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Headaches in childrenBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/headaches-in-children/DS01132
Headaches in children are common and are usually not 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. That's why it's important to pay attention to your child's headache symptoms and to consult a doctor if the headache worsens or occurs frequently. Headaches in children can usually be treated with over-the-counter pain medications and other lifestyle and home measures.
Children get the same types of headaches that adults do, although their symptoms may be different. For example, a migraine in an adult almost always affects just one side of the head, whereas a child's migraine often affects both sides of the head. In addition, headache symptoms in children don't always meet the full criteria for a specific type of headache. As a result, it may be difficult to pinpoint a specific type of headache in a child, especially in a younger child who isn't able to adequately describe his or her symptoms. As a child grows into adolescence and adulthood, headache symptoms may evolve, as well.
In general, though, certain symptoms tend to fall more frequently under certain categories.
Migraines can cause:
- Head pain
- 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 and hold his or her head to indicate severe pain. Migraines in children may last an hour or more.
Tension-type headaches are typically characterized by the following features:
- A pressing tightness that occurs on both sides of the head
- Pain that's usually more dull than throbbing
- Pain that's not worsened by physical activity
- Headache that's not accompanied by nausea or vomiting, as is often the case with migraine
Telltale signs in younger children may include withdrawal from regular play and a desire to sleep more. Tension-type headaches can last from 30 minutes to several days.
Cluster headaches are uncommon in children under 10 years of age. They usually:
- Occur in groups of five or more episodes, ranging in frequency from one headache every other day up to eight a day
- Involve a sharp, stabbing pain on one side of the head that lasts from 15 minutes to three hours
- Are accompanied by teariness, congestion, runny nose, or a heightened sense of restlessness or agitation
Chronic daily headache
Both migraines and tension-type headaches can increase in frequency. If your child has headaches more than 15 days a month for more than three months, doctors call this "chronic daily headache." Sometimes, an infection or minor head injury precipitates a continuous, persistent headache. This problem can also occur when your child takes pain medications — even the nonprescription variety — too frequently.
When to see a doctor
Most headaches aren't serious, but seek prompt medical care if your child's headaches:
- Occur at least once a week
- Follow an injury, such as a blow to the head
- Feature persistent vomiting or visual changes
- Are accompanied by fever, along with neck pain or stiffness
A number of factors, singly or in combination, can cause your child to develop headache. Some of these factors include:
- Illness and infection. Common illnesses such as colds, flu, and ear and sinus infections are some of the most frequent causes of headache in children. More-serious infections, such as meningitis or encephalitis, also can cause headache, but are usually accompanied by other signs and symptoms, such as fever and neck stiffness.
- Head trauma. Accidental 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. Also contact a doctor if your child has a steadily worsening head pain after a head injury.
- Emotional factors. High levels of 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 kind of food preservative found in such foods as bacon, bologna and hot dogs — have been known to trigger headaches, as can the food additive monosodium glutamate (MSG). Also, too much caffeine — contained in foods such as soda, chocolate, coffee and tea — can cause headaches.
- Problems in the brain. Rarely, a brain tumor or abscess, or bleeding in the brain, may create pressure on areas of the brain, causing a chronic, worsening headache. Typically in these cases, however, headache is accompanied by other symptoms, such as visual problems, dizziness, lack of coordination and other neurological problems.
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
Preparing for your appointment
For headaches in children, you typically 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).
Because appointments can be brief and there's often a lot of ground to cover, it can help to be well prepared. Here are some tips to help you get ready for your child's appointment and 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, as well as any vitamins or supplements, that your child is taking.
- Write down questions to ask your doctor. Don't be afraid to ask questions or to speak up when you don't understand something your doctor says.
List your questions from most important to least important in case your time with your doctor runs out. For headaches in children, some basic questions to ask your doctor include:
- What is likely causing the symptoms?
- Are tests needed to confirm the diagnosis?
- What is the best course of action?
- Does my child need prescription medication, or would an over-the-counter medication work?
- What kind of follow-up, if any, is needed?
- What can we do at home to help lessen the pain?
- What can we do at home to prevent headaches?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did the symptoms first start?
- 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?
- What, if anything, makes it better?
- What, if anything, makes it worse?
- Have the symptoms changed over time?
- What treatments have you tried?
- What medications does your child take?
- Do other family members experience headaches?
What you can do in the meantime
While waiting for your child's appointment, place a cool, wet cloth on your child's forehead and encourage him or her to take a nap in a dark, quiet room.
