Headaches

Whether they're pounding and throbbing or dull and aching, headaches are common in kids. Headaches can have a wide range of causes and many levels of severity. It's important to understand how to recognize when a headache is just a passing pain and when it's something more and requires medical attention.

Causes of Headaches

Headaches are thought to be caused by changes in chemicals, nerves, or blood vessels in the area. These changes send pain messages to the brain and bring on a headache.

In general, kids get the same types of headaches as adults. And headaches often are hereditary, so if a parent gets them, their kids might too.

Some of the many potential headache triggers include:

• certain medications (headaches are a potential side effect of some)
• too little sleep or sudden changes in sleep patterns
• skipping meals
• becoming dehydrated
• being under a lot of stress
• having a minor head injury
• using the computer or watching TV for a long time
• vision problems
• menstruation
• experiencing changes in hormone levels
• taking a long trip in a car or bus
• listening to really loud music
• smoking
• smelling strong odors such as perfume, smoke, fumes, or a new car or carpet
• drinking or eating too much caffeine (in soda, coffee, tea, and chocolate)
• consuming certain foods (such as alcohol, cheese, nuts, pizza, chocolate, ice cream, fatty or fried food, lunchmeats, hot dogs, yogurt, aspartame, or anything with the food additive MSG)

In some cases, headaches are caused by certain infections, such as:

• ear infections
• viral infections, like the flu or common cold
• strep throat
• sinus infections
• Lyme disease

Most headaches aren't signs that something more is wrong, but occasionally headaches are caused by more serious medical conditions.

Common Types of Headaches

When kids get more than the occasional headache, two of the more common kinds they get are tension headaches and migraines.

Tension Headaches

Fairly common in kids, tension headaches can be brought on by a variety of emotional and physical stressors. The pain is often described as:

• constant pressure around the front and sides of the head, which can feel like someone stretched a rubber band around it
• constricting
• dull
• aching

A major distinction between tension headaches and migraines is that tension headaches typically are not accompanied by nausea or vomiting, and they're usually not made worse by physical activity - symptoms that do often occur with migraines.

Migraines

About 5% of school-age kids and at least 10% of teens get migraine headaches, recurrent headaches with additional symptoms. Often triggered by things like stress, sleep deprivation, and menstruation, migraine headaches can cause the following symptoms:

• pounding, throbbing pain or dull, steady pain on one or both sides of the head
• dizziness
• stomachaches
• nausea and/or vomiting
• seeing spots or halos
• sensitivity to light, noise, and/or smells

Most migraines last anywhere from 30 minutes to several hours. Some can last as long as a couple of days. Some people with migraines:

• just don't feel right. Light, smell, or sound may bother them or make them feel worse. Sometimes, if they try to continue with their usual routine after the migraine starts, they may become nauseated and vomit. Often the pain begins only on one side of the head. Trying to perform physical activities can make the pain worse.
• get auras, a kind of warning that a migraine is on the way (usually about 10 to 30 minutes before the start of a migraine). The auras may only be seen in one eye. Common auras include blurred vision, seeing spots, jagged lines, or flashing lights, or smelling a certain odor.
• experience a migraine premonition hours to days prior to the actual headache. This is slightly different from auras and may cause cravings for different foods, thirst, irritability, or feelings of intense energy.
• have muscle weakness, lose their sense of coordination, or stumble.

Unfortunately, parents of an infant or toddler who are unable to say what hurts may not be able to tell if their little one is having migraines. Young kids with headaches may be cranky, less active, may vomit, or look pale or flushed.

Migraine variants that are thought to happen only to kids and are precursors to the more common migraines of adulthood include paroxysmal vertigo and cyclic vomiting.

Paroxysmal vertigo is described as a sensation of spinning or whirling that comes on suddenly and disappears in a matter of minutes. Kids who experience this may momentarily appear frightened and unsteady, or unable to walk. The vertigo typically goes away by the time a child is 5 years old.

