Overview of Headaches in Children

Answers to Common Questions About Childhood Headaches and Migraines

Girl with headache
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Headaches are pretty common in children—in fact, scientific data shows that by the time a child is 7, at least 37 percent have experienced an occasional headache. By the time a child is 15, that figure increases to more than 80 percent.

You may also be surprised to learn that headaches are more common in boys prior to puberty and in girls after puberty (due to hormonal changes associated with the menstrual cycle).

Can Headaches in Children be a Sign of Something Serious?

Although parents tend to worry about the possibility that a headache indicates something serious, like a brain tumor, the vast majority of headaches are not due to a serious underlying condition. In fact, the most common cause of headaches in children is the onset of an ordinary short-term illness, such as a cold or flu.

What Kinds of Headaches Do Children Have? 

There are two major categories of headaches in children:

  • Primary Headaches: headaches not caused by any underlying medical problem, and include migraine, tension headache, and the less common cluster headache. 
  • Secondary Headaches: headaches that occur as a byproduct of some other condition such as a viral illness or sinus, ear, or eye infection, meningitis, head injury, brain tumor, stress, anxiety, depression, or a side effect of some medications.

Migraines in Children 

Migraines tend to run in the family.

The majority of children who experience migraine headaches without aura have family members who share the condition. 

As is true for adults, such children may find that their migraines are triggered by a variety of things, such as:

  • Processed foods
  • Cured meats
  • Aged cheese
  • Nuts
  • Chocolate
  • Sodas
  • Citrus fruits
  • Hunger
  • Dehydration
  • Fatigue
  • Disruption of normal sleep patterns
  • Overactivity
  • Stress and anxiety
  • Motion sickness
  • Certain medications

The symptoms of migraine headaches in children can include:

  • Presence of aura  (a period of time just prior to the head pain during which the child notices odd flashes of light or color, irritability, sleepiness or an uncomfortable ill feeling)
  • Throbbing or pounding headache on both sides of the head (a one-side headache is more common in adults)
  • Headache in the forehead or temples
  • Migraines are usually shorter in children but can last 2 to 72 hours
  • Increased pain with movement
  • Sensitivity to light or sound, or both -- children may have a difficult time articulating this
  • Abdominal pain
  • Nausea and vomiting
  • Lightheadedness
  • Difficulty thinking

Tension Headaches in Children

Children with tension headaches describe their pain as feeling like a tight, squeezing band of pain around their head. The headache is often accompanied by tight or painful muscles in the neck and shoulders. Tension headaches may occur when the child is under stress or having a hard time handling anxiety or an emotional situation.

The length of such headaches can vary widelyfrom 30 minutes or less to several days.

Cluster Headaches in Children 

Although very uncommon in children, cluster headaches seriously interfere with a child's ability to function normally. These headaches feel like a severe, sharp, piercing pain on one side of the head. Even though these headaches are extremely painful, they are typically brief and usually gone in about 3 hours.

When Should We See a Doctor About My Child's Headaches? 

If your son or daughter has a headache that's clearly associated with something like a cold or ear infection, you don't need to rush your child to the doctor's office. But if he or she has regular bouts of headaches that aren't associated with a mild illness, you should call the child's doctor to see whether an evaluation is needed. By all means, make an immediate appointment if the headaches begin after your child has experienced a head injury or if the headaches apply to any of the following conditions:

  • Severely disabling
  • Described by your child as the "worst headache" of his or her life
  • Increasing in frequency
  • Occurring monthly or more often
  • Causing your child to wake up from sleep, or your child wakes up with a headache
  • Accompanied by:
    • Vomiting
    • Changes in vision
    • Any other odd or worrisome symptoms, including mood or personality changes, weakness, difficulty walking or talking, memory problems, loss of bowel or bladder control, or confusion
    • Fever, stiff neck or neck pain

How Can I Help My Child Avoid Headaches?

The simplest steps to avoiding a headache are the most important. Make sure your daughter or son eats regularly, stays hydrated and gets sufficient sleep. Try to identify sources of stress in your child's life at home or at school, and help to alleviate them.

If your child gets regular headaches, consider keeping a headache diary. This is a place where you and/or your child should record in some detail what happened on a headache day as a way of spotting the "triggers" that might be responsible for bringing on the headaches.

Use the headache diary to record information about each headache, such as the date it occurred, how long it lasted, and how severe it was. Also, include information about what was happening with your child that day, including details about meals, sleep, exercise, stress, any unusual activities or exposures to smells or chemicals.

Once you've identified factors that might be involved in triggering your child's headaches, you can try to eliminate those triggers from your child's life or find strategies that help your child cope with the triggers. 

How Can I Help My Child When He or She Has a Headache? 

Most children with headaches know what they need, which should include a quiet, dark room, away from any noise or excitement. Some children are soothed by a cool cloth placed on the forehead. Sleep is often the best medicine.

What Medications are Used for Headaches?

Over-the-counter analgesics—as Tylenol (acetaminophen) and nonsteroidal anti-inflammatories like Motrin or Advil (ibuprofen)—can be used to relieve headache pain. But remember that you should never give aspirin or aspirin-containing preparations to children or teenagers for viral infections (with or without fever) because it increases their risk for a serious illness called Reye's syndrome.

Migraines can vary considerably from child to child and as a child grows. Moreover, some children's headaches are more resistant to treatment through medications. Depending on your son or daughter's age and whether the headaches are resistant, your doctor may prescribe a stronger prescription medication called a triptan—such as Imitrex (sumatriptan).

If your child has very frequent migraine episodes, you may want to inquire whether he or she might benefit from a daily preventive medication, like amitriptyline (Elavil) or an anti-seizure medication. 

Other Options for Treating Children's Headaches

If your son or daughter seems to have a high level of stress, or if you feel that anxiety is contributing to their headaches, consider looking into ways to help your child learn to relax. Biofeedback and self-hypnosis can help your child cope with stress in a self-soothing manner. Cognitive behavior therapy can also help teach your child how to replace negative, stressful thoughts and behavioral patterns with more positive ones.

 

Sources:

Anttila, P. Tension-Type Headache in Children and Adolescents. Lancet Neurology. 2006 March 5(3):268-74.

Brenner, M., & Lewis, D. The treatment of migraine headaches in children and adolescents. The Journal of Pediatric Pharmacology and Therapeutics, 2008 Jan-Mar;13(1):17-24.

Haslam, R.H.A. (2007). Headaches. Nelson Textbook of Pediatrics, 18th ed. Philadelphia: Saunders Elsevier.

Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.

Headaches in Children. Achenet.org. 2006. American Headache Society. 17 Apr. 2008. 

Kohen, D.P., & Zajac, R.  Self-Hypnosis Training for Headaches in Children and Adolescents. Journal of Pediatrics. 2007 June 150(6):635-9. 

Mariani, R., et al. Cluster headache in childhood: case series from a pediatric headache center. Journal of Child Neurology. 2014 Jan;29(1):62-5.

Lewis, D.W. Headaches in Children and AdolescentsAmerican Family Physician. February 15, 2002; 65(4):625-32.

U.S. Food and Drug Administration. Aspirin Comprehensive Prescribing Information

Winner, P. American Headache Society: Pediatric and Adolescent Migraine. Accessed 2016.

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