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What to Do When Headaches Happen

Four Simple Steps for Headache Prevention

Skipping meals and not getting enough sleep are the most common triggers for migraines in young children and adolescents.

Skipping meals and not getting enough sleep are the most common triggers for migraines in young children and adolescents. "A healthy lifestyle can help kids control their headaches," says Andrew Hershey, MD, PhD, director of the Headache Center at Cincinnati Children's.
"These are basic things you can do every day that just keep you healthy."

  • Stay hydrated. Children and teens need from four to eight glasses of caffeine-free beverages every day.
  • Exercise regularly. "I tell kids they need to sweat for 20 to 30 minutes at least three times a week," Dr. Hershey says. "They should choose a fun exercise that they enjoy."
  • Eat balanced meals at regular hours. Do not skip meals. Breakfast is especially important.
  • Get regular sleep and enough sleep. Most children and teens need to sleep eight to 10 hours each night and keep a regular sleep schedule to help prevent headaches.

Children of all ages experience all kinds of headaches.

"A single headache is fairly common," explains Andrew Hershey, MD, PhD, director of the Headache Center at Cincinnati Children's Hospital Medical Center. "By the age of 5, 25 percent of children will have a single, significant headache episode. By age 15, 75 percent will experience a headache."

For some, headaches continue to recur – in up to 10 percent of children ages 5 to 15 and in as many as 28 percent of girls and 14 percent of boys ages 15 to 19.

Headaches Defined

Recurrent headaches take many forms, including tension-type headaches and migraines.

A tension-type headache can last anywhere from 30 minutes to several days. This type produces mild to moderate pain, without throbbing, that can be felt all over the head. Sensitivity to light or sound, but not both, may accompany the headache. Tension-type headaches do not cause vomiting nor do they typically interrupt a child's regular activities.

Migraines, if untreated, can last anywhere from one to 72 hours. These headaches are associated with nausea and/or vomiting or sensitivity to light and sound. Migraines are also characterized by at least two of the following:

  • A pounding, throbbing sensation (children might describe a "banging" pain) 
  • Pain in a specific part of the head (most commonly across the front or temple in children) 
  • Limited activity due to the pain (or the pain gets worse with activity) 
  • Moderate to severe intensity

"If a child throws up recurrently with a headache, then it's very likely to be a migraine," says Dr. Hershey. Headaches resulting from a tumor or a mass in the brain can also cause vomiting, but in those cases the child would usually vomit every day and symptoms would increase in severity. Migraines tend to be more episodic, occurring a couple times a month.

Treating the Pain

When a child complains of a headache, don't ignore the pain,
Dr. Hershey advises. "Recent evidence shows that ineffective or inappropriate treatment can ultimately make headaches worse in terms of their lifelong prevalence."

At-home treatment is the first course of action. Many over-the-counter non-steroidal anti-inflammatory medications such as ibuprofen or naproxen sodium work well. These drugs should be used as quickly as possible and in the proper dose. Drinking more fluids during  a headache may also help the pain go away faster.

Dr. Hershey cautions parents to avoid overuse of these medications. "Typically, more than three times a week may actually worsen the headaches – causing medication overuse headaches."

It's also a good idea to tell your child's doctor about any recurrent headaches. "The most sensitive test for recurrent headaches and migraines is a neurological exam, which can rule out any secondary causes for headaches," says Dr. Hershey. "This exam can be done by your child's primary care physician."

A referral to the Headache Center at Cincinnati Children's is in order for children who are unresponsive to initial treatment, who are missing school or other activities, or who are not satisfied with their current treatment. "The Headache Center offers a multidisciplinary approach," Dr. Hershey says. "Children are seen by a child neurologist, who has special training in headaches; a child psychologist, who evaluates other potential impacts of headaches on a child's life; and a nurse practitioner, who provides patient education. We offer a full range of headache treatment options."

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