Migraine Headache   Rebound Headache   Tension-Type Headache   Pediatric Headache

How Common Is Pediatric Headache?

Like adults, children and adolescents suffer from headaches. Most often, their headaches are not serious, and they are not the result of any life-threatening disease. Research shows that more than half of school age children have had headaches, and as many as 10% have severe or frequent headaches.

As children get older, they are more likely to have headaches. Before puberty, headaches affect both boys and girls about the same. After puberty, though, girls are two to three times more likely to suffer from headaches than boys.

Frequent or severe headaches can interfere with a child's daily life, and may keep her from school or play. There are many different reasons a child may have headaches. If headaches are severe, are getting worse over time, or are accompanied by other symptoms (like vision changes or vomiting), the doctor should be consulted. Sometimes a specific cause for the headaches can be found, but more often the cause is not any other disease -- the only problem is the headache itself. Doctors can recommend treatments to help with headache pain experienced by children and adolescents, no matter what the reason is for the pain.




Types of Pediatric Headache

Some headaches occur only once, and these are called acute headaches. Acute headaches might be due to infection or trauma.

Infection: There are many infections that may cause headaches in children. For instance, the flu commonly starts with headache and fever. Children with ear infections or sinus infections also often have headache symptoms. In very rare instances, headache may be due to more severe infections, such as meningitis or encephalitis. If serious infection is suspected, the child must be brought to a doctor promptly.

Trauma: A short-lasting headache after a bump to the head is common in children. If there is any doubt about the condition of a child after a head injury, call a doctor or go to the emergency room right away. If the child was unconscious, does not remember the fall or bump, is nauseated or throwing up, is acting irritable or confused, is dizzy or has trouble seeing, or has a headache serious enough to interfere with sleep or play, see a doctor immediately.

Some children have chronic or recurrent headaches. Parents might worry that long-lasting headaches in children or repeated headaches might be caused by a brain tumor. This is very uncommon. Actually, headaches that children and adolescents get repeatedly are usually migraine headaches or tension headaches.

Migraine Headaches: It is thought that about 5 to 10% of children have migraine headaches. Migraines differ from child to child, but usually children experience many of the following:

	The child has headache pain that is moderate to severe.
	The child has headache pain that is throbbing or pounding.
	The child has headache pain that is worse on one side of the head, or pain that is on both sides of the head in the forehead area.
	The child feels nauseated or vomits.
	The child shows a sensitivity to light, sound or smells, or has tenderness of the scalp.
	The child goes to a darkened, quiet room and tries to sleep. Children with migraines rarely want to move around, watch TV, read or listen to music, because these all tend to make the headache worse.

Migraine headaches may occur only once in a while, or may occur more than once a week. Headaches may last anywhere from a few hours to several days. Between headaches, the child feels fine.

Some children with migraines have "auras" before the headache begins, when their vision may blur or they may see flashing lights, spots or colored zig-zag lines. Less common auras include weakness in an arm or leg, funny feelings (tingling, pins and needles) in an arm or leg, speech difficulty, or abdominal pain. Headaches usually start during the aura or shortly after the aura stops. If your child complains of any of these symptoms for the first time, it is important to take him to a doctor. The doctor will make sure that the child is experiencing an aura (which does no permanent damage and goes away completely between headaches) and not anything more serious.

Doctors and researchers don't know exactly what causes migraine headaches. Some migraines do have "triggers," however:

Stress: Parents should ask children suffering from migraines if they are worried, upset or anxious about anything. Stress for children usually originates from school or the home. Any known sources of stress (i.e., a recent divorce) should be discussed with the child's doctor.

Hunger: In some children, missing meals or not eating enough at meals can trigger migraine headaches.

Diet: Doctors think that a diet plays an important role in migraines for some children. Foods that might trigger migraines are cheeses, chocolate, caffeine, citrus fruits and food preservatives. It is unknown why foods can cause migraine headaches to start.

Exercise: Hard exercise can bring about migraines in some children. Eating before and after exercise may help prevent these attacks.

Motion sickness: Children who experience motion sickness while riding in a car, boat or plane may later develop a migraine headache.

Sleep deprivation: Not getting enough sleep or poor sleeping habits can trigger migraine headaches in children. Good sleeping habits, including going to bed and getting up at about the same time every day, may help control some headaches.

Environment: Bright lights, flickering lights, noise, strong smells or weather changes can sometimes cause migraines to start.

Tension-Type Headaches: Doctors and researchers don't know much about the causes of tension-type headaches. In some children, they seem to be associated with stress. For these children, tension headaches might start when the child is feeling stressed or anxious; for instance, before going to school. Tension headaches usually hurt on both sides of the head, with a steady, non-throbbing pain that may feel like a pressure or tightness in the head. The child does not usually feel nauseated. While the child may want to sit quietly during a headache, movement, lights, watching TV, reading or listening to music usually do not make the headaches any worse.

Tension headaches last anywhere from a half hour to many days. It is possible for a new tension headache to start every day for a long period of time.




