletely understood and are thought to arise from the interplay of inflammation, nerves and blood vessels running to the brain. Alterations in blood circulation precipitate the infamous headthumpers with their raft of other symptoms.  And, we do know in preschool and school age children, a fair number of pediatric migraine sufferers describe abdominal discomfort as the most prominent symptom of their episodes, especially nausea and belly pain. Interesting, eh?

In the study, researchers followed 208 children, ages 6-18 year old, diagnosed with migraines in 3 European medical center emergency rooms. Parents were questioned  about their children’s headaches and personal health history. Analysis of the data showed children with migraine headaches were more likely to have had a history of colic than children without migraine headache histories—(about 73% versus 26% respectively).

Here’s the rub:  the researchers propose the colicky symptoms in infants could be due to disruptions in blood flow to the gut that mirror the supposed mechanism of migraines in older children and adults. In effect, the babies  have a headache in their stomach. Total bunk? Not necessarily.  But, as parents and clinicians, we have remember the old trap of ‘association doesn’t necessarily mean causation.”  In other words, this baby migraine theory could explain some or all of colic. Or, not.  The study goes on to propose (like all good researchy papers) with a call for more research, including trialing migraine therapies on infants with colic. Given babies are fragile research subjects, and the enthusiasm for trying pharmaceuticals on them is low, this is not likely to happen soon.

So,  babies will continue to fuss and kick and scream during their grandma’s time while we suss this out. Meantime,  I recommend that parents work with their child’s primary care provider on the tried and true approaches to reducing colic-related fussiness. White noise (such as fans, washing machines, or TV screen snow), gentle rocking, or spins around the block in the stroller or carseat work best. For other mainstream and complementary and alternative approaches, see here: (http://www.mayoclinic.org/medical-edge-newspaper-2010/oct-29a.html  )

And, stay tuned colicwatchers! We will see if this new theory on an old problem bears out.

Link to the Journal of the American Medical Association Article

http://jama.jamanetwork.com/article.aspx?articleid=1679399