Headaches in Children
What are Headaches?
Headaches are pain or discomfort experienced in the head or face area. Headaches occur when nerves in the head and neck, are stimulated or experience pressure. This causes them to send pain messages to the brain resulting in a headache. Headaches can be acute (sudden) or chronic (recurrent). Headaches in children are considered chronic when they are experienced at least 15 days within a month.
Types of Headaches in Children
Headaches can be divided into two separate categories based on what is causing them:
Primary headaches are not due to any other health condition and are a result of dilated (widened) blood vessels, tight muscles, inflammation, chemical imbalances, and/or miscommunication of nerves located in the head and neck. Types of primary headaches include:
- Tension Headaches. These are the most common type of headache and are usually triggered by stress or mental/emotional conflict. They are caused by head and neck muscles contracting too hard.
- Migraines. While less common in children, researchers estimate migraines occur in 1 in 5 teens. On average they begin in children ages 7-10 with a family history of migraines. Migraines are typically associated with chronic headaches in children when neurological exams are normal.
- Cluster Headaches. While these are the least common type of headache seen in children, they mostly occur in boys older than age 10. Cluster headaches typically occur in a series that last weeks to months and return every year or two.
Secondary headaches are less common and caused by an underlying medical issue affecting nerve pressure and/or the brain. These headaches can occur from infection, bleeding, or tumors.
What Causes Headaches in Children?
The exact cause of headaches in children is not fully understood. However, there are common culprits when it comes to children experiencing chronic primary headaches. Common causes of recurrent primary headaches include:
- Sleep. Too much or too little sleep.
- Meals. Skipping meals and dehydration.
- Activity. Too much or too little activity.
- Relaxation. Stress due to lack of relaxation time.
- Triggers. External factors including certain food, smells, or environments.
Learn more about the SMART acronym when it comes to determining causes of recurrent headaches in children. Beyond these common causes, recurring primary headaches in children can also be due to:
- Family history of migraines.
- Too much screen time.
While secondary headaches can be a resulting symptom of many different underlying medical issues, there are common conditions associated with secondary headaches in children. Common causes of secondary headaches include:
- Strep Throat
- Vision problems (worse than 20/30) causing eye strain
Headaches caused by the above will typically go away when the underlying condition is resolved. Rarer causes of secondary headaches in children include:
- Increased cerebrospinal fluid (CSF)
- Infections in the brain
- Brain Tumors
- Vascular Malformations
- Idiopathic intracranial hypertension (Pseudotumor cerebri)
- Low intracranial pressure (leakage of CSF)
- Excessive use of medication to treat headaches
- Head Injury
Symptoms of Headaches in Children
While symptoms of headaches in children vary with each child, there are some common symptoms that help identify what type of headache your child is experiencing. Symptoms associated with the different types of headaches in children include:
Symptoms of Tension Headaches
- Slow onset
- Dull pain, such as pressure (squeezing) around the head
- Pain on both sides of the head
- Pain in the back of the head or neck
- Pain is mild to moderate
Symptoms of Migraines
- Sharp, throbbing pain
- Pain on one or both sides of the head
- Sensitivity to light
- Abdominal discomfort
- Sweating during headache
- Paleness during headache
- Nausea and/or vomiting
- Auras – seeing shapes, lines, or flashes of light before a headache
Symptoms of Cluster Headaches
- Headaches occur in series
- Severe pain on one side of the head
- Pain behind an eye
- Runny nose or congestion with headache
- Forehead swelling
- Affected eyelid droops and/or swells
- Affected eye has a small pupil and/or redness
Symptoms of Secondary Headaches
- Early morning headaches
- Worsened pain with coughing or sneezing
- Sudden onset of pain
- Severe pain
- Headache that becomes more severe or consistent
- Behavioral changes with headaches
- Changes in vision
- Muscle weakness or balance issues
- Seizures or epilepsy
- Repeated vomiting without nausea
- Very young child with headaches
- Headache pain that wakes a child up
When to See a Doctor for a Child’s Headache
While children most commonly experience primary headaches that can be treated with ibuprofen or acetaminophen and resolved with lifestyle adjustments, if your child is experiencing symptoms of secondary headaches, you should consult their doctor. Headaches caused by an underlying condition will only be resolved with treatment of the greater medical condition. You should also see a doctor for your child’s headache if:
- They have experienced a recent head injury
- Headaches are chronic and not eased with over-the-counter pain medication
- Symptoms get progressively worse
- New symptoms arise.
When to go to the Emergency Department for a Child’s Headache
If your child is suffering from a severe headache accompanied by confusion, blurred vision, or trouble walking, they should be taken to your closest emergency department right away. When a headache is combined with stiff neck, fever, vomiting or a rash, this also requires emergency attention, as it could be a sign of a serious infection like meningitis.
How are Headaches Diagnosed?
The causes of headaches in children are diagnosed through a physical exam that includes questions for you and your child, a thorough health and family history regarding headaches and a neurological exam.
Questions a doctor might ask your child include:
- 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?
Questions a doctor might ask parents include:
- 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 underlying condition is the suspected cause of your child’s headache, they may also undergo other tests including:
- (MRI). A test that uses large magnets, radiofrequencies, and a computer to create an image of the organs and tissues in the body.
- CT scan. A test that uses X-rays and a computer to create a detailed image of the body including bones, muscles, fat and organs. They are more detailed than standard x-rays.
- Spinal tap (lumbar puncture). This test measures pressure inside the head and can check for infection in cerebrospinal fluid.
- Blood tests. Can include a complete blood count, iron levels, ferritin levels and thyroid function test.
- Polysomnogram. This test records breathing and muscle movements during sleep. It will be conducted if an underlying sleep disorder is the suspected cause of your child’s headaches.
Child Headache Treatments
Treatment for a child’s headache depends on their symptoms, type of headache, severity of the headache, age, and their general health. Treatment for your child’s headache may include:
- Rest and cold compress
- Coping strategies to manage stress
- Avoiding triggers
- Sleep regulation
- Improved diet
- Consistent meals
- Increase water intake
- More exercise.
If your child is experiencing migraines, their doctor might prescribe medication:
- Abortive medicines. These prescription medications interact with specific receptors in blood vessels in the head to stop a headache in progress.
- Rescue medicines. These include over-the-counter medication such as acetaminophen or ibuprofen that help stop a headache. Learn more about ibuprofen and acetaminophen.
- Preventive medicines. These prescription medicines can be taken daily to reduce severe migraine headaches by deterring their onset.
Quick response is the key to treating headaches. If you wait too long after the onset of a headache, the pain is less likely to be improved.