Cover Story

As a psychologist at Walter Reed Army Medical Center, Stacey A. Williams, PhD, provides clinical services for military personnel of all ages. But recently, she has developed an expertise in treating a specific population: children with migraines, most often girls ages 12 to 16.

"These are predominantly very bright children, who are very focused on achievement," says Williams, chief of pediatric behavioral health at the center, located in Washington, D.C. "When their headaches get worse, for whatever reason, they start missing school and get so anxious about falling behind that they refuse to go back."

That's when their parents get involved. Generally, a mother will take her child to a pediatrician, the pediatrician sends the child to a neurologist and the neurologist prescribes medications.

If after three months the child is still experiencing pain and missing school, says Williams, the neurologist often realizes that the child's condition may have far less to do with pain and far more to do with psychosocial stressors. That's when the neurologist recommends a visit with Williams.

Adolescents come to her often on high doses of painkillers and beta-blockers that, "unfortunately, are slowly increased, although they're not providing any kind of relief for the total problem," she says.

At the first visit, Williams talks to the children about their fears of falling behind academically, asking whether they have truly been threatened with failure. "I often find that there's no data to support that fear, so I ask 'Well, if we talk to your teacher about your medical problem, do you think your teacher won't listen?' They'll usually respond, 'Well, maybe,' and the children start to see that perhaps it's not so bad, that they have support from their parents and teachers."

She then teaches the children how to relax using biofeedback. "We put a lead on their fingers and they get to see on the computer screen that by relaxing, they can either make a ball move in a circle or they can get music tones to go louder," she explains. "In the era of Nintendo, kids love that."

And it works. Within four visits, most of her patients are taking less medication. A further bonus is that the children learn how to treat themselves.

"Adolescents certainly love to feel like they're in control, so I teach them how to handle their pain, how to relax, so they can get their blood to go where it's supposed to go and control their headaches. That's a very inviting message for them."

In working with the children and their parents, she often finds that the dynamics between adult and child are what prompt the children's headaches. Many times, it's a tense relationship between mothers and daughters that's troublesome, she finds.

In such cases, "the headache is the child's escape, the one time these girls can tell Mom 'Get lost, leave me alone,' and run in their rooms and turn off the lights without retribution or guilt," she says.

She works "very, very gingerly," with the mothers to help them understand how they may be unwittingly contributing to their daughters' migraine pain. "It's like stepping on eggs, but I make it clear that it's very hard to be an adolescent because one minute they want to hug Mom and be sick and pathetic, and other times they want to be the No. 1 cheerleader in charge of their lives."

Williams helps the mothers develop empathy and feel less threatened that their children are leaving or rejecting them. She helps them embrace the idea that their child is trying to grow up, to model them, to be independent.

Overall, she finds the children benefit quickly from her interventions. "Children are so trusting; they are able to learn different ways of looking at their fears and facing reality," and, therefore, learning new ways to cope with pain.

--S. MARTIN