Headache in children: Symptoms and when to see a doctor - Medical News Today

Headache is a frequent complaint among children, but it is typically mild and usually not serious. However, recurrent headaches can affect a child's behavior and may prevent them from performing daily activities.

One in five American school-aged children are prone to having headaches. Before puberty, headaches are more common in boys, and after puberty, they are more common in girls.

Headaches can upset children and cause undue worry to parents or caregivers. However, most headaches are mild and go away in a few hours. Less than 5% of headaches are due to severe conditions.

This article discusses headaches in children, symptoms, and when to consult with a doctor.

Adults and children typically experience the same headache types, but they may experience them differently.

The International Headache Society (IHS) classifies headaches into two categories — primary and secondary. Primary headaches have no known cause, while secondary headaches result from another condition.

Primary headaches make up 21.8–66.3% of headaches in children receiving care in the emergency room. Below, we look at some common primary headaches in children.

Tension headache

Tension headache is the most common type of headache in children. It is generally mild and occurs when the neck and scalp muscles contract in response to stress and anxiety. Symptoms include:

• dull, pressure-like pain
• pain that may worsen on the scalp, temples, shoulders, and back of the neck
• pain that presents all over the head
• pain that may worsen with stress, glare, noise, and fatigue

Migraine

Nearly 1 in 10 children have recurrent headaches due to migraine. It is less common than tension headache but is more severe. Migraine tends to recur, persist, and run in families.

Symptoms of migraine include:

• throbbing or pulsating pain, on one side of the head or on both sides but with one side more painful
• pain that worsens with activity
• nausea and vomiting
• visual disturbances
• irritability
• crying
• restlessness
• agitation
• abdominal pain

Cluster headache

Cluster headaches are uncommon in children younger than 10 years old, and males are three times more likely to be affected than females. These headaches occur in repeated episodes of pain that affects one side of the head, behind the eye. They can last 15–180 minutes and can occur up to eight times per day.

Other symptoms include:

The exact cause of most tension and migraine headaches in children is unclear, but health experts believe they occur due to changes in brain chemistry and the altering of nerves and blood vessels. These changes may cause pain signals resulting in a headache.

Watching TV and using digital devices for long periods may worsen a headache, possibly because of screen brightness or posture difficulties. A 2021 study noted that limiting screen time may be important in reducing headache symptoms.

The IHS has an extensive list of conditions that can cause headaches. Brain, head or neck trauma, infections, and problems in the mouth, eye, ear, and nose can cause headaches.

Other possible causes of headaches include:

• dehydration
• skipping meals
• too much or too little sleep
• changes in sleeping patterns
• certain medications
• hormonal changes, such as menstruation
• smoking
• strong odors
• light and sound disturbances
• certain foods and beverages, such as alcohol, chocolates, and caffeine

In rare cases, a child may experience headaches because of a serious underlying condition, such as:

Individuals should immediately take a child to the emergency department if a headache follows a head injury or if the following symptoms present:

• loss of muscle coordination, also known as ataxia
• seizures
• stiff neck
• visual irregularities
• confusion
• being less alert or being extremely sleepy
• persistent vomiting
• high fever
• atypical blood pressure, breathing, or pulse rate
• slurred speech
• numbness or tingling

Moreover, a person should contact a doctor if a headache:

• occurs more than once a week
• returns or becomes worse
• is worse in the morning
• disrupts a child's performance of daily activities at home, school, and in other settings

A child's doctor will require their medical history and will likely ask questions about the headaches to understand what may be causing them. They may ask about:

• the frequency and severity of the headaches
• when the headaches first began
• any noticeable pattern or triggers
• a child's diet, routines, and sleeping patterns
• allergies, medicines, and any other medical conditions
• any family history of headaches
• any recent injuries or falls

They may also look for possible triggers and ask a person to keep a headache diary where they or their child can record activities, frequency, and severity of the headaches.

Doctors or healthcare professionals will perform a physical exam and a neurological exam to check for any problems with a child's sensation, movement, and coordination. They may also order blood and imaging tests such as a CAT or MRI scan. If a child presents with seizures, the doctor may also request an EEG.

If any other symptoms are present, a child's doctor may also request a consultation with other specialists such as pediatric neurologists, ophthalmologists, psychologists, or ear, nose, and throat specialists.

Treating a headache depends on its cause. Adjusting elements, such as exercise, diet, and sleep, and avoiding triggers may help.

If headaches occur without other symptoms, simple remedies may include:

• lying down in a cool, quiet room
• relaxation and breathing exercises
• placing a cold or warm compress across the forehead

Treating tension headaches in children

For tension headaches, resting at home, taking a nap, eating balanced meals, and over-the-counter (OTC) pain relief may help a child with their symptoms.

However, parents and caregivers should limit giving OTC medicines to no more than three times per week to avoid medication overuse headaches, also known as rebound headaches.

Doctors may also recommend nondrug treatments for tension headaches and migraine. These include:

Treating migraine in children

Doctors may prescribe medications to children with frequent migraine episodes. These medications divide into two categories:

Most headaches that children experience are self-limiting and subside after sufficient rest or home remedies. Some children outgrow headaches, but they may return later in life, while others persist until adulthood.

Proper education, lifestyle adaptations, avoiding triggers, and close communication with a doctor or healthcare professional can help children with persistent headaches to continue their everyday activities.