Treatments

If a child has frequent or severe headaches, she should be seen by a doctor. The doctor will first take a careful history, which will involve asking the child and parents questions that will help the doctor understand why the child is having headaches. The doctor may ask questions about past illnesses or injury, when the child had her first headache and what her headaches have been like since then. The doctor will probably also ask the parents many questions about the child's recent headaches, such as:

	How often has she had the headaches?
	How severe have the headaches been?
	How long have the headaches lasted?
	What time of the day or night does she usually get headaches?
	Where is the pain?
	How does the child act when she has the headaches? What does she do?
	What causes the headaches or makes them worse (stress, hunger, exercise, bright light, etc.)?
	What makes the headaches better?
	What treatments have been tried and how well have they worked?
	Has she missed school or other activities because of the headaches?
	Do headaches make it hard for the child to sleep, or does the pain wake her up during the night?
	Is there a history of headache in the family?

Depending on the age of the child, the doctor may also ask her to answer each of these questions. Often, the doctor wants to speak with the child alone. It is important for the doctor to hear the child describe her symptoms in her own words. Also, talking to the child alone ensures that the she feels free to discuss aspects of her headache that she may not be comfortable discussing in front of her parents.

The doctor may want the parents and/or child to keep a record of the headaches (sometimes called a "headache diary"). This involves writing down how often the child has the headaches, how bad the headaches are, how long the headaches last, what medications were given and whether or not they helped, and anything that makes the headaches begin, get worse, or get better.

Once important information about the headaches has been gathered, the doctor may do a physical exam. Sometimes, the doctor wants to do some tests. These tests might include blood tests, a cranial computed tomography (CT), or a magnetic resonance imaging (MRI) study.

If the child is found to have an infection or other disease, treatment might be available for that condition. If the doctor can find no cause for the headaches, this does not mean that there is no treatment. Remember, doctors do not know the cause for the common tension-type headaches or migraine headaches. But there are treatments they can offer to help with the headache symptoms.

For migraine and tension-type headaches, treatment might begin with good sleep and nutrition habits. Things that trigger the headaches, if identified, can be avoided. For some children, these simple changes can make a big difference in how often they suffer from headaches, how bad the pain is and how long the headaches last.

Drug Treatment: Doctors often first recommend acetaminophen (like Tylenol®) for headaches in children. If this does not stop the pain, it is important to let the doctor know -- NEVER give more medicine to a child than the doctor recommends. Even though acetaminophen is available without a prescription, it can still be dangerous to a child if too much is given.

There are many other medications that the doctor can try for the headaches. The more information the child and parents are able to give the doctor about the headaches, the easier it will be for the doctor to find the best medication for that child. However, even with good information about the headaches, it might take trials of several different medications before the most effective one is found. This is because each child reacts differently to medications -- if two children with exactly the same headache symptoms are given the same medication, one may feel better and one may not.

Also, medication may be prescribed for the child's nausea, vomiting or diarrhea, if these symptoms are present.

Preventive treatment (called "prophylactic" treatment): These are medications given to the child daily to help prevent headaches from starting. Preventive treatments may be prescribed by a doctor if the child's headaches are severe and occur often. Sometimes children and adolescents who have very bad headaches, and their parents, choose not to use preventive treatments. This is usually because they do not want to take medications every day. This is a choice that each child and his parents must make based on how hard it is for the child to cope with the headaches and how well medications work if taken after the headaches start. There are many preventive medications that can be tried.

Nondrug Treatment: Some nondrug treatments, like biofeedback and relaxation therapies, can be helpful, particularly in older children. These techniques are taught to the child, who can practice and then use them to cope with headache pain as it starts. Also, if the techniques are practiced every day, they may even help prevent headaches from starting. Biofeedback machines measure electrical impulses or heat from the child's skin and show these measurements on a TV screen, a flashing light bulb, or a beeper. The feedback from their own bodies can help the child to practice relaxation and make internal adjustments that help relieve the headache pain.

Because stress and anxiety play a part in many childhood headaches, it might be helpful for some children to see a mental health specialist, like a psychologist. Mental health specialists can help children with the relaxation techniques described above, and also help them deal with the stress and anxiety they are feeling.

Summary

Like adults, children suffer from headaches. Headaches may result from infection or injury, but most repeated headaches have no clear cause. These are usually migraine headaches or tension-type headaches. Doctors may be able to offer medication and nondrug treatments to help control pain in migraine or tension-type headaches.




Headache/Pain Clinic Treatment
Most often, migraine headache patients can be successfully managed by one physician without the need for a comprehensive pain clinic treatment. However, some migraine patients with severe headaches that fail to respond to routine measures may need a multidisciplinary approach involving several headache specialists, which may be provided in headache and pain clinics.




Pediatric Headache Websites

eMedicine: Emergency Medicine - Pediatrics, Headache

eMedicine: Neurology - Headache, Pediatric Perspective

National Guidelines Clearinghouse: Pediatric Migraine

Pediatric Pain Treatment - Guidelines: PainTopics.org

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