Headaches in Children: Symptoms, Diagnosis And Treatment

We do not associate children and headaches. But headaches in children are common (1). In the US alone, 20% of children aged 5-17 (over 10 million children) suffer from a headache every year (2). So if your child says that his head hurts, it probably does.

Here, we tell you about pediatric headaches, what causes them, and the accompanying symptoms, diagnosis, and treatment options.

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Causes Of Headaches In Children

It can be a dull, throbbing, or pounding pain. It could be short-lived or a chronic headache. But it is there.

Headaches in children can be due to a variety of reasons. Common causes include (3):

• Excess physical strain

• Emotional or mental stress

• Skipping a meal

• Dehydration (can cause headaches in children and adults)

• Excessive crying

To know what causes headaches in children, we need to learn about the types of headaches.

Headaches are generally classified as primary (i.e., the headache itself is the disease) or secondary to another illness and represent one of the symptoms of that illness. The most common types of primary headaches in childhood are migraine and tension-type headaches, while the most common secondary headaches are associated with an infectious illness or are related to an injury.

Primary headaches

Tension headaches and migraine headaches are two forms of primary headaches. Tension headaches are more common in children and adolescents and typically last for a few minutes. Around 20% of adolescents experience them (4). They can cause a tightening pain around the temples and on both sides of the head. Tenderness of the scalp is also a common symptom.

Migraine headaches occur in 10% of adolescents. The pain can be described as throbbing or pulsating and usually occurs on one side or part of the head. Some children may also experience pain on both the temples, but rarely at the back of the head. A migraine headache is more severe than a tension headache and can last for hours, sometimes days. Nausea and vomiting are other symptoms of migraine.

Read more about the symptoms of a migraine here.

Secondary headaches

The underlying illness causing the headache could be:

• Impaired visual acuity is by far the commonest cause of headache in children

• Mild trauma to the head or neck

• Problems with sinuses, eyes, teeth, ear, or other parts of the face

• Psychological problems such as depression, anxiety disorders

• Infections like meningitis, sinusitis, etc

A headache can sometimes be a symptom of tumors which manifests as early morning headaches with projectile vomiting’s. Hence all headaches should be addressed immediately.

Cluster headaches

Cluster headaches usually affect children aged over 10 (5). These headaches occur in series on one side of the head, usually behind the eye, and last over a week or month. The affected eye may turn red, become watery, and have dilated pupils. Swelling of the eyelid, runny nose, or congestion and a swollen forehead are other symptoms.

When To Worry About Headaches In Children?

Headaches in adolescents are usually due to migraine, stress, and dehydration. But they should be a matter of concern when (6):

• Sudden onset associated with vomitings, neck stiffness, fever, and intolerance to light

• They are frequent and occur more than once a month

• They are present when the child wakes up and the headache does not go away even after getting adequate sleep

• The pain is persistent and does not go away easily

• The pain is always severe or progressive

• The child loses consciousness due to the pain

While these signs need you to call the doctor immediately, they may not always indicate a medical condition.

Headache Symptoms In Kids

Symptoms vary as per the type of a headache (7). The differences are mostly in the intensity of pain, duration, onset, and how it affects the child’s daily activities. For instance, migraine headaches are also accompanied by:

• Blurry vision

• Sweating

• Nausea and vomiting

• Flashing lights in the line of vision and

• Sensitivity to light and sound

Symptoms of tension headaches include:

• Slow onset of pain

• Pain on both sides of the head Mild pain, which could sometimes be moderate but not severe

• Change in the child’s sleeping patterns

• Pain in the posterior neck or head, sometimes

These symptoms could indicate that a headache is a sign of a serious illness.

• A very young child complaining of a headache

• Sudden onset of severe headaches

• Headaches experienced on waking up or that wake up a sleeping child

• Pain that worsens when the child coughs, sneezes, or strains the head by moving it vigorously

• A progressive headache, where the pain runs from mild to severe quickly

• Recurrent nausea or vomiting every time the child has a headache

• Changes in vision

• Variations in the child’s personality

• Weakness in legs, problem in moving, or balancing legs and arms

• Epilepsy or seizures

You must consult a doctor immediately in all these cases.

Diagnosing A Headache

A thorough diagnosis is necessary to determine the exact cause of headaches and to understand the extent of the problem. The doctors would check the child’s medical history and conduct a physical examination, following which they would recommend certain tests. Typical questions that a physician may ask include:

• When does the headache occur?

• Which part of the head hurts during the headache?

• How long does the headache last?

• Has there been a head injury or trauma?

• Have there been any changes in sleeping or eating patterns?

• Does a particular body posture trigger or reduce a headache?

• Does the child have a sleeping problem?

• Are there any signs of emotional or psychological stress?

• Is the child able to read from a distance comfortably without straining?

• Is headache associated with vomitings or photophobia?

If necessary, the doctor may recommend neurological tests for diagnosis of primary headaches. Other diagnostic tests, mentioned below, may be recommended for secondary headaches.

