Doctors Notes:

Your Child and Headaches

Angela Smith

Hello, and thank you for reading about headaches in children! This may come as a surprise to you, but just like adults, children can also suffer from headaches. In fact, 90% of children complain of headaches at some point in their life by the time they reach 18 years old.  Symptoms and treatment in a child, however, may be slightly different from you and I. I’d like to take a moment to discuss the most common types of headaches in the pediatric population, how to help prevent/treat those headaches, and how to recognize when medical attention is warranted.

The most common types of headaches in children are tension headaches and migraines, although headaches can also be caused by medication overuse, viral illnesses, injuries, bacterial infections. Rarely, headaches can be  from something such as a brain tumor, or other uncommon issues. For the purpose of this blog post, however, I’m going to discuss tension headaches and migraines in detail today.

Tension Headache vs Migraine:

Characteristics of Tension Headaches:

• Band-like pain that often starts in the back of the head and extends around to the front. The pain may also be diffuse, including the entire head.
• Pain that doesn’t stop your child from doing normal activities (like sports or going to school), but may slow them down.
• Pain described as pressure or squeezing.
• Pain that is mild to moderate intensity.
• Pain that doesn’t worsen with physical activity (although they may not want to participate if they have a headache).

Characteristics of Migraine Headaches:

• Pain in the temples or in the frontal head region. In younger children, the pain tends to be on both sides of the head, rather than just one side like adults.
• Pain that stops your child from doing activities.
• Pain described as pounding or throbbing.
• Pain that is moderate to severe.
• The headache may be associated with light sensitivity, sound sensitivity, nausea and vomiting.
• The headache may be preceded by an aura (visual symptoms that typically start 5-10 min prior to the onset of the headache is the most common in children, but can also include numbness or tingling, difficulty speaking, a funny smell or taste as well)
• Pain lasting at least 2 hours, but may last up to several days (younger children, however,  may have shorter headaches)
• Many children who suffer from migraines have relatives who suffer from them as well.

Please note that young children may exhibit symptoms different from older children, mostly because they have a hard time explaining how they feel. Some children may become irritable, they may vomit or appear pale, or may appear depressed or angry. Younger children also tend to be able to play through their headaches so it may be hard to identify headaches in this age group.

How to Prevent Headaches

• Go to bed at the same time every night and wake up at the same time every morning. Goodrest and a steady routine can greatly reduce the number of headaches your child experiences. Cell phones should NEVER be in your child’s room at night. Get them an alarm clock if they use a phone as one.
• DRINK WATER!!!! I cannot express how important water is to your child when it comes to headache reduction. Your child should be drinking half of their body weight in ounces of  water per day in order to be considered adequately hydrated. (If they weigh 100 pounds they should be getting at least 50 ounces of water per day)  If s/he plays sports, then you can add on some more!
• Avoid skipping meals. This means your child needs to eat 3 healthy meals a day and at least 2 snacks. So if your child doesn’t like to eat breakfast, make sure she eats at least something that has protein in it before running out the door. A scoop of peanut butter, a hard boiled egg, or a generous handful of almonds would do.
• Exercise at least 30 minutes every day!! Keep the body in motion and avoid activities such as video games, tablets and TV. Get your child up and moving.
• For some children, there are certain foods that may trigger a headache. These foods are typically high in nitrates (processed meats like bologna, hot dogs, bacon, pepperoni, prepackaged lunch meats, etc) or contain MSG (Raman noodles, flavored chips and crackers, Chinese food, etc). You may need to start reading food labels and try to avoid these ingredients if your child appears sensitive.
• Avoid using pain-relievers more than 2 times a week. Some children will actually develop a headache if they overuse pain-relievers, so you’ll want to only use medication when truly needed. If your child has a mild headache, just have them drink a glass of water, lie down in a dark room and rest. Most of the time, the headache will resolve without using a medication.
• Avoid stress. This is a hard one, especially for our adolescent children. School can be very stressful, so if your child seems overly stressed, you may need to evaluate what type of load they have on their plate. If your child is going to school, in 3 extracurricular activities, works and has chores at home, it might be too much. School is obviously not an option to give up, but maybe they need to stop working or stop one of the extra activities. There may  be a time that your child may require counseling to help deal with stress.
• Keep a diary of your child’s headaches. This can be most helpful if you’re trying to identify a trigger to the headache. You can track when the headache started and ended, where the pain was and what if felt like, sleep the night before, stressors, foods eaten, water intake, what helped the headache and any other symptoms your child has during or before the headache. This can be very helpful to your provider if you end up coming in to our office for a headache evaluation.

When You Need to see a Provider

Although most headaches are benign and don’t require evaluation in our office, there may be a time when an appointment would be warranted.

Please call our office if your child’s headache:
• starts after a head injury
• consistently wakes him or her from sleeping, especially if associated with vomiting
• is in a child less than 3 years old
• lasts longer than 24 hours and isn’t responding to treatment (ibuprofen and rest)
• is happening more than 4 times per month

Call our office immediately or go to the emergency room if headache is sudden, severe, and happens with other symptoms, such as:
• vomiting
• neck pain or stiffness
• double vision or change in vision
• confusion
• loss of balance
• trouble swallowing or speaking
• fever of 100.4 or higher

Thank you for reading and I hope 2019 brings nothing but health and happiness to your family!!
Angela Smith, CPNP