Headaches In Children

Overview

Headaches in children are more common than you might think, globally it’s reported that almost 60% of adolescents and children suffer from headaches.¹ Like adults, children can suffer from migraines, tension (stress) and even chronic headaches. This article covers some important points like why a child has a headache, how to prevent headaches in children and when to consult a doctor.

Causes of headaches in children

Headaches in children can have some obvious causes, such as dehydration, the need for glasses, minor head injuries and anxiety.^2,3 Others can be from infections and underlying conditions.¹ There are 2 broad categories for headaches in children, primary and secondary headaches. Primary are similar to headaches that adults suffer from; secondary headaches occur, usually with an underlying cause.

Primary 

• Migraine 
• Tension (stress) / anxiety

Secondary

• Tiredness /Hunger/dehydration
• Shortsighted / anxiety
• Infection/brain Tumours 

Signs and symptoms of headaches in children

Childhood headaches present differently from headaches in adults, they may last a shorter amount of time and of course, young children may not be able to communicate what they are experiencing. Of course, each child is unique so symptoms may vary.

Primary headaches in children:

Paediatric migraines:

• Throbbing headaches that tend to get worse with movement
• Sensitivity to sound or light
• Nausea and vomiting, with or without abdominal cramping (tummy ache) 
• The feeling of numbness in the arms or legs (pins and needles), clumsiness and confusion

Tension headaches:

• Mild to moderate pain, without throbbing or other migraine-specific symptoms
• Pressure or the feeling of tightening in the neck or head muscles
• Tiredness or increased sleep

Cluster headaches:

• Headaches that occur in a regular pattern, usually with a sharp “stabbing” pain on one side of the child’s head
• Congestion, runny nose or watery eyes
• Irritable and restless

Chronic headaches:

• Frequent headaches are those that occur often, more than 15 days a month
• Usually caused by long-term infections, head injuries or medication (Be aware of broader symptoms of injury, infection and side effects of medications such as fever, and inflammation around wounds or rashes) 

Secondary headaches in children:^4,5

Infections causing headaches:

• Viral and bacterial infections can usually be recognised by fever, cold sweats, pus and swollen tonsils. The most common infections in children are respiratory infections, such as ears, throat and chest.
• In rare cases, meningitis and encephalitis may be the source of the headaches

Diet-linked headaches:

• MSG (monosodium glutamate) containing foods
• Caffeine
• Fizzy drinks (soda) and energy drinks
• Chocolate
• Nitrates (preservatives found in cured pork)

Genetic headaches: 

• Migraines can be hereditary as can chronic headaches

Head injury:

• If your child has suffered any trauma to their head, seek appropriate medical attention / first aid
• Bumps and bruises (purpling of the area) can be a visual indicator of head trauma
• Pain at the site of injury should lessen, if it gets worse contact your doctor

Anxiety / Stress headaches:

• Emotional triggers can be a cause of headaches, bullying, cyberbullying or even stress at home could be the source
• Depression may be an underlying cause of headaches in children. Recognising sadness or loneliness may help them to open up and relieve some of the tensions they have been internalising

Brain-related headaches: 

• Tumours - uncontrollable growths that can be cancerous. Although they are more common in adults they do sadly affect children 
• Abscesses - brain abscesses are often associated with fungal and bacterial infections. These are very rare, especially in children, and usually occur in immunocompromised patients such as those undergoing chemotherapy
• Burst brain aneurysm - sudden agonising headaches are not normal, these are called “thunderclap headaches”. They are often likened to being hit in the head and are usually followed by a stiff neck

Management and treatment for headaches in children

Identifying the cause of secondary headaches will allow you and your child to avoid repeat incidents.^6,7 Psychological stresses may involve seeking counselling, this will help your child learn how to manage their mental health (coping methods) instead of internalising their pain. 

A paediatric referral may be required for chronic headaches (more than 3 episodes a week), further assessments will allow your doctor to identify any genetic predispositions or other medical causes. 

Over-the-counter medications are available to help relieve the symptoms of a headache, these include paracetamol and ibuprofen. Prescriptions may be given for relief of symptoms, in some cases, these may include triptans for migraines or domperidone which is an anti-sickness medication. 

