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"My Head Hurts!"

Children's gets to the bottom of headaches with helpful advice for parents.

8/10/2011 

Nothing can be more irritating – or even debilitating – than a really bad headache. Throbbing, sharp pain can make it difficult to concentrate or feel good, especially if accompanied by nausea.

Headaches can be a common problem in children but fortunately most are not caused by an underlying disease or disorder. Recognizing the symptoms of the type of headache your child has, being aware of testing and treatment options, and knowing when to seek expert pediatric medical care can save your child from needless discomfort.

Generally headaches are less prevalent in childhood compared to adolescents and adults. However, many adults with headaches began having their headaches as children, with 20 percent reporting the onset before age 10, according to the American Headache Society.

Types of headache

As in adults, headache in children can be divided into two categories – primary or secondary. Understanding what type of headache your child has is important because it will affect treatment, level of disability and lifestyle factors that will impact how to take care of a child with headaches. For example, a child with migraines may have a common factor that precedes their attack, such as a particular food or low blood sugar. Therefore, it is critical to know how to avoid conditions that may increase the risk of an attack and have medications specific to the headache being treated.

  • Primary refers to headaches that occur on their own and not the result of other health problems. Primary headaches include migraine, migraine with aura (a visual disturbance characterized by blurry vision, flashing lights, colored spots or sometimes dizziness), tension-type headache and cluster headache.
  • Secondary refers to headaches that result from some cause or condition, such as head injury or concussion, blood vessel problems, medication side effects, infections in the head or elsewhere in the body, sinus disease or tumors. There are various causes of secondary headaches, ranging from rare, serious diseases to easily treated conditions.

Dr. ErreichThe majority of children with headaches have primary headaches, especially tension-type and migraine. Dr. Steven Ehrreich, medical director of pediatric neurology at Children’s Hospital Central California, said many of our patients have headache as the chief complaint.

“Although tension-type headaches are more common, we see more migraines proportionately because they may be more intense and may not respond to over-the-counter medications,” said Dr. Ehrreich.

Tension-type headache

This type of headache has also been referred to as a tension headache, muscle contraction headache, stress-related headache and “ordinary” headache. These headaches can be either episodic or chronic and may include tightness in the muscles of the head or neck.

A tension-type headache can last from 30 minutes to several days. Chronic tension headaches may endure for months. The pain usually occurs on both sides of the head, is steady and non-throbbing. The pain is typically mild to moderate in severity. Usually the headache does not affect the person’s activity level.

Tension-type headaches typically are not associated with other symptoms, such as nausea or vomiting. Some people experience sensitivity to light or sound with the headache, but not both.
Typical triggers: Tension-type headaches may be due to emotional factors such as stress, poor posture, or muscle spasms and tightness.

Migraine headache

Migraine headache is a chronic neurological disorder characterized by moderate to severe headaches and nausea that occur at intervals of days, weeks or months. Light and/or sound sensitivity is also common. Migraines are often genetic and run in families, but can also be caused by head trauma or surgery of the head or neck.

Between 4 percent and 10 percent of children have migraine headaches; if untreated, they can last from one to 72 hours. In children migraines do not necessarily occur on one side of the head and may start in the front or both temples. While auras are not seen as often during childhood and may appear later in life, they may occur in some children between five minutes to an hour prior to the headache.

Generally migraines are about three times more frequent in females than males. However, they may be more common in boys during the younger years but girls surpass the boys by puberty.

Sometimes the attacks have a pattern. Teenage girls, for example, may tend to have onset of migraine at the time of their menstrual cycle. Migraine pain tends to get worse with exertion, and rest or sleep may relieve the pain. The pain can be so severe that it is difficult or nearly impossible to continue normal daily activities.

Typical triggers: Skipping meals, dehydration, overheating, lack of sleep and psychosocial stressors may incite a migraine.

When to seek medical care

You should consult your family doctor if your child’s headaches are frequent or severe or include unusual symptoms such as:

  • An early morning headache progresses throughout the day.
  • Early morning vomiting without nausea (upset stomach).
  • Headaches that wake a child from sleep.
  • Personality changes in the child.
  • Headaches are increasing in frequency and severity.
  • Headaches have a sudden, maximal onset (rather than a gradual/crescendo onset).
  • Headaches fail a first line of treatment.

Testing

Medical tests for headaches are typically not necessary, unless the child’s history or examination suggest possible cause, such as obstructive sleep apnea, increased intracranial pressure, etc. “If imaging tests are desired, a MRI scan is preferable to a CT scan except if there is serious concern for increased intracranial pressure,” said Dr. Ehrreich. “Imaging tests are not needed if the examination and history are normal.”

Treatment

Treatment is individualized depending on the age and weight of the child and the frequency and severity of attacks. Treatment strategies may require medication while others do not.

Triggers of the condition should be evaluated, especially in chronic or frequent headaches. For example, chiropractic treatment may be helpful if postural problems are causing pain. If a specific food causes the headache then that food or additive should be avoided.

If medication is needed, it may be used either to prevent a headache or stop one in progress. The National Headache Foundation recommends the following treatment suggestions for children with headaches:

  • Make lifestyle changes such as regular sleep and eating habits.
  • Drink plenty of fluids, especially when playing in hot weather.
  • Limit caffeine and sugar intake.
  • Families should monitor the time a child spends doing schoolwork, playing and watching TV.
  • For children under age 12 with infrequent attacks, analgesics (over-the-counter painkillers) and antiemetics (drugs that treat nausea/vomiting) are useful at the time of the attack. Narcotic analgesics should be avoided when possible.
  • Migraine-specific medications (triptans) have not been approved by the FDA for use in children under 18. However, these medications have been studied in children and are safe and effective in certain cases.
  • Psychological counseling can be useful to deal with family and school issues.
  • Children are very receptive to biofeedback therapy.

In addition, Dr. Ehrreich pointed out that over-the-counter medications such as acetaminophen with or without caffeine or ibuprofen can produce rebound headaches when used around the clock for more than a day or so. “In that case, the medication needs to be stopped and an alternative should be used,” said Dr. Ehrreich. “For instance, naprosyn or Aleve does not seem to cause rebound headaches.”

Preparing for an appointment

As with any medical appointment, the patient should bring a list of medications currently being taken, including strengths and dosages, and what has already failed. A headache diary is especially helpful that records the dates and times of the child’s headache, possible triggers (e.g., odors, foods, situations), how long it lasted and how much pain the headache caused.

“Learning the signs and symptoms that might be associated with a headache can also help the parent and the child recognize an upcoming episode,” said Dr. Ehrreich.

How do you know if your child “really” does have a headache?

According to the American Headache Society, here are some key signs:

  • They sit quietly in a chair, bed or sofa and do not watch TV.
  • They do not want to exert themselves.
  • They may fall asleep at an unusual time.
  • They may have nausea, vomiting or other stomach-related symptoms.
  • Light and noise may bother them.
  • They may seem lethargic or fatigued.