Headaches in Children

Migraine Headaches

Migraine is an inherited neurological condition. If either parent has migraine attacks, there’s a strong possibility your child will, too. “Migraine is by far the most common headache-related condition I see in my practice,” Dr. Cheyette says.

Children sometimes have classic migraine headache symptoms – intense pain on one side of the head, vision changes, nausea, etc. “But children with migraine can also have very nebulous symptoms, for example, repetitive bouts of nausea and throwing up that make parents think they keep getting the flu,” Dr. Cheyette says. “And if they do have a headache and I ask where it hurts, about 90 percent point straight to their foreheads.”

“Because kids’ symptoms can be different, migraine often goes undiagnosed until the child becomes a teenager or adult,” she says. “But there are very specific and effective treatments for childhood migraine and early diagnosis can have huge benefits for your child.”

As with adults, a child having a migraine attack may have other symptoms, including sensitivity to movement, light, sounds and smells. Less commonly, children may see auras—spots, halos or other visual distortions.

Tension Headaches

Adults aren’t the only ones who feel stressed. Tension -- physical and emotional -- also gives children headaches. “Tension headaches usually don’t hit until the teen years,” Dr. Cheyette says. “When I see a younger child with what seems to be tension headaches, it often turns out to be migraine. But the stresses of being a teenager, along with the lack of sleep that seems to be so common, can bring on tension headaches.”

Teens with tension headaches often report feeling a band of pressure around the head or a constant pressure on one or both sides of the head. The pain tends to be dull or aching, rather than sharp or pulsing. Tension headaches usually come on slowly and often begin in the middle of the day. As Dr. Cheyette notes, the cause can be as simple as not getting enough sleep or skipping meals. But teens may also be dealing with complex pressures, such as being bullied or having too much to do. Depression in children can also manifest through frequent tension headaches.

Exercise-Induced Headaches

Very rarely, children develop short-lasting headaches brought on by exercise or coughing.

“For example, a teenage boy might start lifting weights and almost immediately develop a headache,” Dr. Cheyette says. “The headache usually goes away quickly, but it can linger for a few hours. Though it’s usually nothing to worry about, this is one of those times we run tests to rule out any underlying conditions.”

“Exercise-induced headaches may go away on their own, but we can also prescribe a medication called indomethacin. The medication works so well that doctors often refer to this headache type as indomethacin-responsive headaches,” Dr. Cheyette says.

Concussion-Related Headaches

“All contact sports—football, soccer, lacrosse and others—put kids at risk of concussion. But without a doubt, I see more concussions in girls who play soccer than I see in both male and female athletes in all other sports combined,” Dr. Cheyette says.

Research supports that observation. According to a 2015 study of high school soccer, for every 10,000 soccer games or practices, girls suffer 4.5 concussions compared to 2.8 in boys. Theories about why include the differences in neck strength. “I also suspect that the protective headbands some girls wear give them a false sense of protection, so that they may play more aggressively,” Dr. Cheyette says.

Parents, caregivers and teens should know the signs and call the doctor if they suspect a concussion. “It’s important to rule out internal bleeding,” Dr. Cheyette says. “Your doctor may suggest different treatment strategies or medications depending on the child’s age, injury and other variables.”

Children and teens with histories of migraine or other headaches, especially, need to choose their sports wisely. “A concussion typically worsens an existing headache condition,” Dr. Cheyette says. “There are plenty of sports to choose from, and it’s pretty hard to get a concussion from a sport like swimming or running track.”

Chronic Daily Headache

Especially common in teens, chronic daily headaches are a frustrating fact of life for many. The CDH diagnosis covers anyone who has headaches 15 days a month or more, so the “daily” part should not necessarily be taken literally. CDH comes in different sizes and shapes—some are tension headaches that come on each day, others combine migraine with tension headaches symptoms, some go away and reappear. The causes also vary. CDH sometimes starts after an infection, minor head trauma, or surgery in another part of the body. Sleep disorders can cause CDH. Intense stress from life events or pressure to achieve can also bring on chronic headaches, as can depression and anxiety disorders.

A headache affects everything a child does, from learning to forming emotional bonds, so the effects can be far-reaching. But there are good treatments available that can turn around a child’s life.

Medication Overuse Headaches

Medicines to treat headache pain sometimes have an unexpected consequence—more headache pain. Any medication taken too often can cause rebound headaches, especially those that contain caffeine. Teens, especially, may get into the habit of taking a couple of ibuprofen or acetaminophen every day for various reasons.

“I often tell them the story of a patient who had daily headaches,” Dr. Cheyette says. “Every day, she took an over-the-counter medication with caffeine for the pain. This went on for a very long time until she needed minor surgery. The doctor told her she had to stop taking the headache medication until after the surgery. As soon as she stopped taking the headache medication, the headaches went away.”

Some medications can be stopped immediately, but others require gradual weaning. Talk to your doctor to determine the best way to help your child stop a medication you suspect is causing rebound headaches.

Diagnosing and Treating Kids' Headaches

If your child has frequent or severe headaches, talk to your pediatrician or find a pediatric neurologist who specializes in treating children’s headaches. Though proven treatments exist for all the headache types, it’s not always easy to pinpoint headache causes in kids. And because treatment for one headache type may not work for another, getting a correct diagnosis is an important first step.

As a parent, it’s important to know that diagnostic tools are seldom helpful in diagnosing recurring headaches. The vast majority of children’s headaches are migraine and tension headaches, which do not show up on CT scans or MRIs. Electroencephalograms that measure brain wave activity, blood tests and other lab tests also don’t show why a child is having headaches. There are a few instances when doctors refer children for diagnostic testing, but they limit testing to prevent unnecessary stress and potential risks associated with some tests. CT scans, for example, expose children to radiation, which may increase a child’s risk of developing cancer later in life. Though today’s CT machines use much less radiation than earlier models and guidelines for lower doses have been set for children, CT scans rarely provide enough insight to warrant their use in diagnosing headaches.

Doctors who specialize in treating headaches can diagnose most headaches by performing a medical exam and asking questions that help them understand your child’s headache pain, patterns and history. You can help your doctor determine what’s causing headaches by keeping a simple headache diary.  On days when your child gets a headache, write down some basic information, including:

• Amount and quality of sleep
• When and what they ate (noting any skipped or late meals) 
• Whether they had enough liquids to stay hydrated (pee is clear or light yellow)
• Particular stressors (exams, public speaking, etc.)
• General emotional state
• Menstrual cycle timing for girls

This may mean going back through the past 24 hours and adding any details you can recall, Dr. Cheyette says. There are a number of apps for headache diaries, or you can just use pen and paper. The exercise can reveal patterns and triggers, and also helps your doctor determine the headache type and which treatments are most likely to work.

“Headache care is a partnership between the doctor, patient and family,” Dr. Cheyette says. “There’s no single treatment that works best for every child or teen. But by looking at the problem together and talking things through, we can find a care strategy that allows your child to enjoy a fuller and happier life.”