Healthy lifestyle choices are crucial in the growth and development of a young brain, make healthier choices for your child by limiting time on devices and monitoring what they eat. The key points include:

• Balanced diet
• Sleep habits
• Exercise
• Hydration
• Scheduled play
• Keeping a journal

Diagnosis

If the headache is serious enough that you attend your local accident and emergency (A&E), your child will be examined for symptoms such as fever, vomiting or head trauma.^7,8 The doctor will also observe your child's gait (manner of walking), behaviour and eye movements, these observations may indicate red flags for secondary headaches.  

Cerebral spinal fluid (CSF) may need to be taken if a central nervous system (CNS) disease is suspected. Acquired hydrocephalus can develop in children (and adults) often due to an illness or injury to the brain, leading to excess water and swelling on the brain. Some people are born with narrowed brain pathways that can restrict CSF flow to and from the brain, this may not show symptoms until later on. A lumbar puncture would be required to retrieve the CSF, this fluid would then be examined by skilled healthcare scientists looking for any abnormalities.  

Diagnosis of chronic and recurrent headaches is usually supported by a journal. A record of symptoms, patterns of onset and monitoring of diet, weight and stressors are key for management and treatment. Primary headaches require additional investigations, neuroimaging may also be required, especially if a thunderclap headache is suspected. Brain imaging can be performed using specialist equipment such as computerised tomography (CT) scans or magnetic resonance imaging (MRI). 

Risk factors

Some major risk factors for childhood headaches include:⁴ 

• Puberty and hormones increase a child's risk of headaches, especially for females
• Children with a family history of headaches or migraines 
• Adolescent children

Complications

If a migraine lasts longer than 72 hours you may need intravenous (IV) medications or other medical interventions to relieve your symptoms. This could be due to migrainous infarction (stroke), meningitis, encephalitis or pressure /fluid/ bleeding on the brain. Complications can result from infections that haven't been successfully managed, special care should be taken for children with a history of otitis media (ear infection), mastoiditis (bone infection), endocarditis (heart infection), and those with compromised immune systems and comorbidities.⁹

FAQs

How can I prevent headaches in children?

Healthy lifestyle choices are crucial in the growth and development of a young brain. Make healthier choices for your child by limiting time on devices and monitoring what they eat. Stay up-to-date with health checks and hygiene, to reduce the risk of eye strain and infections. For adolescents, try to identify other stressors such as exams, strained peer or teacher interactions and other mental health triggers. The following are the key points to help prevent these headaches:

• Balanced diet
• Sleep habits
• Exercise
• Hydration
• Scheduled play
• Regular eye health checks
• Communication 
• Limited screen time
• Keeping a journal
• Managing hygiene

How common is headache in children?

Headaches in children are very common but usually resolved with over-the-counter medications such as paracetamol or steps to maintain a healthy lifestyle balance. Pay extra attention to teenagers and their mental health, girls during puberty due to an excess of hormones and children that have a family history of headaches or migraines. 

When should I see a doctor?

The following types of headaches in children warrant an immediate need to see a doctor:

• Headaches that affect balance or loss of feeling and weakness in an arm or leg
• Headaches that wake your child up from their sleep
• Headaches that make your child projectile vomit
• Headaches that are connected to a seizure
• A thunderclap headache
• Headaches that cause loss of vision

Summary

Headaches in children are broadly categorised as primary or secondary headaches. Primary headaches include migraines and common headaches from general dehydration, hunger and tiredness, secondary headaches are usually caused by a different source. These can include emotional triggers and stressors, poor diet, infections or more serious causes like abscesses and bleeds on the brain. Depending on the type of headache symptoms can present as throbbing, light and sound sensitivities and flu-like symptoms. 

Management of headaches is usually addressing the source of the symptoms, keeping a diary of the headaches will help you to identify these for your child. Over-the-counter medications can be used to ease many of the symptoms, however, additional medical intervention may be required, in some cases, such as a brain scan or lumbar puncture to examine CSF. Look out for migraines that last over 2 hours and thunderclap headaches as these are not typical headaches and could indicate a more serious problem.