Brain, Spinal Cord and Nerve Conditions and Diagnoses

Headaches

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TV Segment

Thomas DeWitt, MD, FAAP, Director of General and Community Pediatrics at Cincinnati Children's, answers Family FAQs on Channel 12, WKRC. On May 6, 2004, he answered a question about Headaches. Watch this segment:

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Radio Segment

Steve Muething, MD, associate director of clinical services in the Division of General and Community Pediatrics, can now be heard weekly "The Health Show," distributed by WAMC/Northeast Public Radio. On July 7, 2004, he spoke about Headaches. Listen to this segment:

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Headaches are a common problem in children and adults. There are many different causes for headaches ranging from rare, serious diseases to benign (not serious) conditions which are not life threatening. These headaches may significantly interfere with participating in activities and school. They are a health problem.

Children may experience different types of repeated or recurrent headaches including tension-type headaches, migraines with aura, migraines without aura, chronic daily headaches and chronic sinus headaches.

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Tension-type headaches

A tension-type headache is steady and not throbbing and usually happens on both sides of the head. Some people say that it feels like a band tightening around their head. It can last anywhere from 30 minutes to many days. It is usually mild to moderate in severity. Most of the time the headache does not change a person's activity level.

Tension-type headaches can be associated with light or sound sensitivity, but not both. Children do not have nausea or vomiting with these headaches.

This type of headache has also been called a tension headache, chronic muscle contraction headache, stress-related headache and chronic non-progressive headache.

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Migraine headaches

Migraine headaches are recurrent headaches that are separated by times without pain. They can last anywhere from hours to days. They are usually severe enough to make a person stop their normal daily activities.

Symptoms

"Warnings" called auras (These auras can include blurry vision, flashing lights, colored spots, strange tastes, or weird feelings before the pain starts.)
Headaches starting on one side of the head (This may vary from headache to headache, and in children, they often start in the front or at the temples on both sides.)
Throbbing or pounding pain during the headache
Nausea, vomiting, and/or stomach pain
Light and/or sounds bother the person
Pain gets better after rest or sleep
Pain gets worse with activity
Someone else in the family has headaches/migraines

Causes

There are different theories about the cause of migraine headaches. Below are some of the current theories. It may be that the true cause of migraines is a combination of these theories.

One theory is the vascular theory. Some doctors and scientists think that tightening and relaxing of the blood vessels in the head can cause the auras before and the pain during the migraine. Some migraine medicines and other treatments (for example, relaxation and good health habits) change the tightening and relaxing of the blood vessels in the head.
Another theory is the neural theory. Some think that when a migraine occurs there is a spreading wave of decreased activation of the brain during the attack. Some medicines and other treatments affect this wave.
A third theory says that migraine may be a disorder of serotonin neurotransmission. Serotonin is a natural chemical in the brain that has important uses in the communication of signals from one brain cell to another. Some migraine medicine and other treatments affect serotonin action in the brain.

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Chronic daily headaches

These headaches occur at least 15 days of the month for at least three months. Some chronic daily headaches may have started as migraine headaches or tension-type headaches and worsen to every day.

When people take pain medicine (Tylenol® [acetaminophen], Motrin® or Advil® [ibuprofen], caffeine, prescription medicines for pain, etc.) almost every day for their headaches, it can cause analgesic rebound headaches. This is when your body becomes used to the frequent use of these medicines. The headache either returns shortly after taking the medicine or it stops working. The best way to make these headaches better is to stop taking pain medicines for a few weeks. After that time, pain medicine use is limited to no more than 2-3 times per week.

Some people with chronic daily headaches are low in certain vitamins and minerals. It is important to eat balanced meals. Children and teenagers may need to take a daily multi-vitamin. Your child's doctor or nurse practitioner may talk to you about getting blood tests to see if your child needs more vitamins or minerals.

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How can I prevent a headache?

Following good health behaviors can decrease the frequency and severity of headaches and migraine attacks. Some of these behaviors to follow include:

Make sure your child drinks enough fluids during the day. Children and adolescents need from 4-8 glasses of fluid without caffeine every day. Drinking fluids with sugar and salt (sports drinks) may also help during a headache or during more activity.
Make sure your child gets plenty of sleep at night (but doesn't oversleep). Fatigue and over exertion are two factors that can trigger headaches. Most children and adolescents need to sleep 8-10 hours each night and keep a regular sleep schedule to help prevent headaches.
Be sure that your child eats balanced meals at regular hours. They should not skip meals.
Try to avoid foods that seem to trigger headaches. Remember that everyone is different, so your child's triggers (if he/she experiences them) may be different from someone else's.
Plan and schedule your child's activities sensibly. Try to avoid over-crowded schedules or stressful and potentially upsetting situations.
If your child's doctor prescribed medicine to prevent future headaches (prophylactic medicine), remember to give it every day, whether your child is having headaches or not.

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How do I treat my child's headaches?

Keep a record of your child's headaches. Write down everything that might relate to the headache (foods, odors, situations), how long it lasted, and how much pain the headache caused.

Give medicine for your child's headache as soon as he/she feels pain. Your child may be taking over-the-counter (OTC) medicine or prescription medicine when he/she gets a headache. Follow the medication instructions. Remember that using these pain medicines (analgesics) every day can cause an increase in headaches. Drinking more fluids (especially sports drinks) during a headache may also help it go away faster. Drinking fluids can be done at the onset of all headaches.

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