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Should Your Child See a Doctor?

Headache

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Definition

  • Pain or discomfort of the scalp or forehead areas
  • The face and ears are excluded

Causes 

  • Viral illnesses: Most headaches are part of a viral illness, especially with colds. These usually last a few days.
  • Muscle tension headaches: Most common type of recurrent headaches. Muscle tension headaches give a feeling of tightness around the head. The neck muscles also become sore and tight. Tension headaches can be caused by staying in one position for a long time, such as with reading or using a computer. Other children get tension headaches as a reaction to stress, such as pressure for better grades or family disagreements.
  • Migraine headaches: Recurrent severe, incapacitating headaches
  • Other common causes: Hunger, exertion, sunlight, coughing
  • Frontal sinusitis: can cause a frontal headache just above the eyebrow. Rare before 10 years old because frontal sinus not developed. Other sinuses cause face pain, not headache.
  • Serious causes: Meningitis or encephalitis. Symptoms include a headache, stiff neck, vomiting, fever and confusion,

When to Call Your Doctor for Headache

Call 911 If…

 
  • Your child is difficult to awaken or has passed out
  • Your child shows confused thinking/talking or slurred speech
  • Your child has blurred or double vision
  • Your child has weakness of arm or leg or unsteady walking
 

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick
  • Stiff neck (can't touch chin to chest)
  • Severe headache
  • Vomiting
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Fever
  • Sinus pain (not just congestion) of forehead
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Headache without other symptoms present over 24 hours
  • Sore throat present over 48 hours
  • Any headache present over 3 days
  • Headaches are a recurrent chronic problem
 

Parent Care at Home If

  • Mild headache and you don't think your child needs to be seen
 

Home Care Advice for Headaches

Treatment for Mild Headache

  1. Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen for pain relief (see Dosage table on container). Headaches due to fever are also helped by fever reduction.
  2. Food: Give fruit juice or food if your child is hungry or hasn't eaten in more than 4 hours (Reason: Skipping a meal can cause a headache in many children).
  3. Rest: Lie down in a quiet place and relax until feeling better.
  4. Local Cold: Apply a cold wet washcloth or cold pack to the forehead for 20 minutes.
  5. Stretching: Stretch and massage any tight neck muscles.
  6. Call Your Doctor If:
    • Headache becomes severe
    • Vomiting occurs
    • Isolated headache lasts over 24 hours
    • Headache lasts over 3 days
    • Your child becomes worse
     

Muscle Tension Headaches: Extra Advice

  • If something is bothering your child, help him talk about it and get it off his mind.
  • Teach your child to take breaks from activities that require sustained concentration. Encourage your child to do relaxation exercises during the breaks.
  • Teach your child the importance of getting adequate sleep.
  • If over-achievement causes headaches, help your child find more balance.
  • Caution: Your child should have a complete medical checkup before you conclude that recurrent headaches are due to worrying too much or stress.

Treatment for Migraine Headache

  1. Reassurance: This headache is similar to previous migraine headaches that your child has experienced.
  2. Migraine Medication:
    • If your child's doctor has prescribed a specific medication for migraine, give it as directed as soon as the migraine starts.
    • If not, ibuprofen is the best over-the-counter drug for migraine. Give ibuprofen now and repeat in 6 hours if needed (See Dosage Table).
     
  3. Sleep: Have your child lie down in a dark, quiet place and try to fall asleep. People with migraine often awaken from sleep with their migraine gone.
  4. Call Your Doctor If:
    • Headache becomes much worse than usual
    • Headache lasts longer than usual
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. Elser JM. Easing the pain of childhood headaches. Contemp Pediatr. 1991 Nov; 8:108-123.
  2. Feign RD, et al. Diagnosis and management of meningitis. Pediatr Infect Dis J. 1992;1:785-814.
  3. Fisher PG. Help for headaches. Contemp Pediatr. 2005;22(11):34-40.
  4. Forsyth R, Farrell K. Headache in childhood. Pediatr Rev. 1999;20:39-45.
  5. Gabis LV, Yangala R, Lenn NJ. Time lag to diagnosis of stroke in children. Pediatrics. 2002;110:924-928.
  6. Lewis D. Pediatric migraine. Pediatr Rev. 2007;28(2):43-52.
  7. Lewis DW, Qureshi FA. Acute headache in the pediatric emergency department. Headache. 2000;40:200-203.
  8. McAbee GN, Donn SM, Mendelson RA, et al. Medical diagnoses commonly associated with pediatric malpractice lawsuits in the United States. Pediatrics. 2008;122:e1282-e1286.
  9. Molofsky WJ. Managing stroke in children. Pediatr Ann. 2006;35(5):379-384.
  10. Molofsky WJ. Headaches in children. Pediatr Ann. 1998;27:614-621.
  11. Rubin D, Suecoff S, Knupp K. Headaches in children. Pediatr Ann. 2006;35(5):345-353.
  12. Singer HS and Rowe S. Chronic, recurrent headaches in children. Pediatr Ann. 1992;21(6):369-73.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 9/15/2010

Copyright 1994-2011 Barton D. Schmitt, M.D.

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