Headaches in Children How common are headaches? What is the impact? •

Very common! 20% of kids from preschool through teenage report frequent or severe headaches in any given year.

•

Headaches are more common in children who have family members with headaches.

•

Headaches can impact quality of life including school attendance, school performance and ability to play or socialize.

What are the symptoms? There are several types of headaches. Some are sporadic (random) and others are related to headache syndromes such as migraine, tension or cluster headaches. Headache syndromes have their own specific set of symptoms. Migraines Migraine headaches can affect one or both sides and are usually accompanied by nausea, vomiting, dizziness, blurred vision and sensitivity to noise or light. •

Migraines can last anywhere between 1 hour to more than a day.

•

Migraines can be accompanied by an “aura”. Auras are temporary symptoms which can occur before headache symptoms. These include: •

Spots, lines, or blind spots in vision

•

Difficulty with moving or balance

•

Tingling of a body part

Tension headaches Tension headaches are episodes of band-like pressure or dull throbbing of mild or moderate severity. They can last 30 minutes or all day. Tension headaches are not usually accompanied by auras like migraines, though symptoms can overlap. Tension headaches usually improve with pain medication. Department of Pediatrics -1-

Cluster Headaches These are very severe headache in adolescents. They affect only one side and often occur with red eye, tearing or nasal drainage on that side. Cluster headaches can occur multiple times per day or many days in a row.

What causes headaches? There are many different causes of headaches. Luckily, most headaches in children are not caused by anything serious. Some causes of headaches include: •

Head trauma or concussion.

•

Medication side-effects. This includes too frequent use of pain-relieving medication.

•

Stress, mood changes or lack of sufficient sleep are the most common causes of tension headaches.

•

Viral upper respiratory tract infection or sinus infection. These infections cause 90% of sporadic (non-headache syndrome) headaches and go away with time.

Very rare possibilities include tumors or nervous system infections (see the section on “When do I need to call my doctor”.)

What is different about headaches in children than adults? •

Young children may not be able to tell you where it hurts. They may rock, cry, or hide.

•

Migraines can look like other problems in children. Sometimes, vomiting or arm pain may actually be migraines!

•

Motion sickness when reading in a car may be linked to migraines.

How do I treat my child’s headache? Over-the-counter (OTC) pain medications such as Tylenol or Motrin are firstline headache medications. If your child still has headache pain after taking these medications talk to your doctor to make sure you are using the right dose. UMHS Pediatrics

Headaches in Children -2-

See your doctor if your child frequently requires more than 2 doses of OTC pain medications per week. Using Tylenol or Motrin too often can cause an “overuse headache.” In these cases, he or she may need to be evaluated for a prescription medication. Opioids, also called narcotic medications (such as Norco, morphine) are often not helpful at treating the type of pain caused by headaches. Are supplements effective in treating headaches in children? Marketers of supplements such Riboflavin, Co-Enzyme Q10, and Butterbur have made claims that they are helpful, but these supplements have not been studied in children and are not recommended! Magnesium may be beneficial, though evidence is lacking. Keep in mind that herbs and supplements (sometimes marketed as “natural remedies”) are not without side effects, and may have serious interactions. Talk with your doctor before you give any herbs or supplements to your child.

When do I need to call the doctor? Call your child’s doctor when your child has any of the following: •

Headaches which are accompanied by other symptoms affecting the nervous system such as:

•

o

Seizures

o

Weakness

o

Balance difficulties

o

Personality changes

o

Neck stiffness and fever. This may indicate meningitis.

Headaches which awaken your child in the middle of the night or occur when your child awakens.

•

Pain which worsens when lying down, coughing, urinating, or passing a bowel movement. UMHS Pediatrics

Headaches in Children -3-

•

Headache location at the back of your child’s head.

•

Changes in the size of your child’s head.

•

New headaches in a young child (younger than 6 years of age).

•

Very severe or unusual type of headache.

•

Rapid increase in frequency of headaches.

•

Headaches which do not improve with pain medication.

•

Severe headache in a child with other health conditions such as bleeding disorders, immune system problems, cancers, high blood pressure.

What should I do at home? •

Give pain medication as soon as a headache develops.

•

Have your child lay down in a quiet, cool, dark environment until symptoms start to improve.

•

Make sure your child does not skip meals, including breakfast. Give your child snacks to carry.

•

Encourage daily exercise, drinking plenty of fluids, good nutrition, and a consistent bedtime schedule with a good night’s rest.

•

Maintain consistent sleep with regular bed and wake times, even on weekends. Aim for the same amount of sleep each night with the goal of 9-10 hours for most kids and adolescents. The following can help to avoid night awakenings and improve quality of sleep: •

Restricting food and fluids a few hours prior to bedtime

•

Reading or relaxing prior to sleep with a set bedtime routine

•

Not having a television in the bedroom

Keep in mind: •

Migraines usually won’t get better with medications alone. Treatment depends on reducing triggers, reducing stress, or improving children’s coping of stress or pain.

•

It is important for children not to miss school because of chronic headaches. If needed, they can go to the nurse’s office for 15 minutes once daily. UMHS Pediatrics

Headaches in Children -4-

•

If depression exists alongside headaches, treatment of depression is important to treat headaches.

Relaxation therapy Relaxation techniques such as progressive muscle relaxation, breathing exercises, visualization techniques and biofeedback can be helpful. A psychologist can help your learn to learn these techniques. Identifying triggers If your child has recurring headaches you can try to look for specific triggers of child’s headaches by maintaining a headache journal. You may identify triggers your child should avoid. Common Headache Triggers Sleep

Specific Foods

Dehydration

Caffeine

Stressful Events

Scents

Weather

Motion Sickness

Hormone Changes

Menses

Birth Control Pills

Aged Cheese

Deli Meat

Hot Dogs

Chocolate

MSG4

(Nitrates)

Disclaimer: This document contains information and/or instructional materials developed by the University of Michigan Health System (UMHS) for the typical patient with your condition. It may include links to online content that was not created by UMHS and for which UMHS does not assume responsibility. It does not replace medical advice from your health care provider because your experience may differ from that of the typical patient. Talk to your health care provider if you have any questions about this document, your condition or your treatment plan. Author: Lisa Matlen, M.D. Reviewers: Kelly Orringer, M.D., Ruti Volk M.S.I. Patient Education by University of Michigan Health System is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License. Last Revised 03/2015

UMHS Pediatrics

Headaches in Children -5-