Headaches in Children: When to Call the Doctor

Headaches Requiring Emergency Care

• If your child develops a sudden, severe headache, especially with a change of mental status, or a headache with a seizure, call 9-1-1. Though it’s rare, children can have strokes. Fast medical care is vital.
• If your child has a headache with a high fever and stiff neck and is incoherent or confused, call 9-1-1. These are symptoms of meningitis, a serious infection that requires prompt medical care.
•  If your child’s headache comes on in the hours or days following a head injury and the headache is severe or your child has other symptoms that concern you, such as losing consciousness, loss of vision or hearing, dizziness or worsening vomiting, call 9-1-1. Most concussions from mild brain trauma resolve on their own, but worsening symptoms may indicate a skull fracture or bleeding in the brain. See our articles Head Injuries: When to Take Your Child to the Doctor and Concussions: What You Need to Know for more on children’s head injuries.

Diagnostic Testing in the Emergency Room

Stroke, meningitis and brain trauma are medical emergencies that require diagnostic testing, which may include a CT scan, MRI or lumbar puncture to check for infection in spinal fluid, and other tests. MRIs show soft tissue and are the most common diagnostic tools used for children’s headaches. “However, most children with headaches will not have a cause show up on the MRI scan,” says Sarah Cheyette, M.D. pediatric neurologist at the Palo Alto Medical Foundation, and author of the book “Mommy, My Head Hurts: A Doctor's Guide to Your Child's Headache. “That is frustrating for most people. Migraines, the most common cause of headaches, leave no trace on an MRI scan.” 

Many diagnostic tests are stressful on children and may carry risks, such as exposure to radiation with CT scans. If you take your child to the emergency room for a headache other than those described above, ask questions before your child undergoes any diagnostic tests. Questions to ask include:

• Why is the test being performed?
• Is this test necessary? If so, why?
• What can the test reveal about the headache cause?
• Are there any risks associated with the test?

Headaches Requiring a Doctor's Care

• If your child is experiencing frequent headaches that interfere with his or her activities, schedule an appointment with your child’s pediatrician or a pediatric neurologist who specializes in treating headaches. Most recurring headaches are easily treatable.  See Kids Get Headaches, Too to learn about common causes of headaches in children.     
• If your child’s headache comes on after a head injury, call your child’s doctor. Mild concussions are common and may take a few weeks to months to heal. Your doctor can offer helpful information on what to expect and advice on promoting brain healing.
•  If your child is having daily headaches that are getting progressively worse, call your doctor. Also call if a headache is one of many symptoms you see developing, such as excessive thirst, reduced alertness, increasing clumsiness, personality changes, differences in walking gait or difficulty speaking.