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Children and Headaches

Headaches are one of the most common neurological problems we see in children in our practice. A child can start complaining of headaches as young as three years old. About 20% of children between the ages of 4-18 years report having frequent or severe headaches.

The most common types of headaches in children are migraine and tension type or stress headaches. Children may also develop chronic daily headaches. A thorough history, physical and neurological examination, and appropriate diagnostic testing (if indicated) will usually enable the clinician to distinguish a benign primary headache from a more serious disease with a secondary headache. Most of the headaches in children are not serious and can be treated by behavioral changes and over the counter medication such as Tylenol or ibuprofen.

 

Headaches in children and adolescents may be due to a primary headache syndrome such as migraine headache, tension-type headache, cluster headache or secondary to an underlying medical condition.  Secondary headaches usually are related to an acute febrile illness (eg, upper respiratory infection, influenza) but may be due to central nervous system infection or space-occupying lesion such as brain tumors.

Head trauma and post concussion syndrome are other common causes of headaches in young children and teenagers.

 

Young children respond to pain differently than older children and adolescent.  Headache pain may not be apparent to parents of younger children, who may react by crying, rocking, or hiding. Chronic pain may cause developmental regression, anxiety, depression, and behavior problems and affect the child's ability to eat, sleep, or play. Older children are better able to perceive, localize, and remember pain. Emotional, behavioral, and personality factors become more important as the child enters adolescence. The variability in presentation in children of different ages may lead to difficulty when applying the standard headache diagnostic criteria.

Most young children may just complain that their head hurts and they may become quiet and withdraw from normal activity. They may not eat, and may become irritable.  Some children may vomit with headaches and avoid bright lights and loud sounds. Other times the child may present with abdominal pain. These types of headaches are called abdominal migraine.

 

Parents should be concerned if the headaches become more frequent and are interfering with the daily life of the child. The parents should seek doctors’ help if the headache are not relieved by over the counter medications. The Pediatric Neurologist does a thorough evaluation of headaches. The evaluation of headaches in children includes a thorough history and physical examination with particular attention to the clinical features suggestive of intracranial infection or space-occupying lesion The headache pattern is often helpful to determine the underlying cause. Further testing such as a Brain MRI or CT scan of the brain is done if the child has recurrent headaches that are not associated with acute trauma, fever, or other obvious provocative cause.

 

The treatment and management of recurrent and chronic headaches in children and adolescents depends upon the underlying cause. Most of the time reassuring the child and the parents that the headache is not due to any serious problem will reduce the severity and frequency of the headaches. Once it is determine that the headaches are tension type headaches or migraine headaches treatment is targeted to the individual requirement. Most of the headaches will get better with behavior modification such as: eating regularly, having adequate sleep time, avoiding too much caffeine, drinking enough water, and avoiding triggers that cause headaches.

 

Treatment of chronic headaches requires a systematic approach over several months through which the child returns to normal activities of daily living.

Specific measures may include:

•  Providing realistic expectations (ie, the frequency and severity of the headaches may decrease over weeks to
    months of therapy, but the headaches may continue)

•  Return to school for children who have been absent; if necessary, they can go to the school nurse or office
    once daily for 15 minutes when headache pain peaks

•  Avoidance of headache triggers (eg, lack of sleep, inadequate hydration)

•  Daily exercise for 20 to 30 minutes

•  Addressing comorbid sleep problems (eg, delayed sleep onset, frequent night waking), mood problems, and
    or anxiety

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