Headaches in Children

http://www.hmc.psu.edu/childrens/healthinfo/h/headache.htm

Headaches in Children


What is it?

A headache is, quite simply, a pain in the head. Headaches in children can range from mild to severe.



Who gets it?

Most children get headaches at one time or another.



What causes it?

The most common cause of headaches in children is the same for adults' tension. Tension headaches are caused by muscle tension in the neck, shoulders, and head. Muscle tension is caused by remaining in one position for a long period of time, such as when playing a video game or sitting at a computer. It can also be caused by stress, such as from school or social situations. Another common cause of headache is fever or congestion from a common cold or other viral infection. Headaches in children can also be caused by problems with the eyes, nose, throat, teeth, and ears; coughing; hunger; medication; and overexertion. However, headaches can also be caused by very serious illnesses. A bacterial or fungal infection of the membrane (meninges) that surrounds the brain and spinal cord, called meningitis, causes severe headache. Severe, recurring headaches can be caused by migraines or a brain tumor. Migraines occur when the arteries in the brain narrow, then widen. Because migraine headaches tend to run in families, there appears to be a genetic link. Headaches that follow a blow to the head, especially when accompanied by loss of consciousness, disorientation, or vomiting, can indicate concussion or other serious brain injury.



What are the symptoms?

Mild to moderate headaches in very young children are often difficult to pinpoint because they are unable to explain what they are feeling. They may simply act irritable. Young children with severe headaches may act extremely irritable, cry, and even vomit. Children older than 10 are more likely to get tension headaches. This type of headache is described as feeling as though a tight band is encircling the head. Your child may also say his or her neck muscles feel sore or tight. Tension headaches develop during the day and get worse as the day goes on. A headache caused by sinus congestion occurs on only one side of the head, with the pain centered across the forehead, down toward the nose, and near the eye. Headache caused by vision problems is usually accompanied by a feeling of eye strain, and is often worse after using the eyes, such as when reading. It is not unusual for a child with a cold and fever to have a mild to moderate headache that goes away as the fever goes down. However, excruciating headache pain with high fever, lethargy, and stiff neck, is a sign of meningitis or other infection of the meninges.



Meningitis is a life-threatening illness that must be treated immediately. Migraine headaches begin as pain in a localized area, such as around one eye or temple. The pain gradually spreads down one side, or to both sides. As the migraine develops, any movement or sound can cause more severe, throbbing pain. These headaches often have a trigger, such as changes in the hormonal cycle (in girls), certain foods or smells, or physical exertion. A child may have some indication that the migraine is coming, called an aura. Common auras include unique smells, visual disturbances, or odd feelings. Other characteristics of a migraine include sensitivity to light and sound and nausea and/or vomiting. A migraine headache can last for anywhere from a few hours to a few days. Migraines can be complicated by other symptoms, such numbness or paralysis on one side of the body, severe pain at the back of the head accompanied by weakness and loss of coordination, noticeable confusion and lethargy, and severe eye pain with eye muscle paralysis. Cluster headaches are a severe type of migraine headache that occur several times in one day and can last for several hours. They are accompanied by nasal congestion, runny nose, and crying.



Headaches caused by brain tumor or brain infection can range from mild to severe, and often occur intermittently without any obvious reason. With a brain tumor, the child may begin to experience weakness on one side of the body, vision problems, convulsions, speech and learning problems, and vomiting, and the headaches may become more severe each time they occur. These headaches are usually worse in the morning and get better as the day goes on. Medication usually doesn't help. Headaches that follow a blow to the head occur suddenly and can be accompanied by nausea, vomiting, disorientation, pupils that are unresponsive to light, loss of consciousness, and personality changes.



How is it diagnosed?

First your doctor will try to determine the cause of the headache. He or she will do this by listening to your and your child's description of the symptoms, by performing a thorough physical examination, and by asking questions about your child's daily life at home and school. Doctors classify headaches as acute, acute recurrent, chronic recurrent, and chronic progressive. An acute headache occurs suddenly, but lasts for a short time. An acute recurrent headache lasts for a short time, but occurs frequently. A chronic recurrent headache lasts for a longer period of time, and occurs frequently. A chronic progressive headache tends to become more severe each time it occurs. This is the most serious type of headache because it may be a sign of a brain tumor or infection. To diagnose the type of headache your child has, your doctor may ask you to keep a diary of when and how often the headaches occur, your child's activities when each headache occurs, and patterns of rest and diet. When tension headaches occur more than fifteen times per month, they are considered chronic tension headaches. Children with these types of headaches may also need to be examined for signs of depression or anxiety. Blood tests may also be ordered to check for any underlying illness.



Sinus-related headaches are indicated when the child's headaches are located around the eye and nasal area, and when the child has a history of upper respiratory infections with the headaches. These are commonly diagnosed through an x-ray of the sinuses. If the headache seems to be vision-related, your doctor will refer you to an ophthalmologist or optometrist for an eye examination. If symptoms point to meningitis, or other bacterial or fungal infections that inflame the meninges, the doctor will hospitalize the child to perform a lumbar puncture, or spinal tap, to check the spinal fluid for signs of infection. He or she will test your child's ability to bend at the neck and place the chin on the chest, as well as general strength and reflexes.



Migraine headaches are usually easy to diagnose because they have such unique symptoms. Children with migraines are frequently treated by a pediatric neurologist, a specialist in the area of the nervous system. A headache diary, mentioned earlier, is especially useful in diagnosing migraines. The doctor may try treating the headaches with migraine medications. If these medications help, then migraine is the probable cause. However, your doctor may also order a magnetic resonance imaging (MRI) or computed tomography (CT) scan. Both are painless procedures that provide the doctor with an image of your child's brain. MRI and CT scans are also used to diagnose brain tumors, brain infections, and brain injuries.



What is the treatment?

Treatment depends upon the cause of the headache. Tension headaches are treated by identifying the source of the tension and trying to prevent or avoid the tension. Once a tension headache begins, an over-the-counter acetaminophen or ibuprofen can provide quick relief. It is extremely important to follow the dosage instructions for your child's age and weight. Healthcare professionals do not recommend giving aspirin to children or teenagers because it has been associated with a life-threatening disorder called Reye's syndrome. Acetaminophen or ibuprofen is also effective for illness-related headaches. In addition, you might try placing a cool washcloth on your child's forehead. Sinus headaches are treated with medications to relieve sinus congestion. Surgery is only considered in severe cases. Vision-related headaches usually stop once the vision problem is treated, usually with glasses or contact lenses. Infections of the tissues surrounding the brain, such as meningitis, are treated with antibiotics. Children with migraines feel better if they lie down in a darkened room and sleep. Your child will also be taught to avoid his or her migraine triggers. These might be certain foods that include nitrates, monosodium glutamate (MSG), and caffeine; strong perfumes; lack of sleep; or hunger. Children with a pattern of recurring migraines are treated with preventive medications, taken on a daily basis, or medications taken at the onset of the migraine. A concussion is a bruise to the brain, and usually heals on its own with time. However, if the child has lost consciousness, he or she will need to be observed for a few days, usually in a the hospital, to make sure there is no lasting injury.



Self-care tips

Headaches in children can have many causes, and are frequently a symptom of some other condition. For this reason, it's important to contact your doctor whenever your child has headaches with no obvious cause such as a cold, lack of rest, or hunger, or if your child begins to have a pattern of recurring headaches. In general, plenty of rest and good nutrition will go far to prevent many acute headaches. Encourage your child not to be an over-achiever and to recognize when it's time to take a break from an intense activity, such as sports, studying, or video and computer games.





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This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.