Pediatric Headaches

A headache is pain or discomfort in one or more areas of the head or face. Headaches can happen once in a while. Or they may happen often.

Headaches are often divided into two groups, based on what causes them:

• Primary headaches. These are not linked to another health condition. They are often caused by tight muscles or changes in blood vessels or nerve signals.
• Secondary headaches. These are a less common type of headache. They are caused by a problem in the brain, or another health condition or disease. These are much less common but include infections, bleeding and tumors of the brain.

Types of primary headaches include:

• Tension headache. These are the most common type of headache. Stress and mental or emotional conflict can trigger tension headaches.
• Migraine. Migraines may start early in childhood. Researchers estimate that nearly one in five teens has migraine headaches. The average age they can start is 7 years old for boys and 10 years old for girls. There is often a family history of migraines. Some girls may have migraines that happen with their menstrual periods.
• Cluster headaches. Cluster headaches often occur in a series that may last weeks or months. This series of headaches may return every 1 to 2 years. These headaches are much rarer than tension headaches or migraines. They can start in children older than age 10. They are more common in teen boys.

Researchers don’t fully understand the exact cause of headaches. Many headaches may be caused by tight muscles and widened (dilated) blood vessels in the head. Stress and mental or emotional conflict can trigger tension headaches. Migraine headaches may be caused by changes in brain chemicals or nerve signals.

Other headaches may be caused by a change in pain signals from nerves in the head, face and neck. Lack of sleep and poor sleep quality are often the cause of chronic headaches. In rarer cases, headaches may be caused by a problem in the brain such as a tumor.

A child is more at risk for headaches if they have any of these:

• Stress
• Poor sleep
• Head injury
• Family history of migraines

Symptoms can be different for each child.

Symptoms of tension headaches can include:

• Pain that starts slowly
• Head hurting on both sides
• Pain that is dull
• Pain that feels like a band around the head
• Pain in the back part of the head or neck
• Pain mild to moderate, but not severe
• Change in the child's sleep habits 

Signs and symptoms of migraines can include:

• Premigraine symptoms (an aura) such as seeing flashing lights, a change in vision or funny smells
• Pain on one or both sides of the head
• Pain that may be throbbing or pounding
• Sensitivity to light or sound
• Nausea and vomiting
• Belly pain discomfort
• Sweating
• Child looking pale and being quiet
• Ophthalmoplegic migraine is less common but can cause double vision, droopy eyelid, or other eye problems. These are often signs of secondary headaches, so other health problems need to be ruled out first.

Symptoms of cluster headaches can include:

• Severe pain on one side of the head, often behind one eye
• The eye that is affected may have a droopy lid, small pupil or redness and swelling of the eyelid
• Runny nose or congestion
• Forehead swelling

Symptoms of a secondary headache may include:

• Headaches that start very early in the morning
• Pain that's made worse by coughing or sneezing
• Sudden onset of pain
• Severe pain
• Headache that's becoming more severe or continuous
• Personality changes along with headache
• Changes in vision
• Weakness in the arms or legs, or balance problems
• Seizures or epilepsy
• Repeated vomiting without nausea or other signs of a stomach virus
• A very young child with a headache
• A child that is awakened by the pain of a headache

Some of these symptoms may be caused by other health problems. Have your child see their health care provider for a diagnosis.

Your health care provider will ask about your child’s symptoms and health history. They may also ask about your family’s health history. They will give your child a physical exam. The physical exam may include a neurological exam.

Your child may be asked questions, such as:

• When do headaches happen?
• What do they feel like?
• Where is the pain?
• How long does the pain last?
• Do changes in position such as sitting up or other activities cause the headache?

You may be asked questions about your child, such as:

• Does your child have changes in walking?
• Does your child have changes in behavior or personality?
• Is your child having trouble sleeping?
• Does your child have a history of emotional stress?
• Is there a history of injury to your child's head or face?

If a more serious condition is suspected ,your child may also have tests, such as:

• MRI. This test uses large magnets and a computer to make detailed images of organs and tissues in the body. It does not use X-rays.
• CT scan. This test uses X-rays and a computer to make detailed images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.
• Spinal tap (lumbar puncture). This test measures cerebrospinal fluid (CSF) pressure. It may also be used to check for an infection in the CSF.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on what type of headache your child has and how severe it is.                                         

The goal of treatment is to stop the headache from occurring. Treatment may include:

• Resting in a quiet, dark environment
• Taking medicines advised by your child's health care provider
• Learning how to manage stress
• Staying away from foods and drinks that trigger headaches
• Getting enough sleep
• Not skipping meals
• Making changes to your child's diet
• Getting exercise

Migraine headaches may be treated with medicine, such as:

• Abortive medicines. These prescription medicines act on specific receptors in blood vessels in the head. They can stop a headache in progress.
• Rescue medicines. These are over-the-counter medicines such as acetaminophen that stop a headache.
• Preventive medicines. These prescription medicines are taken daily to reduce severe migraine headaches.

In some cases, a headache may need medical care right away. Your child may need to stay overnight in the hospital to be watched. They may need testing or surgery.

Talk with your child’s health care providers about the risks, benefits and possible side effects of all treatments.

Headaches of any type that come back again and again (recurrent) can cause:

• Behavior problems
• Problems with grades at school
• Depression

Headaches in a child may be prevented by things such as:

• Taking medicines advised by your child's health care provider
• Learning how to manage stress
• Staying away from foods and drinks that trigger headaches
• Getting enough sleep
• Not skipping meals
• Making changes to your child's diet
• Getting exercise

Call the health care provider if your child has:

• Symptoms that don’t get better, or get worse
• New symptoms