Headaches

Headaches are common in children. Older children and teenagers experience headaches more frequently, but young children can be affected, too.

The precise mechanisms of headache pain are not entirely known. Many headaches are thought to be the result of tight muscles, expanded blood vessels in the head and temporary changes in brain chemistry. Most are considered “primary” headaches, meaning that they’re not the sign of another illness.

The different types of headaches

Tension type headaches are the most common type of headaches. Stress is often a factor in these headaches. The most common symptoms of tension type headaches are:

• head pain that starts slowly
• pain on both sides of the head
• pain that is dull and steady, not pulsing
• pain that feels like a band around the head
• sensitivity to light or sound
• pain that is mild to moderate, but not severe

There is typically no nausea with tension type headaches. The pain is not aggravated by routine physical activity, so a child usually doesn’t need to rest with these headaches.

Migraine headaches occur in about 20 percent of people. Migraines can start at any age, but about half of people who have migraines have their first migraine before the age of 20. Before age 7, more boys have migraines than girls. After puberty, more girls are affected. The prevalence of migraines rises from about 3 percent of children under 7 to about 20 percent of teenagers and adults. Children with migraines often have family members who also have migraines.

The most common symptoms of migraines are:

• pain on one or both sides of the head
• pain that is severe
• pain that lasts from one to 72 hours
• pain that is throbbing or pounding
• pain that is made worse by bright light or sounds
• pain that is made worse by routine physical activity
• nausea and vomiting
• becoming quiet, pale and sweaty

Some features of children’s migraines are unique compared with adults’. For example, children are more likely to experience pain on both sides of the head rather than on just one side. Children may also have a hard time precisely describing their headache pain; for example, they may just say, “It hurts!” This can make it challenging to understand a young child’s headaches, and it makes parents’ observations of their child’s symptoms especially important.

Before a headache starts, your child may have a migraine “aura.” The most common type is visual aura, which includes changes such as a sense of flashing lights, stars and sometimes even a temporary loss of vision. These changes usually last for about five minutes to an hour, and stop once the headache pain begins. However, children experience migraine auras much less often than adults do.

Cluster headaches are headaches that happen in a series that may last weeks or months. They usually start in children older than 10. Teenage boys experience these headaches more frequently than girls. The most common symptoms of cluster headaches are:

• severe pain on one side of the head, usually behind one eye
• a droopy or red, swollen eyelid, or a small pupil, on the same side of the head as the pain
• runny nose or congestion
• swelling of the forehead

Secondary headaches are associated with other medical conditions. Headaches can be caused by many different medical problems, including upper respiratory infections, infections of the central nervous system and brain injuries. Brain tumors are the most commonly feared cause, but it is important to note that while headache pain in children is common, brain tumors are very rare.

Why does my child get headaches?

Even though we know that muscle tension, expanded blood vessels and certain processes that occur in brain cells are responsible for different types of primary headaches, important questions remain: What sets these mechanisms in motion? Why does a child’s body respond in such a painful way? And what can be done to prevent these responses?

There are many things that can cause headaches. We call these “triggers.” Different people have different triggers. Your child’s headache triggers might include:

