Headaches in children

Headaches in children are common and usually aren't serious. Like adults, children can develop different types of headaches, including migraines or stress-related (tension) headaches. Children can also have chronic daily headaches.

In some cases, headaches in children are caused by an infection, high levels of stress or anxiety, or minor head trauma. It's important to pay attention to your child's headache symptoms and consult a doctor if the headache worsens or occurs frequently.

Headaches in children usually can be treated with over-the-counter (OTC) pain medications and healthy habits such as a regular schedule for sleeping and eating.

Children get the same types of headaches adults do, but their symptoms may be a little different. For example, migraine pain in adults often lasts at least four hours — but in children, the pain may not last as long.

Differences in symptoms may make it difficult to pinpoint headache type in a child, especially in a younger child who can't describe symptoms. In general, though, certain symptoms tend to fall more frequently into certain categories.

Migraine

Migraines can cause:

• Pulsating or throbbing head pain
• Pain that worsens with activity
• Nausea
• Vomiting
• Abdominal pain
• Extreme sensitivity to light and sound

Even infants can have migraines. A child who's too young to tell you what's wrong may cry or rock back and forth to indicate severe pain.

Tension-type headache

Tension-type headaches can cause:

• A pressing tightness in the muscles of the head or neck
• Mild to moderate, nonpulsating pain on both sides of the head
• Pain that's not worsened by physical activity
• Headache that's not accompanied by nausea or vomiting, as is often the case with migraine

Younger children may withdraw from regular play and want to sleep more. Tension-type headaches can last from 30 minutes to several days.

Cluster headache

Cluster headaches are uncommon in children under 10 years of age. They usually:

• Occur in groups of five or more episodes, ranging from one headache every other day to eight a day
• Involve sharp, stabbing pain on one side of the head that lasts less than three hours
• Are accompanied by teariness, congestion, runny nose, or restlessness or agitation

Chronic daily headache

Doctors use the phrase "chronic daily headache" (CDH) for migraines and tension-type headaches that occur more than 15 days a month. CDH may be caused by an infection, minor head injury or taking pain medications — even nonprescription pain medications — too often.

Most headaches aren't serious, but seek prompt medical care if your child's headaches:

• Wake your child from sleep
• Worsen or become more frequent
• Change your child's personality
• Follow an injury, such as a blow to the head
• Feature persistent vomiting or visual changes
• Are accompanied by fever and neck pain or stiffness

Talk to your child's doctor if you're worried or have questions about your child's headaches.

A number of factors can cause your child to develop headaches. Factors include:

• Illness and infection. Common illnesses such as colds, flu, and ear and sinus infections are some of the most frequent causes of headaches in children. Very rarely, meningitis or encephalitis may cause headaches.
• Head trauma. Bumps and bruises can cause headaches. Although most head injuries are minor, seek prompt medical attention if your child falls hard on his or her head or gets hit hard in the head. Also, contact a doctor if your child's head pain steadily worsens after a head injury.
• Emotional factors. Stress and anxiety — perhaps triggered by problems with peers, teachers or parents — can play a role in children's headaches. Children with depression may complain of headaches, particularly if they have trouble recognizing feelings of sadness and loneliness.
• Genetic predisposition. Headaches, particularly migraines, tend to run in families.
• Certain foods and beverages. Nitrates — a food preservative found in cured meats, such as bacon, bologna and hot dogs — can trigger headaches, as can the food additive MSG. Also, too much caffeine — contained in soda, chocolates and sports drinks — can cause headaches.
• Problems in the brain. Rarely, a brain tumor or abscess or bleeding in the brain can press on areas of the brain, causing a chronic, worsening headache. Typically in these cases, however, there are other symptoms, such as visual problems, dizziness and lack of coordination.