• Visual acuity and fundus to determine the eyesight and intraocular pressure

• MRI brain helps in diagnosing any structural abnormalities of the brain and sinuses

• MRA helps in checking the blood vessels to the brain

• CT Scan helps detect any tumors, aneurysms, neurological problems, or abnormalities in the brain

• Polysomnogram

• Spinal tap or lumbar puncture is usually recommended to diagnose underlying medical conditions like meningitis and encephalitis

Treatment

Treatment for headaches also depends on what is causing them.

• The child’s age

• Type and extent of the headache

• Child’s medical history

• Child’s tolerance to specific drugs, therapies, and changes in lifestyle

The treatment methods range from cold compresses, rest, and over-the-counter (OTC) medications to prescription medication, changes in lifestyle and therapies, among other options.

• Rest is all that the child may need in case the headache is due to stress or strain, or tension headaches.

• OTC pain medications such as ibuprofen or acetaminophen can relieve headaches in kids. Ideally, avoid giving aspirin to the child. You must talk to the doctor before giving pain medicines.

• Prescription medication can be used to treat severe headaches caused due to migraines. Triptans, which are commonly prescribed to treat migraines, are safe and effective for older children (8). These medications relieve pain and control symptoms such as nausea and vomiting.

Sometimes, overuse of medicines or the body’s reaction to a medicine can also cause headaches. So make sure that you consult the doctor before giving the child any medicine.

• If a psychological problem such as depression or anxiety is causing the headaches, alternative therapies may be recommended.

Relaxation therapies

such as yoga, breathing exercises, and meditation can be used to deal with anxiety problems. Cognitive behavior therapy may be recommended to help the child deal with everyday stress and cope with stressful situations positively.

Biofeedback training is another therapy that teaches a child to control certain bodily responses such as muscle tension, heart rate, and blood pressure to cope with the pain (9). The idea is to help the child control the automatic or involuntary nervous system. The training is usually combined with relaxation therapies.

• Alternative therapies such as acupuncture and massage can also be used to relieve tension headaches.

• Research has revealed that dietary supplements such as magnesium, riboflavin, and a vitamin-like compound named Coenzyme Q-10 can reduce the number of days a person is affected by migraines, in a year (10).

Talk to your child’s doctor before trying the supplements, OTC medicines, or alternative therapies for the child.

How To Prevent Headaches In Kids?

Besides adequate rest, you can prevent headaches in the child with the help of these home care tips.

• Keep the child away from headache triggers such as loud music, bright lights, sudden movements, change in lifestyle, excessive physical or emotional strain and decrease screen time.

• Have adequate sleep as lack of it is one of the most common causes of headaches in children.

• Sometimes, cool compress can help alleviate the pain due to tension headaches. Holding a bag of frozen vegetables or an ice pack can help mitigate the pain.

• If your child has a migraine, try to keep the surroundings as quiet as possible.

• Fear, anxiety, and worry are a few emotional triggers of headaches in children. Teaching the child breathing exercises or meditation can help them cope with stressful situations.

• Give the child healthy food including fresh fruits and vegetables, and avoid oily or fatty foods. Foods which fluctuate blood sugar can also lead to headaches (11).

• Dehydration headaches can be prevented by ensuring that the child drinks adequate water during the day.

If your child gets a headache more often than not, maintain a headache diary and make a note of:

• When the headache started (approximate time based on when the child has begun complaining)

• When it has ended

• What the child was doing before the pain began

• What the child had eaten before the onset of a headache

• What the child had been doing before the headache subsided

Recording the child’s diet, activities, and moods can help you figure out the cause of headaches through the process of elimination.

Home Remedies For Headaches In Children

Herbal or natural remedies can aid in alleviating or eliminating headaches in children. However, they may not always work in case of secondary headaches.

• Feverfew, known as the anti-migraine herb, helps eliminate almost 25% of the migraine headaches (12). Feverfew supplements can be taken as a preventive for migraine headaches after consultation with the doctor.

• Peppermint oil has a soothing effect on the nerves and can help relieve tension headaches in children. The oil contains menthol which can help relax the muscles and eliminate pain. Take a drop or two of peppermint oil, mix it with almond or jojoba oil, and massage the temples with it.

• Steam Inhalation with or without lavender oil or eucalyptus oil can relieve the child of sinus headaches.

• Cinnamon can also help relieve muscle tension and pain. Add a pinch of cinnamon in a glass of warm milk and give it to the child to alleviate tension headaches (13).

• Cloves also have pain-relieving properties and can relieve primary headaches in some people. Add cloves in the kid’s food or get them to chew a clove or two during the day.

Please note that these remedies may not work for all children. Make sure you talk to the doctor before trying these home remedies for headaches in kids.

A healthy diet that has vegetables, fruits, and herbs can be a good first-step to prevent headaches. A disciplined lifestyle, where the child eats and sleeps on time every day, can also prevent an onset of tension headaches.

Have you any tips for dealing with headaches in children? Share them with us here.

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