Headaches

Description

A headache refers to pain or discomfort anywhere in the region of the head or neck. Headaches are the most common health complaints experienced by every person at some point during their life. Children also suffer from headaches but may experience slightly different symptoms. Most headaches are not serious.

Types

Like adults, children can experience different types of headaches including:

  • Migraines
  • Stress-related headaches
  • Cluster headaches
  • Chronic headaches

Symptoms

Migraines are throbbing, pulsating headaches which may be associated with nausea, vomiting, increased sensitivity to light or sound, pain with exertion or abdominal pain. Migraines in children usually last less than 4 hours while in adults they are usually more prolonged.

Tension-type headaches are non-pulsatile in nature and associated with tightness of the head and neck muscles. Pain is generally felt on both sides of the head and does not alter with activity. Pain may be present for half an hour to several days and may cause your child to be less active and sleep more often.

Cluster headaches, rarely seen in children under the age of 10, cause sharp stabbing pain on one side of the head which may be accompanied by congestion and restlessness. This is characterised by five or more headache episodes occurring in a single day or spread out over a week.

Headaches that occur more than 15 days in a month are termed chronic daily headaches.

Causes

Headaches in children may be associated with stress, anxiety, infection, injury, frequent use of pain medication, presence of a tumour, abscess or from certain foods. They commonly occur in girls after puberty, older teens and those with a positive family history.

Stress may be triggered by problems at school, home or among friends. Common infections such as flu, ear and sinus infections can cause a headache. Meningitis causes headaches along with other symptoms such as neck stiffness and a fever. Minor head bruises and bumps can lead to headaches. You should contact your doctor if your child has received a hard blow to the head or falls directly on the head. Head injuries can sometimes cause headaches that steadily become more intense and need investigation. Some headaches tend to run in families. Certain foods such as caffeine and MSG, a food additive can trigger headaches. Sometimes a chronic worsening headache may originate from problems in the brain such as an abscess, bleeding or tumour. In such cases, other symptoms such as dizziness, poor coordination and visual problems may also be present.

When should I contact a doctor?

Headaches in children are usually not serious, but you should contact a doctor if:

  • The headaches worsen or occur more frequently
  • Your child has had an injury to the head
  • Your child wakes up due to a headache
  • Vomiting or visual changes accompany headaches
  • There is neck stiffness or fever
  • You notice a change in your child’s behaviour

Diagnosis

A headache may be difficult to identify in children who are too young to describe their symptoms. Crying while holding the head can be an indication. Your doctor will review all associated symptoms and family history and perform a physical examination focusing on your child’s neurological status. Imaging studies may be ordered to help identify an underlying cause. A spinal tap may be ordered if raised intracranial pressure or inflammation of nervous system is suspected. This involves obtaining a sample of spinal fluid from the lower back for manometry and laboratory evaluation.

Treatment

Treatment of headache depends on underlying cause and type of headache. Maintaining record of headache is very important. Your child’s neurologist may recommend maintaining a headache diary (insert link) before recommending any treatment. This will help analyse the headache pattern, severity and the impact it causes on daily functioning of your child. To treat a headache, neurologist may recommend rest, pain medications including over the counter medications or prescription medication for migraines, control of environmental factors such as light and sound and adequate fluid intake. Some children find therapies such as relaxation exercises, massage, cognitive behavioural therapy and biofeedback training useful for dealing with tension and headache triggers such as stress and depression.

Self-Management

Most headaches can be managed at home with over-the-counter medications. When administering these medications to your children keep the following in mind:

  • Make sure your child receives the correct dosage and frequency
  • Don’t give medications for more than 3 days as overuse can trigger a rebound headache
  • Use aspirin cautiously and avoid giving it if your child has just recovered from chicken pox or an illness with flu-like symptoms. This can lead to a life-threatening condition called Reye’s syndrome.

Besides medication, your child may also find relief with application of a cool wet cloth to the forehead, Headaches can worsen if your child has not eaten anything so offer a healthy snack such as fruit, biscuits or cheese.

Prevention

To help prevent or relieve headaches in your child the following is recommended:

Control stress: Stress, anxiety and depression can arise from your child’s relationships, difficulty with school work, and strenuous schedules. Managing these stressors can often reduce the frequency of headaches.

Encourage healthy habits: Good habits that improve health also reduces the likelihood of headaches. Make sure your child has adequate sleep, physical activity, good nutrition and plenty of water.

Watch out for triggers: Being aware of your child’s diet, activities and medication use can help you find out what usually brings on a headache. Caffeine for example might trigger a headache.

Jot it down: Maintaining a headache diary can help you identify and avoid headache triggers. It can also help your doctor determine the characteristics of your child’s headache so that appropriate treatment can be planned.

Medications: If your child’s headaches are chronic and affecting his or her quality of life, your doctor may recommend preventive medications. These can include conventional headache preventative medications or anti-seizure or antidepressant medications at low doses which are sometimes prescribed to reduce headache severity and frequency.

  • Australian Medical Association (AMA)
  • Royal Australasian College of Physicians, Australia (RACP)
  • Australian and New Zealand Child Neurology Society, Australia (ANZCNS)
  • Epilepsy Society of Australia (ESA)
  • International League Against Epilepsy (ILAE)
  • International Child Neurology Association (ICNA)