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Headaches

What is a Headache

Headaches are a very common complaint in older school-age children and adolescents. We have a separate care tnstruction on Migraine Headaches. This set of instructions is for headaches that are not migraines. Of course, everyone knows what a headache is in general – pain in the head! Many different things cause headaches, though. Most of these are not serious and will go away with time and a little rest and pain relievers. A few are more serious and need other treatments. A few serious conditions can cause headache as one of their symptoms. We discuss those near the end, under “Other Conditions That Might Be Present.” Here are the most common causes of headaches in children and teens:

  • Tension headache – most common in older children and teens. Tension headaches feel like a tight “band” around the head, and are often worse at both temples. They are the result of muscle tension in the neck and shoulders either from emotional stress or from standing or sitting in one position for too long.
  • Vision problems – children who complain of headaches near the end of school every day, or always sit too close to the TV to watch it often actually have trouble seeing. They compensate by squinting and peering in school, and by sitting up close at home.
  • Anxiety or depression – teens who are feeling depressed, anxious, or worried, or who are having turmoil in their lives, may complain of a headache even when we cannot find a physical cause. These teens are not lying or making up symptoms. They actually have a headache, which is their body’s way of responding to their distress.
  • Sinus headache – in children over 5 to 6 years old, sinus headaches cause pain in the forehead and cheeks. Some people describe this pain as a “heaviness” in the face. Other people have tooth pain with it. Children and teens with sinus headaches often suffer from allergies or asthma as well. Sinus headaches are common during and after sudden changes in weather, or after flying in an airplane. Sinusitis, an infection of the sinuses, can also cause headaches. Sinusitis can cause severe pain, fever, and tenderness over the sinuses. People with sinusitis often have cloudy yellow or green drainage from one or both sides of the nose. Bad breath is another symptom of sinusitis.
  • Strep throat and flu – in pre-school and early school-age children, a strep throat infection is often the cause of a headache. Influenza (the flu) can cause a headache in children of any age.

What is the biggest concern?

Just about every parent whose child complains of a headache has a nightmare moment thinking that it might be a brain tumor. That’s a normal reaction, but fortunately brain tumors in children are very rare; so are strokes and the other serious conditions that older adults can get. In the small number of children who do develop brain tumors, the symptoms are usually persistent for more than a few days. They often cause obvious problems such as difficulty speaking, walking, or with coordination. Most doctors are concerned about a complaint of headache in a child under the age of about 8 years old – these children don’t usually develop tension headaches, and if they need some attention they tend to complain of tummy-achesinstead.

Headache  treatment

It is difficult to decide how to treat a headache in a child unless we are fairly sure of the cause. You can always give your child some pain reliever, however, even before your doctor goes to work to try to determine the cause of the headache. Most headaches are easy to relieve with acetaminophen (Tylenol® and others) or ibuprofen (Motrin® or Advil® or others). A warm bath or shower, and/or a shoulder and neck massage can help a great deal, especially if the headache is a tension headache. You and your older child or teen may be able to identify certain postures or positions that could add to a tension headache. For example, if your child always “hunches over” a book or a paper, that can produce neck muscle soreness. This can also be a sign of vision problems. Every child with a headache that persists or recurs should have a vision test to be sure s/he doesn’t need glasses or contacts. If anxiety or depression are the cause, your doctor may refer your child to a therapist or counselor. Some doctors may also start your child on medication, depending on how severe the condition is. Doctors treat sinus headaches in many different ways. Some doctors prescribe or recommend decongestants, antihistamines, and/or nasal steroid sprays to open clogged sinuses. Infected sinuses (sinusitis) need antibiotic treatment, as do other infections such as strep throat.