Any child can develop headaches, but they're more common in:

• Girls after they reach puberty
• Children who have a family history of headaches or migraines
• Older teens

The following may help you prevent headaches or reduce the severity of headaches in children:

• Practice healthy behaviors. Behaviors that promote general good health also may help prevent headaches for your child. These lifestyle measures include getting plenty of sleep, staying physically active, eating healthy meals and snacks, drinking up to eight glasses of water daily, and limiting caffeine.
• Reduce stress. Stress and busy schedules may increase the frequency of headaches. Be alert for things that may cause stress in your child's life, such as difficulty doing schoolwork or strained relationships with peers. If your child's headaches are linked to anxiety or depression, consider talking to a counselor.

• Keep a headache diary. A diary can help you determine what causes your child's headaches. Note when the headaches start, how long they last and what, if anything, provides relief.

  Record your child's response to taking any headache medication. Over time, the items you note in the headache diary should help you understand your child's symptoms so that you can take specific preventive measures.

• Avoid headache triggers. Avoid any food or drinks, such as those containing caffeine, that seem to trigger headaches. Your headache diary can help you determine what prompts your child's headaches, so you know what to avoid.
• Follow your doctor's plan. Your doctor may recommend preventive medication if the headaches are severe, occur daily and interfere with your child's normal lifestyle. Certain medications taken at regular intervals — such as certain antidepressants, anti-seizure medications or beta blockers — may reduce the frequency and severity of headaches.

To learn about the nature of your child's headache, your doctor will likely look to:

• Headache history. Your doctor asks you and your child to describe the headaches in detail, to see if there's a pattern or a common trigger. Your doctor may also ask you to keep a headache diary for a time, so you can record more details about your child's headaches, such as frequency, severity of pain and possible triggers.
• Physical exam. The doctor performs a physical exam, including measuring your child's height, weight, head circumference, blood pressure and pulse, and examining your child's eyes, neck, head and spine.
• Neurological exam. Your doctor checks for any problems with movement, coordination or sensation.

If your child is otherwise healthy and headaches are the only symptom, no further testing usually is needed. In a few cases, however, imaging scans and other evaluations can help pinpoint a diagnosis or rule out other medical conditions that could be causing the headaches. These tests may include:

• Magnetic resonance imaging (MRI). MRIs use a powerful magnet to produce detailed views of the brain. MRI scans help doctors diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities. An MRI can also be used to examine the blood vessels that supply the brain.
• Computerized tomography (CT) scan. This imaging procedure uses a series of computer-directed X-rays that provide a cross-sectional view of your child's brain. This helps doctors diagnose tumors, infections and other medical problems that can cause headaches.
• Spinal tap (lumbar puncture). If your doctor suspects that an underlying condition, such as bacterial or viral meningitis, is causing your child's headaches, he or she may recommend a spinal tap (lumbar puncture). In this procedure, a thin needle is inserted between two vertebrae in the lower back to extract a sample of cerebrospinal fluid for laboratory analysis.

Usually you can treat your child's headache at home with rest, decreased noise, plenty of fluids, balanced meals and OTC pain relievers. If your child is older and has frequent headaches, learning to relax and manage stress through different forms of therapy may help, as well.

Medications

• OTC pain relievers. Acetaminophen or ibuprofen (Advil, Motrin IB, others) can typically relieve headaches for your child. They should be taken at the first sign of a headache.

  Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. Aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children. Talk to your doctor if you have concerns.

• Prescription medications. Triptans, prescription drugs used to treat migraines, are effective and can be used safely in children older than 6 years of age.

  If your child experiences nausea and vomiting with migraines, your doctor may prescribe an anti-nausea drug. The medication strategy differs from child to child, however. Ask your doctor or pharmacist about nausea relief.

Caution: Overuse of medications is itself a contributing factor to headaches (medication overuse headache). Over time, painkillers and other medications may lose their effectiveness. In addition, all medications have side effects. If your child takes medications regularly, including OTC products, discuss the risks and benefits with your doctor.

Therapies

While stress doesn't appear to cause headaches, it can act as a trigger for headaches or make a headache worse. Depression also can play a role. For these situations, your doctor may recommend one or more behavior therapies, such as:

• Relaxation training. Relaxation techniques include deep breathing, yoga, meditation and progressive muscle relaxation, in which you tense one muscle at a time. Then you completely release the tension, until every muscle in the body is relaxed. An older child can learn relaxation techniques in classes or at home using books or videos.

