Health Library

Headaches

Headaches are a common health problem in both children and adults. There are many 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 or 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 brain.

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

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, can include flashing lights, colored spots, difficulty talking or loss of feeling (numbness) or a pins-and-needles feeling in a body part before the pain starts. This occurs in about 10 percent 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
• Pain is described as moderate to severe in intensity (4-10 on the 0-10 pain scale)
• 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 hypersensitive nervous system appears to contribute to the susceptibility of migraine. In some patients this is associated with “cutaneous allodynia.” This symptom is a heightened sensitivity to sensations that are normally not bothersome to the point that they are noticeable (i.e., wearing a hat or ponytail). This is thought to be directly due to central sensitization (areas of the brain become overly sensitive).
• Some think that when a migraine occurs there is a spreading wave of decreased activation of the brain during the attack.
• 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. 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 referred to as the trigeminovascular theory.
• Serotonin is a natural chemical in the brain that has important uses in the communication of signals from one brain cell to another. Other neurotransmitters including dopamine and CGRP have also been shown to be involved with migraine.

Tension Headaches

A tension-type headache is a recurrent headache that 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.

Chronic 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) almost every day for their headaches, it can cause medication overuse headaches. 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 two to three 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 multivitamin. 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.

Preventing 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 to control the impact of your migraine. Good health behaviors can decrease the frequency and severity of headaches. Healthy behaviors include:

• Drinking enough fluids during the day. Children and adolescents need six to eight glasses of fluid without caffeine every day. Drinking fluids with sugar and salt (sports drinks) may also help during a headache or play / exercise.
• Getting plenty of sleep at night (but not oversleeping) on a regular basis. Fatigue and over exertion are two factors that can trigger headaches. Most children and adolescents need to sleep eight to 10 hours each night and keep a regular sleep schedule (even on the weekend) to help prevent headaches.
• Eating balanced meals with fruits and vegetables three times a day. Children should not skip meals.
• Engaging in regular activities and exercise. They are essential to a healthy brain and should be part of your child’s lifestyle. Exercise at least three to four times per week, if not more.
• Maintaining regular exercise and good eating habits. Obesity may contribute to worsening headaches and disability.

If your child has more than three to four headaches per month, your child’s doctor may prescribe medicine to prevent future headaches. Remember to give it every day, whether your child is having headaches or not.

Treatment for a Headache

Keep a record of your child's headaches. This should include time of day, week and month (especially in girls), any initiating factors (weather, menstrual periods, activities), 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 Doctor If:

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