Your doctor will want to hear from you after a few days to be sure your child is feeling better. If 2-3 days of pain relievers don’t help, and your doctor does not find any of the other causes that we’ve talked about, please let him or her know. S/he may then want to do some other tests, such as CT or MRI scans, to look for other causes. If your child has frequent or prolonged headaches, you can also help your doctor make the diagnosis by keeping a “headache diary.” This is just a notebook in which you write down the time of day a headache starts and ends, what was going on just before the headache (such as food or activity), what the specific symptoms were, and what made the headache better. This will help you, your child, and your doctor detect patterns in the headaches that could be very helpful in making a diagnosis and getting the right treatment.

Symptoms of a Serious Headache?

As we’ve noted, most headaches in children and teens are nothing to worry about if they go away quickly with over-the-counter medications and rest. Although they are rare, some more serious conditions can cause headaches. Here are some things to watch out for:

  • Headache that lasts for more than one day without ever completely going away
  • Complaint of headache in any child younger than 8 years old
  • Headaches that are worse in the morning and get better as the day goes on
  • Headaches that awaken a child from sleep
  • Headaches associated with vomiting
  • Headaches that cause drowsiness or lethargy
  • Changes in speech, coordination, or walking
  • Unusual facial expressions, facial weakness, drooling, or difficulty swallowing
  • Changes in vision
  • Fever that develops at any time during a headache, or preceded the headache
  • Stiff neck
  • Avoidance of bright light
  • Seizures
  • Headache in any child with sickle cell disease, hemophilia, platelet disorders (such as “ITP”), leukemia
  • Headache in any child with a severely impaired immune system (such as children with HIV/AIDS, severe combined immuno-deficiency syndrome (SCID), or children taking immune-suppressive medications such as chemotherapy, high doses of steroids, or children with organ transplants)

If any of these occur, please be sure to call your doctor’s office right away. If your child has any of the items listed above in bold print, please go directly to the emergency room.

Other points of concern

Some older children and teens may develop headaches after injuring their heads. If they are afraid of getting in trouble, they may not tell you about the injury. Please be sure to ask your child if s/he hit her or his head (or got hit in the head) if your child has an unusual headache. This is especially important if the headache keeps getting worse and either lethargy or vomiting begins. You can read our Aftercare Instruction on Closed Head Injury.

Older children and teens often complain of a “headache” if they are anxious about school or some other activity or obligation. Younger children generally complain of a tummy-ache in these circumstances. For this reason, if your child less than 8 years old complains of a headache, please take him or her seriously and make an appointment to see the doctor.

Other Conditions that Might Be Present with a Headache

We have mentioned the most common and most alarming conditions that can cause headaches in children. A few rarer conditions include:

  • “Pseudotumor cerebri” (sued-oh-tumor sir-eeb-rye) – this unusual condition involves increased pressure inside the skull, which can produce symptoms similar to a tumor (hence the name). It is unusual, but when it happens it is most often in adolescent girls who are overweight, or in teens of either sex who take certain acne medications.
  • Brain tumor – brain tumors are quite rare in children, but they can, unfortunately, happen. There are several different types of brain tumors, each with a different set of problems and ways to treat it. The headache that a brain tumor causes is usually persistent, worse in the morning, may cause vomiting, and often causes changes in gait, coordination, speech, or other visible signs. Please don’t be afraid to tell your doctor if you are worried about a brain tumor. Chances are excellent that s/he will be able to easily reassure you about it, and doctors never object to knowing what their patients or their families are concerned about.
  • Stroke – strokes are even rarer than brain tumors in children, except in some cases if a child has another underlying condition. Children with sickle cell disease can have strokes if the sickle-shaped blood cells block blood vessels in their brains. Children with clotting problems, such as hemophilia, ITP, or von Willebrand’s disease can have bleeding inside the brain.
  • Meningitis/encephalitis – these two conditions involve infections of the brain and its covering tissues, either by viruses or by bacteria. Children with either of these conditions usually have fevers. They may be either lethargic (too sleepy) or irritable, and they often complain of stiff neck and that light hurts the eyes. If your child develops any of these symptoms please call your doctor or go to the emergency room immediately.