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Kids' Headaches: The Diagnosis Is Difficult

Headaches aren't only for adults. Kids get them, too. By the time children reach high school age, most have experienced at least one headache, according to the National Headache Foundation.

There are two basic types of headaches. Primary headaches have the headache as the only symptom and it will stop once treated. Secondary headaches are caused by another condition and don’t usually go away until the condition is treated.

Primary headaches include tension-type and migraine headaches. Hundreds of conditions or circumstances can cause headaches. These can span the range from not harmful to very serious. They include dehydration, hunger, sleep deprivation, infections, foods containing caffeine, medicines, hormonal changes, head injury, meningitis, brain aneurysm, and tumor. Fortunately, most headaches in kids are not caused by these problems, but by tension.

Your pediatrician can determine what kind of headache your child has. The healthcare provider will need to talk to both you and your child to determine whether the headache has an emotional side to it. He or she will also do a complete physical exam including a neurological exam. Sometimes it is necessary to perform brain imaging in the form of either a CAT scan or MRI. Your pediatrician will advise you when it is necessary to perform brain imaging and which test is preferable for your child.

Tension-type headache

This is the most common type of headache in children, and the most likely causes are emotional upsets or stress. Your child may describe the pain as widespread or like a tight band around the head. This type of headache does not usually cause nausea and vomiting, nor is it associated with other symptoms, such as fever, change in mental status, or other physiologic changes. 

Tension headaches are almost always related to stressful situations at school, competition, family friction, or too many demands by parents. The healthcare provider needs to also determine whether anxiety or depression may be present.

These headaches are usually easily treatable with over-the-counter medicine, such as acetaminophen or ibuprofen. Your healthcare provider will instruct you how to administer these medicines safely. It is also important to identify possible triggers and make lifestyle changes including diet, sleep patterns, exercise and study habits. 

Migraine headaches

A migraine headache is sometimes one-sided and throbbing. It is occasionally accompanied by nausea and vomiting, or sensitivity to light, noise or both. Some migraines are preceded by aura, which are usually one-sided sensory changes that point to the beginning of a migraine. Children who have a family history of migraines have a greater chance of developing migraines themselves. Fortunately, migraines may disappear in some children several years after they appear. However, many children who develop migraine headaches will go on to have them during the rest of their lives. Research has shown that symptoms will have happened in about a fourth of migraine sufferers before the age of 5. And in about half before the age of 20.

It is important to realize that a migraine headache may happen after a head injury, especially after injury in sporting activities like football and baseball. The child will usually recover fully over time.

There are two ways to treat migraine headaches. There are medicines used to stop an acute migraine headache, and there are others used to prevent frequently occurring headaches. Your healthcare provider will advise you on the proper medicines you can give to best control the symptoms of your child's migraine headaches.  

Immediate care

These headaches require immediate medical attention:

  • A headache in a child who has had a blow to the head or a recent history of head trauma. This is especially true if the headache is steadily getting worse.

  • A headache with fever, nausea or vomiting, confusion, significant sleepiness or loss of consciousness after the headache starts, stiff neck, changes in vision, seizures or fainting episodes, or skin rash.

  • A headache that comes on suddenly and seems to be the worst headache the child can possibly imagine having. Watch for this, especially if the child has a history of never having headaches.

Online Medical Reviewer: Adler, Liora C., MD
Date Last Reviewed: 9/3/2015
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