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Joe Elser: Pediatrician 

Treating headache in children

click to enlarge PEDIATRICIAN: Joe Elser.
  • PEDIATRICIAN: Joe Elser.

When a baby holds its head in its hands and cries until it falls asleep and then wakes up happy again, its mother may know right away what's happening.

It's migraine, and it's genetic — which is why moms, sufferers themselves, may rightly suspect the cause of their infants' distress.

Dr. Joe Elser — who, as it happens, also has migraine headaches — sees about 900 new patients every year in Arkansas Children's Hospital's migraine clinic, a clinic he started in 1987. He's seen thousands of pediatric migraine sufferers over the years — experience few other physicians have.

Headache is common in children; the Migraine Research Foundation says 10 percent of school-aged kids suffer from migraine. “I'm convinced that a 2-month-old with colic has migraine,” he said — though he laughingly added that his colleagues say that with him, everything is migraine.

“I can do things for these kids,” Elser said, thanks to triptan medications, a revolution in the treatment of migraine. For children who have weekly headaches, he treats with daily prophylactic drugs, including the anti-seizure med Topomax, the tricyclic antidepressants Elavil and the calcium channel blocker Verapamil. The drug Imitrex is safe to use in children as young as 18 months. Elser is currently participating in a study of triptans to compare how quickly they alleviate the pain.

Though the cause of their pain is DNA deep, there are ways a child can keep from triggering a headache, Elser says. If allergies are a trigger, they need to get their allergies under control. They need to make sure they're getting good sleep (too much can cause headache), exercise smartly (dehydration is a trigger) and avoid foods that experience tells them will bring on the pain. Elser says teen-agers can benefit from learning stress management techniques; psychologists in the headache clinic work with teens on ways to relax. They do not need to have their vision checked, a common myth about headaches, Elser said.

A native of Hot Springs, where he was in a Medical Explorers Boy Scout post, Elser sees kids from birth to age 21 in the General Pediatric Clinic. He realized during a stint at Children's during his senior year at the University of Arkansas for Medical Sciences that he liked working with children. “Kids are special,” Elser said. “They rarely do things to themselves” that send them to the doctor. “Most sick kids get better,” he added. “You see terrible things,” he acknowledged, “but the good outweighs the bad.”

It's also a specialty in which Elser doesn't have to wear a white coat. He believes the physician uniform intimidates children, so he dresses in casual clothes, a habit that the chancellor once said he couldn't understand, Elser said. “If you had on you what we have on us,” Elser said he told the chancellor, he'd see the wisdom in the polo shirts.

Elser, who also teaches and does hospitalist duty at Children's, said that nearly one in four children he sees at Children's is Hispanic. They now know — though they didn't at first — that they can come to Children's and not be grilled about whether they are legal. And thanks to the state's funding of insurance programs like ArKids First and Medicaid, Elser said, most children who come to Children's are insured. When the state passed a soda pop tax in 1992 to bolster Medicaid, Children's was “able to take care of kids like never before,” Elser said.

Not only does Elser have migraines, he's simpatico with kids for another reason: He and his wife, Angie, have six, ranging in age from 5 to 18.

 

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