A headache is a feeling of discomfort or pain involving the facial area or head. The anomaly may be single or frequent and confined to one or more head and face regions. Headaches are usual in childhood, and their frequency increases during adolescence. Usually, they are nothing to worry about.
However, it's essential to pay attention to the child's headache symptoms and seek prompt medical care if the headache(s):
- Are accompanied by neck stiffness/pain or fever
- Occur with visual changes or persistent vomiting
- Follow a head injury, such as a blow to the head
- Become more frequent or worsen
- Change the child's personality
- Wake the child from sleep
- Affects a very young child
- Are a cause for concern
- Seizures or epilepsy
There are two main types of headaches based on the cause, namely primary headaches and secondary headaches. Secondary headaches are less common and are caused by other diseases such as brain disorders and dental problems. Primary headaches are not associated with another health condition. They are usually caused by widened blood vessels, tight muscles, nerve signal changes, or swelling in certain brain parts.
Primary headaches include:
- Congestion headache is associated with sinus congestion and viral infections, for example, colds and flu.
- Tension headaches - Are the most common type and are usually triggered by stress and emotional/mental conflict.
- Analgesic rebound or medication overuse headache - Occurs due to frequent use of painkillers (more than twice a week for several weeks). It's becoming more prevalent.
- Cluster headaches - Often arise in a series that can take weeks or months. The headaches series may recur every one to two years. These headaches may start in children older than age ten and usually affects teen boys.
- Migraines - May begin early in childhood and affects nearly one in five adolescents. Generally, migraines start at the age of seven years for boys and ten years for girls. Often, the patients have a migraine family history. Some girls may experience these headaches during their menstruation.
Causes & Risk Factors
The exact reason why headaches occur has not been established. However, researchers believe that tight muscles and widened or enlarged blood vessels in the head are responsible. Recent studies suggest that migraines may occur due to changes in the brain's electrical signaling or chemicals. Other headaches may arise because of communication changes in the nervous system areas, that transmit pain signals from the head, face, and neck regions. Low sleep quality and sleep deprivation are often responsible for persistent headaches.
Therefore, headaches in children may be related to many factors including vision problems, genetics, infection, stress, head trauma, dehydration, diet, medications, and hormones. In rare cases, there is an actual brain abnormality such as brain malformation or tumor.
The risk factors for headaches in children include:
- Family history of migraines
- Girls at puberty
- Older teens
- Head injury
- Poor sleep
Signs & Symptoms
Differences in symptoms can make it challenging to identify the type of headache a child has, especially in younger children who cannot explain the symptoms. However, some symptoms appear to come into certain groups more frequently.
Tension headaches symptoms can include:
- Dull pain
- Pain that starts slowly
- Mild to moderate pain
- Head hurting on both sides
- Change in the child's sleep habits
- Pain that circles the head like a band
- Pain in the back region of the head or neck
The headaches can last from 30 minutes to a few days.
Cluster headaches symptoms include:
- Chronic daily headache
- Swelling of the forehead
- Nasal congestion or runny nose
- Severe pain on one side of the head, often behind one eye
- A droopy lid, small pupil, or eyelid redness and swelling of the affected eye
Migraines signs and symptoms may include:
- Pre-migraine symptoms like a change in vision, unusual smells, or seeing flashing lights
- Increased sensitivity to sound or light
- Pain on one or both sides of the head
- A child being quiet and appearing pale
- Throbbing or pounding pain
- Abdominal pain/discomfort
- Nausea and vomiting
Secondary headache symptoms may include:
- Severe pain
- Changes in vision
- Seizures or epilepsy
- Sudden onset of pain
- A very young child with a headache
- Personality changes along with headache
- The problem of a headache awakening a child
- Headaches that begin very early in the morning
- Pain that is aggravated by sneezing or coughing
- Headache that is becoming acute or continuous
- Balance problems or weakness in the arms or legs
- Headache that is becoming more severe or continuous
- Frequent bouts of vomiting without nausea or other stomach virus signs
It's essential to see a health care professional for a diagnosis.
Diagnostic testing and a comprehensive medical evaluation may reveal the full extent of the headache. The healthcare provider will diagnose the headache through detailed patient history, physical evaluation (including a neurological exam), and diagnostic tests.
S/he may also take the complete medical health history of the family. S/he will want to know when the headaches happen, the headache's location, the feeling, duration, and the effect of changes in position on the headache, etc. The doctor will also inquire about any history of head or face injury, trouble sleeping, history of emotional stress, etc.
In severe cases, s/he may order diagnostic tests, such as:
Magnetic resonance imaging (MRI)
To make high-quality images of body organs and tissues
A computerized tomography (CT) scan
o obtain detailed pictures of any region of the body, including the organs, muscles, fat, and bones
Lumbar puncture or spinal tap
The test assesses cerebrospinal fluid (CSF) pressure and can also be used to examine for a CSF infection
A painless test used to record breathing and muscle movements. It's usually conducted if there is an indication of a sleep abnormality
In severe cases, headaches in children may require urgent medical care, including hospitalization for diagnostic testing, observation, or even surgical intervention. In general, management is individualized based on the underlying cause, type of headache, the child's age, symptoms, and overall health.
The treatment aims at stopping the headache from reoccurring. It may include:
- Staying away from known headache causes, including some foods and drinks, lack of sleep and fasting
- Resting in a quiet, dark environment
- Stress management
- Regular exercise
- Dietary changes
The doctor may prescribe medication for migraine headaches such as:
Taken daily to decrease severe migraine headaches
Can avoid an ongoing headache by working on particular receptors in the brain's blood vessels
Over-the-counter medicines that can prevent a headache, such as an acetaminophen
Rest or relaxation can virtually relieve an occasional mild headache. Other home remedies include:
Applying a piece of ice wrapped in a washcloth or cold, wet washcloth on the child's head or neck. N/B Applying ice directly on the skin can damage the skin.
Having the child take a warm shower or placing a warm wet washcloth on its head or neck
Ibuprofen may also provide relief, but it's essential to ask for the pharmacist, nurse, or doctor's right dosage. Parents must avoid using aspirin or other medicines unless prescribed by the child's doctor.
Prognosis & Long-Term outlook
Frequent headaches can lead to behavioral issues, problems at school and depression.
Prevention & Follow Up
It's possible to prevent or reduce the severity of headaches in children through:
- Practicing healthy behaviors
- Following the doctor's plan
- Avoiding headache triggers
- Getting enough sleep
- Not skipping meals
- Reducing stress
Maintaining a journal may help to identify the causes of the child's headaches.