• stress: Pressure at home, school or work can cause headaches. Stress can be either emotional or physical, such as an illness. Reducing stress can help prevent headaches. And various types of cognitive-behavioral therapy can help your child manage her body’s response to stress.
• skipping meals: Often, children fail to eat regular meals. Many skip breakfast, and some don’t like to eat lunch at school. Skipping meals is a common trigger for headache pain.
• dehydration: Not drinking enough fluids can also cause headaches. It’s important to learn how much and what type of fluid your child is drinking, and to help her get enough fluid throughout the day.
• irregular sleep habits: Getting either too much sleep or not enough sleep can cause headaches. It’s important to help your child maintain a consistent sleep schedule every night—she should try to go to bed and wake up at the same time every day, including weekends, holidays and vacations.
• irregular physical activity: Overexertion from excessive physical activity and a lack of regular exercise are both known to cause headaches. Getting regular physical activity can help make headaches less frequent and less painful.
• medication side effects: Sometimes headaches occur as a side effect of medications used to treat different problems. Talk to your child’s doctor or pharmacist if she starts getting headaches after starting or changing a medication.
• depression or anxiety: It’s important not to overlook symptoms of depression or anxiety. Even if these symptoms are not a direct cause of your child’s headaches, they may still be contributing to her pain. If you notice any changes in your child’s mental or emotional state, discuss these issues with your doctor.
• changes in weather: Changes in the season, as well as day-to-day weather changes, can cause headaches. There may be medications or other therapies that can help your child’s weather-related headaches.
• hormones: Girls sometimes experience migraines that are timed with their menstrual cycles. Classically, these “menstrual migraines” begin one day before the start of a menstrual period, when the estrogen level drops. However, these headaches may also occur during the period, just after it, or in the middle of the cycle. Keeping a headache diary may help to show whether this is an issue for your daughter.
• food triggers: Various foods may trigger migraines and other types of headaches, although food triggers are less common than we once thought. Some of the most common food triggers are:
  • chocolate
  • aged cheese
  • preserved or processed meats (such as deli meats and hot dogs)
  • nuts (such as peanuts, peanut butter and various other nuts)
  • monosodium glutamate (MSG)
  • caffeine (coffee, tea and sodas)
  • alcohol
  • artificial sweeteners
  • yeast (in freshly baked breads and donuts)
  • some vegetables (such as peas, beans and onions)
  • citrus fruits and juices (such as oranges, lemons and grapefruits)
  • some other fruits (especially bananas)
  • dried fruits preserved with sulfites (such as figs and raisins)

It’s important to keep in mind that every person is unique: What triggers one child’s headaches may not be what triggers your child’s. And only 5 to 15 percent of people with headaches have any known food triggers.

Therefore, we don’t recommend that you avoid all of the foods listed above. Instead, keep a diary of your child's headaches, and if you find a connection between your child’s headaches and a certain type of food, then you can stop giving her that food. Make sure to talk about any diet changes with your child’s doctor, too.

The Children’s Hospital Boston neurologists and pain management specialists who care for children with headaches are sensitive to these complex issues, and we take the time that’s needed to talk with you and your child and learn about her unique situation. Our goal is to work with you and your child as a team. Your knowledge of your child’s situation, combined with our experience in helping families like yours, is the key to success.

FAQ

Q: How often do headaches occur in children and teens?
A: Headaches are common in school-aged children: About nine out of 10 children complain of headaches at some point in their childhood. Children tend to suffer from headaches more frequently as they get older.

Migraines are more common in boys than girls before the age of 7. In the teenage years, migraines are more common in girls than boys. The prevalence of migraines rises from about 3 percent of children under 7 to about 20 percent of teenagers and adults.

Q: At what point should I bring my child in for an evaluation?
A: If your child’s headaches are disruptive to normal life, talk with her primary care provider.

If your child has any of these symptoms, contact your health care provider right away:

• a severe headache that happens suddenly
• headaches that wake your child up in the middle of the night
• headaches that happen when waking up in the morning
• headaches that happen more often than usual or are much worse than they used to be
• a headache that happens with a high fever or stiff neck
• a headache that happens after a head injury
• a headache that causes changes in vision, such as double vision
• a headache that’s associated with difficulties in walking, balance problems or confusion

If your child needs immediate care, your primary care provider may evaluate your child, send you to an emergency room or have you contact us, as appropriate.

If your primary care provider refers you to Children’s, contact us in the Headache Program.

Q: Why do headaches occur?
A: Many headaches are the result of tight muscles, expanded blood vessels and certain processes that occur in brain cells. To learn more about the different things that may set these mechanisms in motion, see Q: What can bring on a headache? below.

