The headache that you describe is indeed most likely migraine headache.  This is fairly common in children.  Let me explain a little about migraine before giving you any suggestion.

There are many reasons for anyone to have a headache.  Influenza infection, for example, that comes in epidemics in winter is often associated with fever, headache, as well as symptoms of a bad cold.  Sinus infection can also give us a bad headache.  Some can get headaches from exposure to too much sun.

Those who suffer from migraine have repeated episodes of fairly severe headache that mostly affect one side of the head, either in the front or on the side above the ear.  They frequently describe a throbbing or pulsating feeling in the head.  Because the headache is quite severe, many children have to stop even their favourite activities and lay down.  Bright light and loud noise can make their headache worse.  Many also feel sick in the stomach, and the headache can get better after they vomit.  These headaches usually last anywhere from one hour to as long as several days.

Some children can experience additional symptoms called aura before the onset of their headaches.  The word aura means a feeling before something important is going to happen.  The aura can include seeing flickering light, spots, or lines; or feeling pins and needles or numbness on one side of the body.

In spite of advances in medical knowledge, we still don’t fully understand how migraine happens, and why it affects some but not others.  There is definitely a genetic component to migraine headache, because it tends to happen in blood-related family members.

Those who are prone to migraine headaches appear to have areas of their brain where the nerve cells are very sensitive.  At the onset of the headache, these brain cells become ‘excited’ and begin stimulating some blood vessels in the brain and make them dilate and leak out protein.  This process of dilating and leaking protein is very similar to other inflammatory process in the body.

As a result of this inflammatory process, the pain nerve fibers that are present around blood vessels become stretched, giving rise to the pulsating pain of migraine headache.

You will understand this explanation better if you ever have had an infected wound.  The blood vessels around the wound become dilated to bring more blood and extra white blood cells to the infected area to fight the germs.  Fluid also leaks out of blood vessels.  The infected wound becomes red and swollen, and you may feel the pulsating pain there.  The only difference is that there are no germs involved in migraine headache.

The most common trigger for migraine headache is stress, which may not be obvious to parents.  In your family’s situation, your son may be stressed by things that his hyperactive brother does, even though this brother may not have done that intentionally.  Lack of sleep is also noticed to be a common cause of migraine, but food is less likely a source of problem for children.

As you can imagine, treatment of migraine in children involve elimination or reduction of some of these triggering factors.  Developing regular sleep habit and having exercise routine are important, and both of these can reduce stress in children.  If your son is consuming too much caffeine (in tea, coffee, or soft drink), this should be reduced also.

Many pain medications are effective in the treatment of migraine headache in children.  Acetaminophen (Tylenol) is one of the most common over-the-counter medicine available.  However, ibuprofen (Motrin or Advil) and naproxen have the additional benefit of reducing the inflammation present in migraine headache.  You can get ibuprofen over the counter, but naproxen requires a prescription from your doctor.

Regardless of which pain medicine that you use, it has to be taken as soon as he feels the pain is coming, instead of waiting until the pain is severe.  The earlier the medicine is taken, the better it works.  Therefore, you should have the medicine available at his school, and he should be allowed to take it when he needs it.  He may have to go into a dark and quiet room when he has a migraine headache.

Although these pain medications are useful for migraine, using them more than 5 times a week can cause more headache.  Therefore, it is important not to overuse pain medicine.

In addition to pain medications, there are several other medicines designed specifically to treat migraine headaches, although their effectiveness in children has not been proven by research.  However, experience from many specialists suggests that some of them can be helpful if regular pain medications are not effective.  Lengthy discussion on these medications is beyond the scope of this column, your doctor should have this information if your son needs them.

For those who have frequent migraine headaches, like more than three times a month, one should also consider using medications that can prevent these headaches from occuring.