Also, consider giving your child over-the-counter pain medications such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to ease symptoms. Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, 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.
Tests and diagnosis
To learn about the nature of your child's headache, your doctor will likely recommend the following steps:
- 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 also 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, shoulders and spine.
- Neurological exam. Your doctor checks for any problems with movement, coordination or sensation.
If your child is otherwise healthy and headache is the only symptom, no further testing usually is needed. In a few cases, however, imaging scans and other evaluations are needed to pinpoint a diagnosis or to rule out other medical conditions that could be causing the headaches. These tests may include:
- Computerized tomography (CT). 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 possible medical problems that may be causing headaches.
- Magnetic resonance imaging (MRI). MRIs use radio waves and a powerful magnet to produce very 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.
- Spinal tap (lumbar puncture). If your doctor suspects that an underlying condition, such as bacterial or viral meningitis, is the cause of 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 (CSF) for laboratory analysis.
Treatments and drugs
Most of the time, you can treat your child's headache at home with rest, decreased noise, plenty of fluids, balanced meals and over-the-counter (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.
OTC pain relievers. Acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) can typically relieve headaches for your child. Some studies show that ibuprofen may work faster than acetaminophen in relieving migraine pain. OTC medications such as these are inexpensive and readily available and don't require a prescription from your doctor. They should be taken at the first sign of headache.
Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, 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.
Prescription medications. Sumatriptan (Imitrex), a prescription drug, is effective and can be safely used in children over the age of 12.
If your child experiences nausea and vomiting with migraines, your doctor may prescribe an anti-nausea drug, such as promethazine. The medication strategy differs from child to child, however. Ask your doctor or pharmacist if you have questions.
Caution: Overuse of medications is itself a contributing factor to headache (rebound 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 products you buy over-the-counter, discuss the risks and benefits with your doctor.
While stress doesn't appear to cause headaches, it can act as a trigger for headache or make headache worse. Depression and other mental health disorders 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, which is accomplished by tensing one muscle at a time, and then completely releasing 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 tapes.
- 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.
Lifestyle and home remedies
Over-the-counter (OTC) pain medications, such as acetaminophen (Tylenol, others) and ibuprofen (Advil, Motrin, 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 rebound headache, a type of headache caused by overuse of pain medications.
- Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 2, 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 measures can help ease your child's headache:
- Rest and relax. 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. Going without meals can sometimes make headaches worse.
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, and avoiding 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 or anti-seizure medications — may reduce the frequency and severity of headaches.
- Bronthius DJ, et al. Approach to the child with headache. http://www.uptodate.com/home/index.html. Accessed Jan. 3, 2011.
- Cummings E, et al. Evaluation and management of headache in the pediatric patient. Emergency Medicine. 2009;41:36.
- Abu-Arafeh I, et al. Prevalence of headache and migraine in children and adolescents: A systematic review of population-based studies. Developmental Medicine & Child Neurology. 2010;52:1088.
- Cruse RP. Management of migraine headache in children. http://www.uptodate.com/home/index.html. Accessed Jan. 3, 2011.
- Cruse RP. Pathophysiology, clinical features, and diagnosis of migraine in children. http://www.uptodate.com/home/index.html. Accessed Jan. 3, 2011.
- Monteith TS, et al. Tension type headache in adolescence and childhood: Where are we now? Current Pain and Headache Reports. 2010;14:424.
- Cruse RP. Tension-type headache in children. http://www.uptodate.com/home/index.html. Accessed Jan. 3, 2011.
- Lewis D, et al. Practice parameter: Pharmacological treatment of migraine headache in children and adolescents: Report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Neurology. 2004;63:2215.
- Lewis D, et al. Practice parameter: Evaluation of children and adolescents with recurrent headaches: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2002;59:490.
- Headaches in children. American Headache Society. http://www.achenet.org/education/patients/HeadachesinChildren.asp. Accessed Jan. 4, 2011.
- Anttila P. Tension-type headache in childhood and adolescence. The Lancet Neurology. 2006;5:268.
- Mahoney KR (expert opinion). Food and Drug Administration, Rockville, Md. Jan. 10, 2011
- Internal analgesic, antipyretic and antirheumatic drug products for over-the-counter human use: Tentative final monograph. Federal Register.1988;53:46204.
- Mack KJ. An approach to children with chronic daily headache. Developmental Medicine & Child Neurology. 2006;48:997.