What patients and families need to know
What is a headache?
A headache is pain or discomfort in the head or face area. Headaches can be single or recurrent in nature, and localized to one or more areas of the head and face.
The exact cause of headaches is not completely understood. It is thought that many headaches are the result of tight muscles and dilated, or expanded, blood vessels in the head. Other headaches may be caused by an alteration in the communication between parts of the nervous system that relay information about pain, coming from the area of the head, face, and neck. Occasionally, there is an actual problem in the brain, such as a tumor or malformation of the brain, although this is rare.
The way a child exhibits a headache may be related to many factors, such as genetics, hormones, stress, diet, medications and dehydration. Recurrent headaches of any type can cause school problems, behavioral problems and/or depression.
There are many different ways to classify headaches. One method divides headaches into two categories:
Primary headaches:These are usually caused by tight muscles, dilated blood vessels, alterations in communication between parts of the nervous system, or inflammation of the structures in the brain and are not linked to another medical condition. Types of primary headaches include the following:
- Migraines. Migraines may start early in childhood. It is estimated that nearly 20% of teens experience migraine headache. The average age of onset is 7 years of age for boys and 10 years of age for girls. There is often a family history of migraines. Some females may have migraines that correlate with their menstrual periods. While every child may experience symptoms differently, the following are the most common symptoms of a migraine:
- Pain on one or both sides of the head (some younger children may complain of pain all over)
- Pain may be throbbing or pounding in quality (although young children may not be able to describe their pain)
- Sensitivity to light or sound
- Nausea and/or vomiting
- Abdominal discomfort
- Child may become quiet or pale
- Some children have an aura before the migraine, such as a sense of flashing lights, a change in vision or funny smells
- Tension headaches. Tension headaches are the most common type of headache. Stress and mental or emotional conflict are often factors in triggering pain related to tension headaches. While every child may experience symptoms differently, the following are the most common symptoms of a tension headache:
- Slow onset of the headache
- Head usually hurts on both sides
- Pain is dull or feels like a band around the head
- Pain may involve the posterior (back) part of the head or neck
- Pain is mild to moderate, but not severe
- Change in the child's sleep habits
- Children with tension headaches typically do not experience nausea, vomiting or light sensitivity.
- Cluster headaches. Cluster headaches usually start in children older than 10 years of age, and are more common in adolescent males. Cluster headaches usually occur in a series that may last weeks or months, and this series of headaches may return every year or two. While every child may experience symptoms differently, the following are the most common symptoms of a cluster headache:
- Severe pain on one side of the head, usually 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
- Swelling of the forehead
Secondary headaches. These are from an organic cause in the brain (problems in the structure of the brain) due to another health condition or disease, and are the least common type of headaches.
The child may have varying degrees of symptoms associated with the severity of the headache depending on the type of headache. Some headaches may be more serious. Symptoms that may suggest a more serious underlying cause of the headache may include the following:
- A very young child with a headache
- A child that is awakened by the pain of a headache
- Headaches that start very early in the morning
- Pain that is worsened by strain, such as a cough or a sneeze
- Vomiting without nausea
- Sudden onset of pain and the "worst headache" ever
- Headache that is becoming more severe or continuous
- Personality changes
- Changes in vision
- Weakness in the arms or legs
- Seizures or epilepsy
The symptoms of a headache may resemble other conditions or medical problems. Always consult your child's doctor for a diagnosis.
The full extent of the problem may not be completely understood immediately, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a headache is made with a careful history and physical examination and diagnostic tests. During the examination, the doctor obtains a complete medical history of the child and family.
Questions commonly asked during the examination may include the following:
- When do headaches occurs?
- What is the location of the headache?
- What do the headaches feel like?
- How long do the headaches last?
- Have there been changes in walking and behavior patterns, or personality?
- Do changes in positioning or sitting-up cause the headache?
- Is your child having trouble sleeping?
- Does your child have a history of stress?
- Is there a history of trauma to your child's head or face?
If the history is consistent with migraine or tension type headaches and the neurological exam is normal, no further diagnostic testing may be necessary.
Other diagnostic tests may include:
- Blood tests
- X-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
- Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
- Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) 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 general X-rays.
Specific treatment for headaches will be determined by your child's doctor based on:
- Your child's age, overall health and medical history
- Extent of the headaches
- Type of headaches
- Your child's tolerance for specific medications, procedures or therapies
- Your opinion or preference
The ultimate goal of treatment is to stop the headache from occurring. Medical management relies on the proper identification of the type of headache and may include:
- Rest in a quiet, dark environment
- Medications, as recommended by your child's doctor
- Stress management
- Avoid known triggers, such as certain foods and beverages, lack of sleep and fasting
- Diet changes
Migraine headaches may require specific medication management including:
Abortive medications. Medications, prescribed by your child's doctor, that act on specific receptors in blood vessels in the head and can stop a headache in progress.
Rescue medications. Medications purchased over-the-counter, such as analgesics (pain relievers), to stop the headache.
Preventive medications. Medications, prescribed by your child's doctor, that are taken daily to reduce the onset of severe migraine headaches.
Some headaches may require immediate medical attention including hospitalization for observation, diagnostic testing or even surgery. Treatment is individualized depending on the extent of the underlying condition that is causing the child's headache. The extent of the child's recovery is individualized depending on the type of headache and other medical problems that may be present.
The Headache Program at Children's National Hospital evaluates and treats more than 2,000 patients annually.
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