• Biofeedback training. Biofeedback teaches your child to control certain body responses that help reduce pain. During a biofeedback session, your child is connected to devices that monitor and give feedback on body functions, such as muscle tension, heart rate and blood pressure.

  Your child then learns how to reduce muscle tension and slow his or her heart rate and breathing. The goal of biofeedback is to help your child enter a relaxed state to better cope with pain.

• Cognitive behavioral therapy. This therapy can help your child learn to manage stress and reduce the frequency and severity of headaches. During this type of talk therapy, a counselor helps your child learn ways to view and cope with life events more positively.

OTC pain medications, such as acetaminophen or ibuprofen (Advil, Motrin IB, others), are usually effective in reducing headache pain. Before giving your child pain medication, keep these points in mind:

• Read labels carefully and use only the dosages recommended for your child.
• Don't give doses more frequently than recommended.
• Don't give your child OTC pain medication more than two or three days a week. Daily use can trigger a medication overuse headache, a type of headache caused by overuse of pain medications.
• Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children. Talk to your doctor if you have concerns.

In addition to OTC pain medications, the following can help ease your child's headache:

• Rest and relaxation. Encourage your child to rest in a dark, quiet room. Sleeping often resolves headaches in children.
• Use a cool, wet compress. While your child rests, place a cool, wet cloth on his or her forehead.
• Offer a healthy snack. If your child hasn't eaten in a while, offer a piece of fruit, whole-wheat crackers or low-fat cheese. Not eating can make headaches worse.

Although they haven't been well studied, a number of dietary supplements have been suggested to help children's headaches, including:

• Riboflavin
• Magnesium
• Coenzyme Q10
• Vitamin D

Check with your child's doctor before trying any herbal products or dietary supplements to be sure they won't interact with your child's medicine or have harmful side effects.

Several alternative treatments may also be helpful for headaches in children, including:

• Acupuncture. Acupuncture practitioners use extremely thin, disposable needles that generally cause little pain or discomfort. Some research has suggested that this treatment may help relieve headache symptoms.
• Massage. Massage can help reduce stress and relieve tension, and may help ease headaches.

Typically, you make an appointment with your family doctor or your child's pediatrician. Depending on the frequency and severity of your child's symptoms, you may be referred to a doctor who specializes in conditions of the brain and nervous system (neurologist).

Here's information to help you get ready for your child's appointment and to know what to expect from the doctor.

What you can do

• Write down your child's signs and symptoms, when they occurred, and how long they lasted. It may help to keep a headache diary — listing each headache, when it happens, how long it lasts and what might have caused it.
• Make a list of all medications, vitamins or supplements your child is taking.
• Write down questions to ask your doctor.

For headaches in children, some basic questions to ask your doctor include:

• What's the most likely cause of the symptoms?
• Are tests needed to confirm the diagnosis?
• What treatments are available and which do you recommend?
• Does my child need prescription medication, or would an OTC medication work?
• What follow-up, if any, is needed?
• What can we do at home to lessen the pain?
• What can we do at home to prevent headaches?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did the symptoms start? Have they changed over time?
• How often does your child experience these symptoms?
• How long does the headache usually last?
• Where does the pain occur?
• Have the symptoms been continuous or intermittent?
• Does your child have other symptoms, such as nausea or dizziness?
• Does anything make your child's symptoms better?
• Does anything make the symptoms worse?
• What treatments have you tried?
• What medications does your child take?
• Do other family members get headaches?

What you can do in the meantime

Until you see your child's doctor, if your child has a headache, place a cool, wet cloth on your child's forehead and encourage him or her to rest in a dark, quiet room.

Consider giving your child OTC pain medications such as acetaminophen or ibuprofen (Advil, Motrin IB, others) to ease symptoms.

Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children. Talk to your doctor if you have concerns.