Cyclic vomiting also occurs in young kids and involves repeated episodes of vomiting. The episodes can last for hours or days and are not usually associated with headache. Cyclic vomiting usually goes away by the time kids grow into teens.

When to Call the Doctor

When your child has a splitting headache, it's easy to worry. Rest assured, though, that only very rarely are headaches a symptom of something serious. However, you should contact your doctor if your child has unexplained or recurring headaches over a short period of time or on a regular basis.

Call the doctor if your child's headaches:

• occur once a month or more
• don't go away easily
• are particularly painful

Also note whether other symptoms accompany the headaches, which can help the doctor identify what might be causing them. Call the doctor if your child also has any of these symptoms:

• decreased level of alertness
• vomiting
• headache when your child wakes up, or one that actually wakes up your child
• headache following a head injury or loss of consciousness
• headache accompanied by seizures
• visual changes
• tingling sensations
• weakness
• clumsiness
• skin rash
• difficulty walking or standing
• difficulty speaking
• neck pain or stiffness
• fever or other signs of infection
• unable to go to school or participate in everyday routines and activities
• change in personality
• drinking or peeing a lot

Diagnosing Headaches

Your doctor may want to do a physical exam and get your child's medical history to help discover what might be causing the headaches. Let the doctor know:

• how severe and frequent the headaches are
• when the headaches first started
• what the headaches feel like, and where they hurt
• whether the headaches have a pattern or change over time
• any other symptoms that your child experiences with the headache
• any injuries that have occurred recently
• anything that triggers the headaches
• your child's diet, habits, sleeping patterns, and what seems to help or worsen the headaches
• any stresses your child might be experiencing
• any past medical problems your child has had
• any medications your child is taking
• any allergies your child may have
• any family history of headaches

To help pin down the problem, doctors often ask parents - and older kids and teens - to keep a headache diary, listing all headaches, when they happen, how long they last, and a few notes about what might have brought them on.

The doctor may do a complete physical exam including looking in the eyes, testing nerves, and having your child do things like walk or touch his or her nose. A doctor also may order blood tests or imaging tests, such as a CAT scan or MRI of the brain, to look for medical problems that might be causing headaches.

How to Help Your Child

Treatment for your child's headaches will depend on what the doctor determines is the likely cause. But most everyday headaches can be cared for at home with little medical intervention.

To help ease your child's pain, have him or her:

• Lie down in a cool, dark, quiet room.
• Put a cool, moist cloth across the forehead or eyes.
• Relax.
• Breathe easily and deeply.

Make sure your child has had something to eat and drink. Kids with migraines may just want to sleep and may feel better when they wake up. A big part of treating migraines is avoiding the triggers that may have caused them. That's where a headache diary can be especially helpful.

You also can give your child an over-the-counter pain reliever such as acetaminophen or ibuprofen. Read the label, though, to make sure that you give the right dosage at the right intervals. If you have any questions about how much to give, check with the doctor. And if your child is under age 2 or has other medical problems, call your doctor before giving your little one any pain reliever. Your doctor will be able to tell you whether you should give it and, if so, how much (based on weight and age).

Never give aspirin to kids or teens unless specifically directed to by a doctor. Aspirin can cause Reye syndrome , a potentially life-threatening condition.

If your child has chronic migraine headaches, the doctor may prescribe a medication to be taken when the headaches come on or daily as a preventive measure. In deciding whether to put your child on medication, the doctor will consider the frequency of the migraines and discuss the potential benefit of the medication versus its possible side effects.

Discuss pain management with your doctor, who will develop a treatment plan that may include approaches that don't involve medicine, such as relaxation, stress reduction techniques, and avoiding possible triggers.

Tracking your child's headaches and their symptoms and following the doctor's recommendations are the keys to finding relief for painful headaches.

Reviewed by: Larissa Hirsch, MD
Date reviewed: April 2009