Q: What are the different types of headaches?
A:Tension type headaches are the most common type of headache. Children can also get migraine headaches. Cluster headaches are less common in children.

Q: What other medical problems can cause headaches?
A: Many different medical conditions may be associated with headaches; upper respiratory infections are the most common. More serious medical problems may also cause headaches. Headaches caused by brain tumors are very rare.

Q: What can bring on a headache?
A: There are many things that cause, or “trigger,” headaches. Different people have different triggers. Common headache triggers include:

• stress, either emotional or physical (such as an illness)
• skipping meals
• dehydration
• irregular sleep habits
• irregular physical activity habits
• medication side effects
• depression or anxiety
• changes in weather
• hormones, including girls’ menstrual cycles
• food triggers

A variety of foods can trigger migraines and other types of headaches. However, food triggers are less common than once thought, and different foods can trigger headaches in different people. So we don’t recommend that you eliminate all of the many potential food triggers from your child’s diet. Instead, if you find a connection between your child’s headaches and a certain type of food, then it’s reasonable to avoid that food. Make sure to talk about any diet changes with your child’s health care provider.

Q: How can I learn more about my child’s headaches?
A: If your child has headaches, it’s a good idea to record them in a headache diary. This may help you understand her symptoms better, see when the headaches happen, find causes and keep track of what provides relief. It’s also an easy way for you to share information with your child’s health care providers so they can better help your child.

Q: How can I help my child get relief from headaches?
A: There are many things you and your child may be able to do to prevent headaches or to relieve a headache that’s already happening, such as:

• resting in a quiet, dark room
• reducing stress
• avoiding known causes or “triggers,” such as foods that are associated with your child’s headaches
• getting regular physical activity
• getting regular sleep
• eating regular meals
• drinking enough fluids

Q: How are medications used to treat headaches?
A: You can use over-the-counter medications such as acetaminophen (Tylenol®) or ibuprofen (Motrin® or Advil®) or medications prescribed by your health care provider to help with your child’s headaches. These “acute” medications are most effective if they’re given at the start of a headache. Generally, your child shouldn’t take these more than twice a week.

It’s important to talk to your child’s health care provider about any medications you’re thinking about giving your child, particularly how much to use. It’s also useful to record any medications you give your child in her headache diary.

Your child’s doctor may also prescribe preventive, or “prophylactic,” medications to keep headaches from happening. Your doctor may recommend preventive medication if your child’s headaches are frequent or are interfering with her daily life or if you need to give her acute medications too often.

You can read more about headache medications on the Treatment & Care tab.                 

Q: Are there other treatments?
A: Yes. We’ve found that non-drug therapies can be extremely effective for treating headaches. The therapies our headache experts may recommend, depending on your child’s situation, include:

• relaxation training
• biofeedback
• psychological counseling
• physical therapy
• acupuncture
• Reiki
• massage therapy

You can read more about these therapies on the Treatment & Care tab.

Q: What if we don’t live close to Boston or one of the Children’s satellite locations?
A: If you come to Children’s for an evaluation but you live outside the Boston area, we will work with you to find professionals in your area who can provide the ongoing care your child needs.

When to seek medical advice

Red flags

If your child has any of these symptoms, contact your health care provider right away:

• a severe headache that happens suddenly
• headaches that wake your child up in the middle of the night
• headaches that happen when waking up in the morning
• headaches that happen more often than usual or are much worse than they used to be
• a headache that happens with a high fever or stiff neck
• a headache that happens after a head injury
• a headache that causes changes in vision, such as double vision
• a headache that’s associated with difficulties in walking, balance problems or confusion

If your child needs immediate care, your primary care provider may evaluate your child, send you to an emergency room or have you contact us, as appropriate.

Even if your child isn’t having any of these acute symptoms, it’s still important to talk with her primary care provider if headaches are disrupting her everyday life. Fortunately, most headaches in children don’t represent a serious underlying medical problem. But if your child is having frequent or debilitating headaches, the pain can hugely impact all aspects of her life, including school performance, social activities, sleep, mood, appetite and family interactions. So it’s worth talking with your child’s health care provider about how to help your child manage her headaches.

