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Handling Headaches

Frequent or occasional headaches can be a problem for children, not just adults.  Some headaches happen for no apparent reason (known as primary headaches), while others may have an underlying cause such as an infection or sinus problem (secondary headaches).

Types of Headaches

There are three types of primary headaches:

  • Migraine – These headaches are the most common primary headache in children. Often there is a family history of migraine. Pain during a migraine can be intense, with throbbing on one or both sides of the head. Activity may make it worse. Nausea, vomiting and sensitivity to light and sounds are common.
  • Tension– This type of headache can last for 30 minutes to a week with mild, non-throbbing pain that does not get worse with activity. Children and teens with a tension headache may also experience nausea and sensitivity to light and sound, but vomiting is typically not an issue.
  • Cluster – With this type of headache, multiple headaches take place during a short period of time. They are typically very severe and last for less than three hours. Cluster headaches occur on one side of the head and may be accompanied by runny nose, teary eyes and facial swelling.

Secondary headaches are not frequently seen in children. When they occur, they may be caused by a wide variety of issues and will often require further testing, such as an MRI or a blood test, to determine the cause.

When to See a Doctor

 If headache days are impacting your child’s schoolwork or causing your child to miss school and other activities, then you should talk to your child’s health care provider. Most likely your child will be referred to a neurologist – a doctor that specializes in conditions of the brain and nervous system.

Be sure to talk to your child’s doctor if your child has:

  • Headaches that are occurring more frequently
  • Sudden onset of “the worst pain ever” or thunderclap headache
  • Severe headache with fever
  • Headaches that get worse over time
  • Headache accompanied by vomiting, behavior changes, sleepiness, change in mental status, weakness and/or double vision
  • Headache with accompanied with neurological symptoms, such as clumsiness, weakness on one side of the body, and/or change in vision
  • Headache after head trauma
  • Headache with environmental exposure, like carbon monoxide exposure
  • Headache that starts in the early morning or wakes your child up from sleep

 Preparing for Your Child’s Visit

 When preparing for your child’s doctor visit, don’t forget to bring a list of all medications your child is taking, including over-the-counter pain relievers, allergy medications and vitamins. Additionally, the neurologist will have a questionnaire asking about patient and family history that can provide valuable insight in determining the cause of your child’s headaches.

 Keeping a headache journal or calendar can be very helpful. Many health care providers will ask you/your child to keep a log as a part of their treatment, but starting ahead of time and having a log to bring to the initial visit can also be helpful. In a notebook or on a calendar, write down the date and any other relevant information each time your child has a headache. Compare entries and make note of any trends you observe. Younger children will need help with this, but older children and teens can be empowered to play an active role in their care. When making entries, think about:

  • Did your child have anything to eat or drink in the time leading up to the headache?
  • Did your child wake up with it or did it start at some other time? Take note of the time of day.
  • What was your child doing? Running outside? Playing video games? Schoolwork?

Treating Headaches

 There are two main ways to treat headaches – preventing new ones and stopping ones that are already in progress.

 Prevention.  Lifestyle changes often are enough to prevent future headaches. Before turning to medication for prevention, consider these simple changes:

  • Getting Enough Sleep – Lack of sleep is a leading cause of headaches in teenagers. Irregular sleep schedules and using electronic devices late into the evening contribute to this issue. Setting a regular sleep schedule and reducing the use electronics can help.
  • Drinking More Water – Many children do not drink enough water during the day, which can make headaches more likely. Encourage your child to drink more water by having them bring a reusable water bottle to school, work and other places. Sparkling water and water infused with fresh fruit, vegetables and herbs are fun, healthy and hydrating alternatives to plain water.
  • Overuse of Medication – Use of NSAID pain relievers (ibuprofen, naproxen) can often lead to rebound headaches: the medication may relieve pain initially but the headache soon comes back.
  • Stress, Anxiety and Depression – Mental health issues are another common cause of headaches in children of all ages. Older students, especially those in high school, might start to experience headaches from stress as they prepare for college, start jobs and try to balance school and extracurricular activities. Helping your student learn ways to manage and reduce stress may reduce stress-related headaches now and help them as adults. Meditation, yoga, biofeedback and counseling are great ways relieve stress and find balance. If these techniques are not enough to fully manage these mental health issues, medication such as an antidepressant may be recommended.
  • Physical Activity – Children and teens should get at least 30 minutes of physical activity each day. A lack of activity can lead to a headache, especially in teens who were active but recently stopped participating in regular activity.
  • Vision Problems – If your child often comes home from school with a headache, a vision check is a good idea. Eye strain, whether it is from reading books or a school whiteboard, can cause a headache in some students. A new pair of glasses might be the only thing needed to solve these headaches. Don’t forget to have your child’s vision examined every year – as your child grows their prescription is likely to change.
  • Trauma, including concussion – Make sure your child wears the right protective headgear when necessary, such as riding a bike or playing certain sports to reduce the likelihood of brain injury. When an injury does occur, make sure your child gets plenty of rest from school, work, extracurricular activities and electronic devices to prevent headaches and promote recovery.

Stopping a headache. The other way to treat headaches is to stop those already in progress.  There are many different types of medications that are available for treating headaches and it may take some trial and error to find what works best for your child. Some medications are designed to stop pain while others may make your child feel sleepy and “sleep off” the headache. In severe cases, IV fluids and pain management may be needed.

When your child has a headache, it is important to take any prescribed medication as soon as the headache starts. They should drink plenty of water and rest in a dark, quite room. Many children find a cold compress or heating pad helps manage the pain.

With prevention and management, your child can get back to being a kid instead of struggling with headache pain.

Learn more about the Institute for Brain Protection Sciences at All Children’s Hospital Johns Hopkins Medicine.

Peter Huszar, MD - Center for Pediatric Neurology, All Children's Hospital Pediatric neurologist Peter Huszar, M.D., leads a Headache Clinic at All Children’s in addition to caring for children with seizure disorders and a variety of general pediatric neurology issues. He comes to All Children’s Hospital from the Children’s Hospital and Clinics of Minnesota, where he served as an attending pediatric neurologist. His clinical interests include headache and he is a member of the All Children’s multidisciplinary pediatric stroke program.

 Dr. Huszar completed his pediatric neurology fellowship training at SUNY Downstate Medical Center in Brooklyn, NY. After graduating from Albert Szent-Gyorgyi Medical University in Szeged, Hungary, he did his pediatric residency training at Hungary’s Erszebet Hospital and at SUNY Downstate Medical Center. He is board certified in neurology with special qualifications in child neurology.

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