“Mommy, my head hurts.”
We get very anxious when a child complains of a headache because we don’t think that children are supposed to get them. However, headaches are actually common in children, and can occur as young as 2 or 3 years old. The vast majority of headaches are benign and manageable.
Tension headaches are the most common type in children. Children complain of mild to moderate pain in their foreheads or temples, and describe it as “tight” or “pressing.” Some complain of sensitivity to light or noise, but dizziness and nausea are rare. Most children with tension headaches are able to continue with their activities.
Migraines are also common. Children complain of a severe, pounding headache that may be associated with nausea, vomiting, dizziness and sensitivity to light and sound. Some children also have an aura, an associated symptom such as seeing zigzags or black spots, feeling pins and needles, or hearing a buzzing or ringing in their ears. These children look and feel miserable. All they want to do is to lie down in a dark, quiet room — and this should be encouraged, as sleep is the best treatment for a migraine.
Migraines are often caused by stress, either physical or emotional. Common triggers are fatigue, hunger, dehydration and over-exertion. Many children also get headaches when anxious, upset or frustrated, or in response to certain foods or smells. Adolescent girls may get increased migraines around their periods.
Secondary headaches are caused by an underlying condition. The condition may either cause headaches on its own or worsen existing headache syndromes.
Many children complain of headaches when they are sick. Sinus headaches are common complaints, although many of these are actually migraines in disguise. True sinus headaches are usually associated with cough and cold symptoms and are more likely to consist of facial pain than actual headache pain.
Headaches that occur after head trauma can linger for weeks. Many children also complain of dizziness, fatigue, noise sensitivity and trouble concentrating. Parents may notice irritability, anxiety or other changes in personality. Rest is crucial in helping these children recover. They need a slow, step-wise return to their usual levels of activity, and should not return to sports until their symptoms are completely gone. The majority of children with concussions will recover completely with time, but they remain at higher risk for problems with repeated head injuries.
Almost every medication can have headache as a side effect, so be aware of which medications your child is taking if he or she starts complaining of headaches. This includes things we don’t always think of as medicine such as herbs, vitamins and supplements. Medication to treat headache, even common over-the-counter remedies such as Tylenol and Motrin, can actually cause persistent headaches when overused, so it is important to limit medication to no more than two times a week.
While most headaches are benign, some symptoms warrant further exploration and should be discussed with your pediatrician, including:
▪ Headaches that awaken your child from sleep or are present immediately upon awakening.
▪ Worsening of headaches with lying down, cough, urination or defecation.
▪ Headaches that are new and severe.
▪ Worsening or changing of a previous headache pattern.
▪ Lack of response to treatment.
▪ Pain always in the same location or persistent nausea.
▪ Worsening clumsiness, weakness, change in personality or school performance, or crossing of eyes.
▪ Confusion, difficulty speaking or weakness/paralysis of one side of the body.
▪ Neck or back pain.
The majority of headaches can be treated with some common sense. If children are hungry or dehydrated, give them food and water. If they are upset, overtired or look ill, encourage them to lie down and rest in a dark, quiet room. If they complain of a headache but are having too much fun to stop, the headache is probably mild and does not need treatment.
Occasional bothersome headaches can be treated with an appropriate dose of Tylenol or Motrin, and children with severe nausea might benefit from anti-nausea medication. Children with severe or frequent headaches may need a daily medication to prevent headaches.
Most children do not require MRIs, CT scans or other tests. The most helpful thing you can do is to keep a headache calendar. You can even download an app to keep track of dates, times, medications given and possible triggers such as food, activity level, emotional state and lack of sleep. Your child’s pediatrician will ask questions and do a detailed examination to see what work-up, if any, is needed. If the headaches are severe, unusual or new, your doctor may refer you for tests or to a specialist, but don’t panic. The vast majority of children with headaches are just fine.
If your child is suffering from headaches and you need more information or to be seen by a specialist, call 305-243-6732.
Paige Kalika, D.O., is a pediatric neurologist at the University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.