Brain, Spinal Cord and Nerve Conditions and Diagnoses

Headaches

Headaches are a common health problem in both children and adults. There are many different causes for headaches in children. A headache is called a primary headache when there is no other health problem causing the headache. The most common types of primary headache include tension-type headache, migraine with aura, migraine without aura, and chronic daily headache. A headache is called a secondary headache when there is another health problem causing the headache to occur, such as a sinus infection or injury to the the brain.

About 10 percent of school age children and about 15-27 percent of teenagers have recurrent primary headaches. Headaches can limit a child’s ability to participate in school, family and social activities.

Tension-type headaches

A tension-type headache is a recurrent headache that is causes a pressing/tightening type pain (not throbbing) and usually happens all over the head. Some people say that it feels like a band tightening around their head. It can last from 30 minutes to many days. It is usually mild to moderate in severity. Tension-type headaches do not usually change a child’s activity level.
Tension-type headaches can also have light or sound sensitivity, but not both. Children do not have nausea or vomiting with these headaches.
Tension- type headache has also been called tension headache, chronic muscle contraction headache, and stress-related headache.

Migraine headaches

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

Symptoms

• "Warnings" called auras (Auras can include blurry vision, flashing lights, colored spots, strange tastes, or loss of feeling (numbness) or a pins and needles feeling in a body part before the pain starts.) This occur in about 10% of children with migraine. This is diagnosed as migraine with aura.
• Headaches starting on one part 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 of the head.)
• Throbbing or pounding pain during the headache
• This pain is described as moderate to severe in intensity
• Pain may get worse with activity or stop people from participating in activities
• The headaches may be associated with
• Nausea and/or vomiting.
• Light and sound sensitivity (A child may want to rest in a dark and quiet room.)
• Oftentimes, other members of the family have 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.

• The genetic inheritance of a hypersenitive nervous system appears to contribute to the susceptibility of migraine. In some patients this is associated with “cutaneous allodynia.” This symptoms is a heightened sensitivity to sensations that are normally not bothersome to the point that are noticable (i.e., wearing a hat or a ponytail). This is thought to be directly due to central sensitization (areas of the brain become overly sensitive).
• 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.
• 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. It appears that these changes are more likely due to neuronal changes in the area of the brain called the trigeminal nuclei, thus it is refered to as the trigeminalvascular theory.
• A disorder of 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. Other neurotransmitters including dopamine and CGRP have also be shown to be involved with migraine.

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 (chronic migraine) or tension-type headaches (chronic 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 medication overuse headaches. This happens when your body becomes use to the frequent use of these medicines. The headache either returns shortly after taking the medicine or the medicine stops working. The best way to make these headaches better is to stop taking pain medicines for four to six weeks. After that time, pain medicine can be restarted but use is limited to no more than 2-3 times per week.

Some children with chronic daily headaches are low in certain vitamins. 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.

How can I prevent a headache?

Migraines, the most common cause of episodic headaches in children, are genetically based. Although you cannot change your genes, you can develop healthy behaviors in order to control the impact of your migraine. Good health behaviors can decrease the frequency and severity of headaches if done regularly. Healthy behaviors include:

• Make sure your child drinks enough fluids during the day. Children and adolescents need 6-8 glasses of fluid without caffeine every day. Drinking fluids with sugar and salt (sports drinks) may also help during a headache or play/exercise.
• Make sure your child gets plenty of sleep at night (but doesn't oversleep) on a regular basis. 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 (even on the weekend) to help prevent headaches.
• Be sure that your child eats balanced meals with fruits and vegetables three times a day. They should not skip meals.
• Regular activities and exercise is essential to a healthy brain and should be part of your child’s lifestyle.
• Obesity may contribute to worsening headaches and disability. The incorporation of regular exercise and good eating habits should be maintained.
• If your child's doctor prescribed medicine to prevent future headaches (preventative medicine), remember to give it every day, whether your child is having headaches or not.

How do I treat my child's headaches?

Keep a record of your child's headaches. This should include time of the day, week and month (especially in girls), any initiating factors (weather, menstrual periods, activities, etc.), symptoms of the headaches, duration of the headaches and treatment used with their effectiveness.

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 start of all headaches.

Call your child's health care provider

• If a headache consistently wakes your child from sleep
• If your child experiences early morning vomiting without nausea (upset stomach)
• If the headaches are worsening or occurring more often
• If your child experiences personality changes
• If your child complains that it is "the worst headache I've ever had!"
• If the headache is different than previous headaches
• If the headache occurs with a fever or stiff neck
• If the headache happens after an injury
• If your child is not headache free after two doses of pain medication
• If your child is frequently using medications for headaches
• If the headaches are causing your child to miss school or social activities 

Rev. 8/08

Your Child's Health

Brain, Spinal Cord and Nerves

• Brain, Spinal Cord and Nerves Overview
• Brain, Spinal Cord and Nerve Conditions and Diagnoses
  • Epilepsy and Seizures
  • Headaches
  • Hydrocephalus(2)
  • Brachial Plexus Injury
  • Craniosynostosis
  • Tourette Syndrome Resources
  • Does Strep Throat Cause Tourette's?
  • Fever-Related Seizures
  • Mild to Moderate Head Injuries
  • Tics, Tourette Syndrome and Medications
• Brain, Spinal Cord and Nerve Tests and Procedures
• Brain, Spinal Cord and Nerve Home Care
• Brain, Spinal Cord and Nerve Treatment