Headaches in children: When should you be concerned?

When a child says his or her head hurts, it’s not uncommon for parents to be concerned.

Headaches in children can stem from a variety of things, but migraines are the most common culprit. The exact cause of migraines is unknown, but they are thought to be the result of abnormal brain activity, which can temporarily affect nerve signals, chemicals and blood vessels in the brain.

Other common causes of headaches include trauma/concussion, eye problems like refractive errors, depression, chronic sinusitis and chronic tension/stress. Fortunately, brain tumors are a rare cause, but it’s the number one concern of families. Some children develop more frequent headaches due to analgesic (pain relieving medication) overuse, caffeine, stress and depression.

Regardless of the cause, headaches are one of the most common neurological symptoms and the source of frequent neurology referrals.

To better understand your child’s head discomfort, ask them to describe what they are experiencing. Keep in mind that headaches can be difficult for adults to explain, let alone children. If your child says things like their headache comes out of the blue, is worse with straining in the restroom, makes them dizzy or off balance, affects their vision, wakes them from sleep or starts in the early morning, call their pediatrician so an evaluation by a specialist can be scheduled.

If your child experiences recurrent headaches but does not use any of the above terminology, ask them the following questions:

• Where on your head does it hurt?
• Does anything trigger or worsen your headache (sounds, screens, flashing lights?)
• Are you nauseous?
• Do you feel dizzy or off balance?
• Are you having trouble seeing normally?

While an occasional headache may not necessarily be cause for concern, if your child is experiencing more than two headaches per week, which affects their participation in their favorite activity, speak with their pediatrician. Once referred to a specialist, most children typically undergo a thorough history and neurological examination rather than imaging studies such as magnetic resonance imaging (MRI) and computed tomography (CT), as they are rarely necessary.

If it is determined that your child’s headache is not cause for concern, try these methods to relieve their discomfort:

• Make sure they are well hydrated.
• Offer them reassurance. It can be scary to feel pain and not understand why.
• Give simple analgesics unless the headache is mild and nondisabling.
• Provide a calm environment free of flashing screens and loud noises.

Proper diagnosis and management of headaches can have a major positive impact on the lives of many children and families.

Dr. Kumar Sannagowdara is a pediatric neurologist at Aurora Children’s Health.