When Kids Get Headaches
July 28, 2004

Life can be a pretty big headache these days - and that applies to your kids, too. Children's headaches are probably underreported, yet you've certainly heard your child complaining about having one. For you, the big question is when to be concerned about your child's headaches. How do you know when the problem is more than worry about an upcoming test or a fight with a friend? What kinds of headaches do children suffer from, and how should they be treated?

When Should You Be Concerned?
Frequency and apparent cause are factors you can use to determine if your child's headaches are reason for concern. Most of the time, you can identify the cause of your child's headache, such as staying up too late, playing in the sun too long or bumping his head. Unexplained or recurring headaches over a short period of time, however, should be brought to the attention of your child's doctor. But how short is a "short" period of time?

"If your 6-year-old is complaining of significant, unexplained headaches once a month or more often over several month's time, I think it would be reasonable to have that child seen by a doctor," says Dr. Hammond, a neurologist. "That frequency in an adolescent who may be under stress at school would not be as worrisome."

Another factor to consider is whether or not there are other symptoms along with the headaches. "Is the child perfectly well between the headaches?" Dr. Hammond asks. "If not, that's cause for concern." In addition, symptoms associated with the headaches themselves can be a flag. Other than simple nausea, which he says is not uncommon with headaches, Dr. Hammond suggests parents look for:
[list][*]decreased level of alertness [*]visual changes [*]tingling sensations [*]weakness [*]fever or other signs of infections[/list:u]
Kids and Their Headaches
In general, children suffer from the same types of headaches that plague adults. An infection in the body can cause a headache; so can medications a child is taking. Headaches also are a potential side effect of most medications.

There are many other potential causes for headaches as well. In young children, dental caries, ear infections and sinusitis can all cause pain that is described as a headache. Children also can suffer from migraine and tension-type headaches, commonly called tension or muscle contraction headaches.

The pounding, throbbing pain of migraine headaches probably afflicts some children early in life. If you have an infant or toddler, it's unlikely you'll be able to tell if he's experiencing migraines because he won't be able to tell you. One thing you might notice, however, is something called a migraine variant. One such migraine variant, called paroxysmal vertigo, affects toddlers. This is described as a sensation of spinning or whirling, which comes on suddenly and disappears in a matter of minutes.

Older children and adolescents suffer more visibly from migraine headaches: either migraine with aura or migraine without aura. The aura is a symptom that usually occurs before the onset of the pain itself. It's most often a visual symptom such as the perception of bright lights followed by black "holes" in the vision.

Diagnosis and Treatment
Most simple headaches will resolve at home with little medical intervention. Home remedies include having the child lie down in a cool, dark room and giving the child an acetaminophen product such as Tylenol. When your child visits a doctor for headaches, Dr. Hammond says you can expect the doctor to conduct a history and an exam of your child to help explain the reasons for the headaches.

History can be very important in helping to provide a diagnosis, so doctors often ask parents to keep a headache diary on their child, listing each headache and a few notes about what may have brought it on. The history will include questions about the severity and frequency of your child's headaches, as well as their pattern or change over time. The doctor may also ask questions about what seems to help or worsen the headaches. The answers to these questions may provide diagnostic clues, especially in the case of migraine headaches, which are known to be triggered by things like stress, sleep deprivation, and certain foods and beverages.

A good review of your child's other organ systems is also important. Disorders within or outside the nervous system may be the cause of the headaches. An examination of the back of the eye, called a fundoscopic exam, will give your child's doctor a sense of any increase in pressure inside your child's brain that may be an indication of a more serious problem.

Two of the more common headache diagnoses made are those of migraine and tension-type headaches. If your child is diagnosed with migraines, his doctor will help identify the things that trigger the headaches and explain to your child how to avoid them. There often are foods involved: chocolate, nuts, or cheeses. Monosodium glutamate seasoning and caffeine may also be triggers. In some cases, the doctor may also prescribe a drug that contains an analgesic, a mild sedative, and a mild vasoconstrictive agent.

If your child suffers from chronic migraine headaches, his doctor may prescribe a medication to be taken daily as a preventive measure. In deciding whether to put your child on preventive medication, the doctor will consider the frequency of the migraines as well as the potential benefit of the medication versus its possible side effects. Two commonly prescribed drugs are cyproheptadine and propranolol.

Patients experiencing tension-type headaches often describe the constricting pain they feel as "constant pressure around the head." These headaches may be the hardest kind to treat, according to Dr. Hammond.

"Those who've had tension-type headaches for a while may be taking medications like acetaminophen, acetaminophen with codeine, or ibuprofen. They may be on a potpourri of medications, and one has to remember that analgesics used in large doses or used chronically themselves can cause headaches or exacerbate the underlying tendency to have headaches."

For this reason, Dr. Hammond advises parents to discuss the medications their child has been taking with the child's doctor, who will develop a treatment plan that may include nonmedicinal approaches to pain relief, such as relaxation and stress reduction techniques.

PsychLinks Online note: Doctors will usually advise you not to give aspirin to children under age 18, especially if the symptoms include fever, because of the link to Reye's Syndrome.