As adults, we get headaches and generally know what works best to treat our headaches when we feel one coming on.  But what about when your child complains of a headache?  What triggers their headaches?  And is the same treatment we use appropriate for our kids?

The Basics about Acute Headaches and Their Causes

Let’s begin with the basics about headaches.  The most important thing to keep in mind is that most headaches in children are not serious and can be easily treated using some simple measures.  Headaches can occur in any area of the head.  There are many different types of headaches as well as causes of headaches in children.  They are especially common in teenagers but can occur at any age. 

So, what are the main causes of headaches in children? 

Viral illnesses such as the common cold or influenza can cause inflammation, swelling, and sinus symptoms, which can lead to headache pain.  If your child has a fever accompanying an illness this can also bring about a headache.  Always keep in mind that the higher the fever, the more painful the headache may be.  Headaches related to illness typically resolve after a few days.

Many adults get a headache when they skip meals or don’t eat enough during the day.  Much like us, our children can experience these as well!  To prevent these from occurring, make sure your child is getting adequate nutrition at every meal and if you suspect the headache may be hunger related, offer a snack or a light meal to see if the headache subsides. 

It’s important to remember that dehydration can also bring on a headache.  Ensuring your child is well hydrated throughout the day can help to prevent this.  [The typical rule of thumb is 8 ounces per year of age, up to 64 ounces daily.]

If you’ve ever thought about making your child wear a helmet all the time or considered wrapping them in bubble wrap, you are not alone!  Children have accidents just like adults do and can develop a headache from their injuries.  Head injuries can cause visible damage (think of a bruise or a cut), and can cause pain to develop at the injury site.  They most often last for several days and will go away with minimal treatment.  Severe, deeper headaches, or pain that encompasses your child’s entire head should be evaluated urgently.

Meningitis is one serious, but thankfully, rare source of headache.  This is a bacterial (or viral) infection of the membrane that covers the spinal cord and brain.  In older children the primary symptoms are neck stiffness (they have trouble touching their chin to their chest), headache, confusion, and fever.  Younger children and infants are more likely to have vomiting and fever and be lethargic and irritable.  If you suspect your child may have meningitis, (s)he should be seen immediately.

Chronic Headaches

So, what if your child has more frequent headaches or their headaches don’t fit with one of the above causes?  There are also chronic reasons that kids get headaches. 

Muscle tension headaches are extremely widespread in adults, but did you know that your child can also suffer from these as well?  Much like adults, kids encounter daily stressors, anxiety, and worry about a variety of things.  These headaches present with a feeling of tightness around the head, but soreness and tightness of the neck muscles can also be present.  Often the result of staying in one position for too long (think about when your child is reading or using a computer or tablet), muscle tension headaches are the most common type of recurrent headaches.

Many adults experience migraine headaches and your child can get them too.  Migraines are severe and very painful and can prevent your child from completing normal activities.  These headaches are described as throbbing and often occur on only one side (unilateral).  Migraine symptoms have a sudden onset and offset.  Your child may have nausea and/or vomiting, as these side effects are present in 80% of cases.  Bright lights and loud noise (and sometimes not so loud noises) can worsen migraines.  There is also a genetic component to migraines so if either parent has a history of migraine, your child may develop them as well.  These headaches can be associated with a variety of triggers that when identified can reduce the frequency and severity of the headaches.

Two other types of recurrent headaches are school avoidance and rebound headaches.  School avoidance headaches are common in the morning on school days and can be associated with anxiety.  They can prevent your child from attending school and are real and are due to a low threshold for pain.  Rebound headaches occur from an overuse of headache medications in high doses.  They are most often tied to use of over-the-counter medications, including NSAIDS like ibuprofen and naproxen.  Caffeine can be present in some over-the-counter pain medications and may play a role.  Treatment of rebound headaches should focus on taking pain medication at the correct dosage and not exceeding treatment more than 3 times each week.

Treatment and Prevention

As important as it is to recognize the various types of headaches, it’s also equally, if not more important, to know the treatment (or prevention) for them.  Mild headaches can be treated relatively easily with supportive measures.  Applying a cold, wet washcloth or cold pack to the forehead or back of the neck for 20 minutes can help ease pain and relieve headaches.  Stretching and massaging tight neck muscles can ease muscle tension that can sometimes bring on mild headaches.  Additionally, offering food or water if your child has not eaten in more than 4 hours may help.  Resting in a quiet, dimly lit room can also be helpful.  Finally, administering an appropriate dose of ibuprofen (or naproxen for older children/teens) for more severe headaches can be beneficial.

If your child suffers from migraine headaches and has been given a prescription for migraine medication, give it as soon as they feel a headache coming on.  If (s)he has not formally been diagnosed with migraines, ibuprofen is the best over-the-counter medication for moderate to severe headaches. 

There are other methods for preventing and managing headaches.  There is evidence to show that riboflavin, magnesium, coenzyme Q10, and vitamin D can be beneficial.  Alternative treatments such as chiropractic care, acupuncture and massage may also be utilized in the management of headaches.

When Evaluation and Treatment is Needed

Now that we’ve identified remedies you can use to relieve headaches, let’s talk about when your child needs medical evaluation and treatment for the complaint of a headache.  If your child is having headaches more than once each month, please schedule an office appointment, as we may be able to identify the reasons for the headaches.  Please remind us  if your child has previously been diagnosed with an immune deficiency or a bleeding disorder, as headaches associated with these may be a reason for more concern.

Head injuries are scary for any parent.  If your child has experienced a minor head injury, we can guide you in the event they need further evaluation – often through a simple phone call. 

If your child’s headache wakes them up from sleep or the headache is present upon waking, or if your child has a headache associated with exercise, please call us immediately as that warrants further evaluation. 

There are some things we cannot evaluate and treat quickly.  The following are instances when you should bypass our office and proceed to the emergency room (MUSC Children’s Hospital ideally) for an urgent evaluation:

  • neck stiffness and cannot touch their head to their chest
  • a purple or blood-colored rash that’s widespread
  • a smile that seems to be crooked
  • one-sided facial weakness that is of new onset 
  • changes in vision, such as double vision or loss of vision
  • eye pain or facial swelling
  • difficult to awaken or has confused thinking, disoriented talking, they are unable to stand or walk without assistance, have slurred speech, or arm or leg weakness

We hope that you learned that headaches can be common and most often are not serious – and how to determine if the headache is serious.  We are here for you and are ready to evaluate your child for any headache concerns you have.