Do children actually have headaches?

Yes they do.  While we’ve all had children complain of headache (or stomach ache) when it’s time to go to bed or do something they don’t want to do, they also have real headaches.  And while the littlest children are unable to properly tell us, they are able to tell or show us what’s wrong at only a few years old.  

How do I know if my child is having a real headache?

The best way to tell is if it causes them to change their behavior.  A child that sits down when they would usually be out playing, or lays down instead of playing on the computer is one that probably does have a headache.  Even if it just slows them down a little, it’s still a change in behavior. If they tell you more than once then it’s more likely that it’s an actual headache.  

Does a headache mean that there is something wrong with my child?

Not necessarily, but it can.  A child can have a headache once or twice, and have nothing wrong.  Or they can have a headache along with some illness, such as strep or the flu.  Chronic headaches can have many different causes, one of which is migraine. Rarely, the cause of headache can be something dangerous, such as a tumor.

Do I need to take my child to the doctor if they have a headache?

Not always.  It depends on what kind of headache your child has.  If it’s just a one time headache they don’t have again, and there’s no other symptoms, then they’re probably fine.  If they have a one time headache, but also signs of acute illness like strep or flu, then you might want to take them in.   

Chronic headaches can have many different causes based on where they are, how long they last, and if there are any other symptoms the child has. It doesn’t hurt to get these checked out by your pediatrician.  Chronic headaches that are either getting worse or with no relief between headaches need to be seen by the pediatrician.

What will my pediatrician do at the visit?

First, they will get a full history of the headaches.  Here it would be good for you to have kept a diary of the symptoms.  It helps to know things like when the headache occurs: morning, evening, daytime?  How long does it last? How often do they occur? Does it happen on weekends, or only during the school week?  Does your child have other problems along with the headache, such as throwing up, sensitivity to sound or light, or seeing things?  Where is the headache on their head? Are there any neurological problems like weakness? Are they generally getting better, worse, or just staying the same?  Have their eyes been checked lately? Have you treated the headaches with anything: what, how often, and did it help at all?

Then we’ll ask about any family history that might be relevant.  For example, if the parent(s) have migraines, it’s very likely the child is having migraines.

The physical exam is often as thorough as a well check.  The main focus of the exam will often be on the neurological exam.  Often these tests make your child feel silly, because they’re asked to do weird things like tap their fingers together, but they tell us a lot about their neurological state.  We’ll also check things like sinuses, the heart, lungs, etc to make sure that everything else is also functioning well.  

The possible cause of your child’s headaches will determine further testing.  Usually no further testing is needed. Sometimes the parent won’t have all the details of the headaches, and if the cause of headache is uncertain, and the exam is normal, we’ll send you back home to record a headache symptom diary to better diagnose them.  Other testing may on occasion include labs, head CT, or head MRI. 

How is headache treated?

Again, it depends on the cause of the headaches, and how bad they are.  It also depends on how each person responds to the headache. Obviously any acute illness, such as strep or sinus infection, will be treated appropriately.  Otherwise, there are a few general categories of treatment.  

First is episodic treatment, or treating each headache as it occurs.  Resting in a cool, dry place, and using a cold pack can help. For many headaches advil or tylenol works just fine.  A big key with treating this sort of headache is to take the medicine as soon as the pain starts. If you wait too long, then even the best medicine won’t help.  One problem with giving OTC pain medicines for headache is that if given too often they can cause headache. To avoid this overuse headache, we recommend using these medicines three times a week or less.   For more painful migraines there are other options, generally triptans, but they still need to be given as soon as the headache is felt. Other prescription medicines, such as those that have codeine in them, are not recommended.

Second is prophylactic treatment.  Prophylaxis is when you take something every day so that you have a decreased number of headaches or decreased amount of pain.  (vaccines are a form of prophylaxis-you take one today so you won’t have the disease later) We usually only do prophylactic treatment in the case of migraines.  There are some medicines that have been shown to be helpful in children, but they’re not perfect and do have some side effects.

Non-medical treatment is very important in headaches, especially those that are chronic or recurrent.  Lifestyle changes can make a big difference. These include things like getting enough sleep every night, eating regularly and properly, getting exercise.  Avoiding drugs that can trigger headaches, like caffeine, alcohol,diet pills, and others, can also help. Some people have foods that trigger migraines, such as aged cheese, so keeping a headache diary can help you identify those.  Behavioral therapy can help your child understand the problem and the importance of managing it, as well as help them to identify barriers to that treatment. Biofeedback has been shown to help some children with relaxation, and decrease the number of migraines.

Will the headaches ever go away?

There are not a lot of studies that follow children long term.  With good treatment and lifestyle, though, most should be manageable.

Links.

Migraines at healthychildren.org.

Headaches at healthychildren.org.