What you can do at home

Everyone’s headaches are different. Keeping a headache diary (pdf) can help you learn more about your child’s unique situation.

The diary can be used to:

• note dates of headaches
• note headache symptoms
• notice causes or “triggers” of the headaches
• find medications and other steps that will help your child

If you keep the diary consistently, in time you may be able to notice a pattern in your child’s headaches that could be very helpful in developing a plan of treatment.

Be sure to bring the diary with you to health care appointments. It can be a big help to your child’s doctor in diagnosing the problem and finding effective therapies.

If your child is young, you may want to work on the diary together. For teenagers, keeping the headache diary themselves can be a way for them to take charge of their headaches, with help from you.

Questions to ask your doctor

You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider and that you understand your provider’s recommendations.

If your child is having headaches and you’ve set up an appointment, you probably already have some ideas and questions on your mind. But at the appointment, it can be easy to forget the questions you wanted to ask. It’s often helpful to jot them down ahead of time so that you can leave the appointment feeling like you have the information you need.

If your child is old enough, you may want to suggest that she write down what she wants to ask her health care provider, too.

Some of the questions you may want to ask include:

• What type of headaches is my child having?
• What seems to be causing them?
• Does my child need any further testing to find the cause of her headaches?
• What can our family do to try to prevent them?
• The next time my child gets a headache, what can we do to ease the pain?
• Are there other treatments we should consider?
• If medications are prescribed: How much should I give my child? How often?
• Are there any symptoms I should be on the lookout for? What do we do if my child has them?
• When does my child need to see you again?

If you’ve been keeping a headache diary, be sure to bring that with you to your appointment.

Complementary approaches

Our headache team at Children’s recognizes the valuable role that complementary therapies can play in caring for children and teens with headaches.

We’ve found that for some patients, acupuncture can be quite effective in helping to relieve headache pain. At Children’s, acupuncture is offered by our colleagues in the Medical Acupuncture Service.

Members of our headache team offer Reiki, a type of relaxation therapy in which a practitioner uses gentle touch to provide relaxation and healing. We may also recommend massage therapy if your child has muscle tension in her back and upper neck area.

If you’d like to learn more about complementary therapies, you may want to visit the website of the National Center for Complementary and Alternative Medicine, a part of the National Institutes of Health. The site includes in-depth information on a wide variety of techniques including acupuncture and Reiki.

If your child receives care from multiple providers, it’s important to tell each provider about any care she’s receiving elsewhere so that her care is well coordinated and safe. Also, tell your child’s health care providers about any steps you’re taking at home to relieve your child’s headaches, whether you’re using over-the-counter medications, lifestyle and diet changes or alternative therapies.

For teens

If you’re a teenager with really painful or chronic headaches, you’re not alone. Our team at Children’s cares for a lot of teenagers who have tension type headaches, migraines and other types of headaches.

It’s no exaggeration to say that you are the most crucial part of your own headache care team. You may want to start learning more about your symptoms by writing them down on your calendar or in a headache diary. This is also a good time to start working on healthy habits like getting enough sleep, eating balanced meals and drinking enough fluids, because those things may help you get fewer headaches or make them less severe.

Some of the therapies your doctor recommends may require work from you—such as taking medications or practicing relaxation techniques on your own. And if you’ve been out of school a lot because of chronic headaches, your doctor may recommend that you go back to school even if you’re still not feeling back to your usual self, because returning to your normal activities can help the recovery process.

You can learn more about the different types of therapy on the Treatment & Care tab. If you have questions about any part of your treatment, or if you aren’t doing the things your health care providers recommend, be open about that and discuss it with them.

A major goal of headache care is to help you take control of what’s happening in your body: You didn’t make your headaches start, but you may be able to help them stop.