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 had some type of headache.

There are two basic types of headaches. Primary headaches have the headache as the only symptom. It will stop once treated. Secondary headaches are caused by some other health problem. They don’t often go away until the health problem is treated.

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

Your child's healthcare provider can determine what kind of headache your child has. They will need to talk to both you and your child to see if the headache has an emotional side to it. They will also do a complete physical exam. This will be done along with a neurological exam. Sometimes your child will need brain imaging in the form of either a CT scan or MRI. Your child's healthcare provider will advise you when it's necessary to do brain imaging and which test is best for your child.

Tension-type headache

This is the most common type of headache in children. 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 often cause nausea and vomiting. It's also not tied to other symptoms, such as fever, change in mental status, or other physiologic changes. 

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

These headaches are often easily treatable with over-the-counter medicine, such as acetaminophen or ibuprofen. Your healthcare provider will tell you how to give these medicines safely. It's also important to identify likely triggers and make lifestyle changes in diet, sleep patterns, exercise, and study habits. 

Migraine headaches

A migraine headache is sometimes one-sided and throbbing. It sometimes occurs with nausea and vomiting, or sensitivity to light, noise, or both. Some migraines come after an aura. This is often a one-sided sensory change that points to the start of a migraine. Children who have a family history of migraines have a greater chance of getting migraines themselves. The younger the child, the harder it is to make the diagnosis of migraine headaches. Migraines in children can have many different symptoms than migraine in adults. They can sometimes be hard to diagnose. Fortunately, migraines may go away in some children several years after they appear. But many children who get 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 age 5. And in about half before age 20.

It's important to realize that a migraine headache may happen after a head injury. This particularly happens after injury in sporting activities like football and baseball. The child will often recover fully over time. Headaches occurring after a head injury should be evaluated by a health professional to rule out concussion or other serious problems.

Migraine headaches are treated in two ways. Medicines can be used to stop an acute migraine headache. Other medicines can be used to prevent frequently occurring headaches. Your healthcare provider will advise you on the correct medicines you can give to best control the symptoms of your child's migraine headaches.  

Immediate care

These headaches need medical care right away:

• 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 quickly 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.