Headaches in children

From the American Council for Headache Education Web site.

Headaches can be divided into two categories, primary or secondary. Primary refers to headaches that occur on their own and not as the result of some other health problem. Primary headaches include migraine, migraine with aura, tension-type headache, and cluster headache. Secondary refers to headaches that result from some cause or condition, such as a head injury or concussion, blood vessel problems, medication side effects, infections in the head or elsewhere in the body, sinus disease, or tumors. There are many different causes for secondary headaches, ranging from rare, serious diseases to easily treated conditions. Sometimes headaches occur almost every day and are called chronic daily headaches.

You should consult your family doctor if headaches are frequent or severe or include unusual symptoms. Your physician may ask you to describe features of your headaches (for example, the location of the pain, pain severity, and any other symptoms associated with the headache attack). To rule out the possibility of secondary headache, the physician may decide to order special tests, including a CT scan or an MRI. Worrisome symptoms that should be brought to your doctor's attention include:

  • Headaches that wake a child from sleep
  • Early morning vomiting without nausea (upset stomach)
  • Worsening or more frequent headaches
  • Personality changes
  • Complaints that "this is the worst headache I've ever had!"
  • The headache is different than previous headaches
  • Headaches with fever or a stiff neck
  • Headaches that follow an injury

What is a tension-type headache?

his type of headache has also been called a tension headache, muscle contraction headache, stress-related headache, and "ordinary headache." These headaches can be either episodic or chronic and may include tightness in the muscles of the head or neck.

A tension-type headache can last from 30 minutes to several days. Chronic tension headaches may persist for many months. The pain usually occurs on both sides of the head, is steady and nonthrobbing. Some people say "it feels like a band tightening around my head." The pain is usually mild to moderate in severity. Most of the time the headache does not affect the person's activity level.

Tension-type headaches are usually not associated with other symptoms, such as nausea or vomiting. Some people may experience sensitivity to light or sound with the headache, but not both. Muscle tightness may be noticed by some patients but doesn't always have to occur.

What is a migraine headache?

Migraine headaches are recurrent headaches that occur at intervals of days, weeks or months. There may or may not be a pattern to the attacks – for example, teenage girls may tend to have attacks at a particular point in their monthly menstrual cycle. Migraines generally have some of the following symptoms and characteristics:

  • Untreated, they can last from 2 to 48 hours in children. Sleep or medical treatment can reduce this time period.
  • Headache starts on one side of the head. This may vary from headache to headache and in children, they may start in the front or in both temples.
  • Throbbing or pounding pain during the headache.
  • Pain is rated as moderate to severe.
  • Pain gets worse with exertion. The pain may be so severe that it is difficult or almost impossible to continue with normal daily activities.
  • Nausea, vomiting, and/or stomach pain commonly occur with the attacks.
  • Light and/or sound sensitivity is also common.
  • Pain may be relieved with rest or sleep.
  • Other members of the family have had migraines or "sick headaches."
  • Warnings called auras may start before the headache. These auras can include blurry vision, flashing lights, colored spots, strange tastes, or weird sensations and usually precede the headache by 5 to 60 minutes.

What are chronic daily headaches?

In adults, headaches that occur at least 15 days per month for at least 3 months have been called chronic daily headaches. In children there is not yet a clear definition.

Some chronic daily headaches may have started as migraine and build to a daily frequency. These are sometimes called transformed migraines. Tension-type headaches that increase to near-daily frequency are known as chronic tension-type headaches. Chronic headaches can result from taking some types of medication – for example, acetaminophen (Tylenol), ibuprofen (Motrin), caffeine, and some prescription medications--almost every day. These are called drug rebound headaches. These headaches either return shortly after taking the medication or the medication stops working. The most effective way to make these headaches better is to stop taking pain medicines altogether for a few weeks. After that time, use of pain-relievers is limited to no more that 2 to 3 times per week.

Some people with chronic daily headaches are low in certain vitamins and minerals. It is important to eat balanced meals. Many children and adolescents may need to take a daily multi-vitamin. Your doctor or nurse practitioner may talk to you about getting blood tests to see if you need more vitamins or minerals.

What causes headaches?

There are different theories about the cause of migraine headaches. Often several family members are affected, suggesting genetic factors are partly responsible. Some individuals ay become hypersensitive to triggers in their environment, such as flickering lights, changing weather patterns, or strong odors. The true cause may be a combination of factors. Some of the possible causes include:

Blood vessel changes. Blood vessels in the head may first tighten and then expand during a migraine attack, changes that may explain the aura before and the throbbing pain during the migraine. Some migraine medication and other treatments may work by counteracting or blocking these changes in the blood vessels.

Brain and nervous system changes. Imaging studies have identified an area in the brainstem at the back of the head that is activated during a migraine attack. A spreading wave of decreased activation occurs in the brain at the onset of an attack, which may account for the blurred vision or numbness that some people experience in the migraine aura.
Serotonin system abnormalities. Serotonin is a natural chemical in the brain that has an important function in transmission of signals from one brain cell to another. Some migraine medication and other treatments affect serotonin action in the brain and can stop a migraine.

What can I do to prevent my child's headaches?

Taking good care of your child can decrease the frequency and severity of his/her headaches:

  1. Make sure your child drinks enough fluids. Children and adolescents need from 4 to 8 glasses of fluid a day. Caffeine should be avoided. Sports drinks may also help during a headache as well as during exercise by keeping sugar and sodium levels normal.
  2. Make sure your child gets plenty of regular sleep at night (but don't let him/her oversleep). Fatigue and over exertion are two factors that can trigger headaches. Most children and adolescents need to sleep 8 to 10 hours each night and keep a regular sleep schedule to help prevent headaches.
  3. Be sure that your child eats balanced meals at regular hours. Do not let him/her skip meals.
  4. Try to avoid foods that seem to trigger headaches. Remember that every child is different, so your child's triggers may be different from another child's.
  5. Plan and schedule your child's activities sensibly. Try to avoid overcrowded schedules or stressful and potentially upsetting situations.

Also, if your child's doctor prescribed daily medication to reduce headache frequency (called preventive or prophylactic medication), remember to have him/her take it every day, whether he/she is having headaches or not.

What do I do if my child gets a headache?

Keep a record of your child's headaches. Write down everything that might relate to your child's headache (foods, odors, situations), how long it lasted, and how much pain the headache caused.

Have your child take pain medication for his/her headache as soon as they feel pain. He/she may be taking over-the-counter medication or prescription medication when they get a headache. Follow the doctor's instructions in using the medication and treatment plan.

Your child needs to be able to treat his/her headaches at school. This means that your child's school nurse needs to know your treatment plan. It is important that you discuss this with your child's doctor, so that all of the forms and permission are completed for treating your child's headaches at school without having to go home. You may even need to educate your child's teachers about headaches and migraines.

Remember that using pain-relievers (analgesics) every day can cause an increase in your child's headaches. Drinking more fluids (especially sports drinks) during a headache may also be very important to help it to go away faster.