There are many ways to help children get relief from headache pain. The headache experts at Boston Children's Hospital have found that the best approach is to use a variety of treatments—for example, medications along with a cognitive-behavioral approach, such as biofeedback.
We make it a priority to thoroughly discuss the treatment possibilities with you and your child. We want you to understand why we're recommending certain treatments, and we listen carefully to your ideas and preferences.
If you come to Children's for an evaluation but you live outside the Boston area, then at your appointment with us, we will work with you to find professionals in your area who can provide ongoing care. Whether it's at Children's or somewhere else, we will help your child get the treatment she needs.
Removing possible causes of headaches
Your health care provider will talk with you about steps that you and your child can take to change things that may be contributing to your child's pain. These include:
- avoiding known causes or “triggers,” such as certain foods that are associated with your child's headaches (see the In-Depth tab for more information on headache triggers)
- reducing stress
- reviewing your child's daily schedule
- getting regular physical activity
- getting enough sleep every night and sleeping on a regular schedule
- eating regular, balanced meals
- drinking enough fluids including water and electrolyte-containing drinks
Paying close attention to good health habits can often go a long way toward helping your child get relief from headaches.
There are a variety of medications that can be used to relieve headaches. Some vitamin and mineral supplements are also effective in treating headaches. Your child's health care provider will recommend medications based on the type of headaches your child is having, how often she gets headaches, how old she is and her overall health and medical history.
Medications that are taken to stop a headache are called acute or abortive medications. These include over-the-counter medications such as acetaminophen (Tylenol®) or ibuprofen (Motrin® or Advil®), as well as medications prescribed by your health care provider.
- These medications should be given right at the beginning of a headache, before it becomes too painful; they're less useful if a headache has already been going on for a long time.
- Generally, these medications (including over-the-counter pain relievers) should not be used more than twice a week. If taken more often, they may cause a “rebound” headache (also called an “overuse” headache), which can be more challenging to treat.
- These medications may be used regularly on a short-term basis to control a migraine or other headache.
- It's important to talk to your health care provider about how much of these medications your child should take and how often she can take them.
Keeping all medications recorded in your child's headache diary—including the name of the medication, dose, and the time your child took it—can be very useful. This information will allow your doctor to assess whether the medications are being used appropriately and suggest ways to make them more effective.
If your child's headaches are interfering with her daily life, or if the acute medications aren't working or have to be used too often, your child's doctor may prescribe preventive, or “prophylactic,” medications. These medications can make headaches happen less often or make them less severe. They are taken daily, whether or not your child has a headache.
Several different preventive medications are available. Our headache specialists at Children's will discuss the options with you, explain the benefits and risks of each of them, and ask you and your child about your preferences.
Don't be discouraged if a new medication doesn't work immediately. Most preventive medications need about two to four weeks to work. We typically start with a low dose of medication and increase it gradually. It's important to keep in touch with your child's doctor so we can make adjustments as needed to make the medication as effective as possible for your child.
Working to find the best medications for your child
Neurologists and pain management doctors at Children's do what it takes to find the best treatment plan for your child's unique situation. We work to stay abreast of the latest information on how different medications work in children and how safe they are. We also draw on our extensive experience in caring for children with headaches and make it a priority to try to minimize any negative side effects from treatment.
Our physicians will explain why we recommend certain medications for your child, how they work and possible side effects.
How we feel, what we think and what we do are all connected. Cognitive-behavioral therapy teaches children and teens how to use these links to reduce their headache pain.
Psychologists at Children's can help children master these skills. They can help your child learn:
- what causes her symptoms
- which skills will best help her cope with her symptoms
- how to identify negative thoughts that make her feel worse
- how to change negative thoughts into more helpful ones that make her feel better
- how to return to regular activity level and school attendance—which, for chronic headaches, can play an important role in reducing pain
When you're in pain, your body becomes “activated”—for example, your muscles can become tense and your heart rate may increase. These bodily responses to pain can, in turn, increase the body's sensation of pain. So learning skills to control your body can reduce pain.
A variety of relaxation exercises can help a child control her body's responses to pain. These techniques include:
- deep breathing
- muscle relaxation
- guided imagery
In guided imagery, the psychologist works with your child to help her imagine being in a place she really enjoys, like on vacation, at the beach or out with friends. The psychologist guides your child to fully imagine the experience of being there. Your child may take home an audio recording of the session so she can play it at home and practice imagining that favorite spot, so that she's ready to use the technique when she needs to manage stress or pain.
Biofeedback is a type of relaxation therapy. It uses electronic instruments to give your child immediate feedback about what effect the relaxation exercises are having on her body. It is performed by psychologists or social workers with specialized training.
We're all familiar with two of the simplest “biofeedback” instruments: the scale and the thermometer. If the scale shows that you've gained weight, you might decide to improve your diet and exercise; if the thermometer shows that you have a fever, you might take medicine or drink more fluids to lower your temperature. Biofeedback therapy is similar: It shows your child what her body is doing in order to help her learn to control how her body reacts to stress and pain.
When we are stressed, our bodies may undergo a number of different changes. For example:
- breathing gets faster
- muscles get tense
- body temperature drops
These bodily responses can contribute to the experience of pain. Biofeedback uses instruments to give your child immediate information about these problematic changes in her body.
During a biofeedback training session, sensors are placed on your child's skin to measure these body functions. No needles are involved, and the sensors do not cause any discomfort. A computer converts the information into sounds and images on the screen (a lot like a video game!) so your child can see how her body is working. By being able to see negative changes in her body, your child can learn how to reverse them.
The psychologist teaches your child a variety of techniques—including the relaxation techniques discussed above—to reverse the body changes that the machines are showing. Once your child learns to control her body's responses with the help of feedback from the instruments, she can learn to do it on her own, any time. The goal is to help your child be in control of her body's responses so she can manage her headache pain.
Headaches can often be made worse by a child's emotional stress. The psychologists on our headache care team at Children's can provide psychological counseling to help your child learn to cope with stress.
In some cases, such as when muscle tension in the head and neck is contributing to a child's headaches, physical therapy can help. If physical therapy is appropriate for your child, our headache care team can refer you to physical therapists at Children's or in your area.
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 very effective in relieving headache pain. At Children's, acupuncture is offered by our colleagues in the Medical Acupuncture Service.
Reiki and massage therapy
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 on the neck and upper back if your child has muscle tension in that 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.
Coping and support
We understand that if your child is having headaches, you may have a lot of questions. Why is this happening? How can I help my child? How are we going to navigate the course of treatment? We've tried to provide some answers in these pages, and our team at Children's will take time to talk with you and discuss your questions.
There are also a variety of resources available to families at Children's that may be helpful to you:
Patient education: Our nurses will be on hand to walk you through your child's treatment and help answer any questions you may have.
Parent to parent: Want to talk with someone whose child has been treated for headaches? We can often put you in touch with other families who have been down a similar road and can share their experience.
Social work and mental health professionals: Our social workers and mental health clinicians have helped many other families in your situation. We can offer counseling and assistance with issues such as coping with your child's condition, dealing with financial difficulties and arranging transportation.
On the Children's For Patients and Families site, you can read all about:
- getting to Children's
- navigating the hospital experience
- resources that are available to your family