KidsMD Health Topics

Headaches

  • Overview

    I can't tell you how thrilled I am. It's like I have a new daughter, seeing her go from where she was last year to where she is now. Nothing has given me greater happiness.

    - Mom of an 11-year-old patient in the Boston Children's Headache Program

    Many children experience headaches at some point. Most have headaches only occasionally, but sometimes children have frequent headaches that disrupt their regular daily lives.

    Headaches have many different causes. They’re generally divided into two categories—primary headaches and secondary headaches. Secondary headaches are caused by another medical condition. The primary headaches that children and adolescents experience are most often migraine and tension type headaches.

    • Most headaches don’t represent a serious underlying medical condition.
    • The pain is generally the result of muscle tension, expanded blood vessels in the head and temporary changes in brain chemistry.
    • Many things can trigger headaches, including dehydration, skipping meals, changes in the weather, stress and irregular sleep schedules.
    • Sometimes, headaches are caused by other medical problems. Parents often worry that their child’s headaches may be caused by a brain tumor, but this is very rare.
    • If you are concerned about your child’s headaches, or if the headaches are interfering with your child’s life, talk to your child’s primary care provider. 

    How Boston Children’s Hospital approaches headaches

    If a child or teenager suffers from frequent or disabling headaches, the pain can have a big impact on her life and her whole family.

    Our specialists at Boston Children’s Hospital have great expertise in diagnosing and treating children’s headaches. We take a comprehensive approach to caring for our patients. Our team includes child neurologists, pain management specialists, psychologists and complementary care providers. We offer a wide variety of treatments and therapies including:

    • medications
    • cognitive-behavioral therapies including biofeedback
    • psychological counseling
    • physical therapy
    • complementary therapies including acupuncture

    We also work with your family to identify anything that may be triggering your child’s headaches—like stress, dehydration or certain foods. Understanding these triggers may help you and your child take steps to prevent or manage the headaches.

    Children with headache problems are evaluated in our Headache Program. If your child has chronic, hard-to-manage headaches, we may also refer her to our multi-disciplinary headache clinic.

    At every step, we take the time to understand your child’s condition, talk with you about our recommendations and answer your questions. We also coordinate care with your child’s primary care provider.

    Our headache specialists see patients not only in Boston but also in Waltham, Lexington, Peabody and Weymouth. The multi-disciplinary headache clinic is in Waltham. We schedule new and urgent patients as soon as possible in the most appropriate office.

    If you live outside the Boston area and it’s hard for you to come to Boston Children’s for follow-up visits, we’ll help you find health care professionals in your area who can provide ongoing care. Whether it’s here at Boston Children’s or somewhere else, we will help your child get the treatment she needs.

     

    Preventing concussions in high school sports

    As kids start training for fall contact team sports, preventing concussions is an increasingly important topic. Watch Boston Children’s Dr. William Meehan give a TV interview on how to prevent concussions.

    Headache diary

    Everyone’s headaches are different. Keeping a headache diary may help you learn more about your child’s situation and enable her doctor to help more effectively. You can download a headache diary at What you can do at home.

    Headaches: Reviewed by Anna Minster, MD, and Alyssa LeBel, MD
    © Boston Children’s Hospital, 2010

  • In depth text

  • Tests

    If your child is having headaches, one of the first things you’ll want to do is to get a solid understanding of her symptoms. Recording her headaches in a headache diary can help you see exactly how often they’re happening, understand your child’s symptoms better and notice possible causes or “triggers.” A record like this is also a good way for you to share information with your child’s health care providers.

    In order to diagnose your child’s type of headaches, find the cause and recommend treatment, your child’s doctor will review her medical history, talk with you and your child about the symptoms and perform a physical and neurological exam. Questions that your doctor may ask include:

    • When do the headaches happen?
    • Where exactly does it hurt?
    • What do the headaches feel like, and how long do they last?
    • How are the headaches impacting your child’s life?
    • Is she having balance problems?
    • Does your child have other symptoms when she gets a headache, such as sensitivity to light or noise, nausea, dizziness or changes in vision?
    • What have you already done to try to relieve the headaches? How has it worked?
    • If you used medication, how much did you give your child? How long after a headache started did she take the medication?
    • Have you noticed anything that seems to cause her headaches?
    • Has your child been under a lot of stress or been having problems in school?
    • Has she been having other medical problems or been injured?
    • Has she been taking other medications unrelated to the headaches?
    • Have the headaches changed recently?
    • Has anyone else in your family had headaches? Has anyone in your family had other neurological problems?

    If your child’s symptoms indicate that her headaches are “primary” headaches (migraine, tension or cluster headaches), and if her neurological exam is normal, no further diagnostic testing may be needed.

    Our neurologists at Boston Children’s Hospital will obtain a detailed history and perform a careful exam to determine whether your child’s headaches could be caused by another medical problem. If needed, your child’s doctor may order diagnostic tests including:

    • blood tests
    • brain imaging scans

    Our headache team will spend time talking with you and learning possible causes of your child’s headache pain. With your permission, we can also speak with your other health care providers or your child’s school to help us assess the situation.

  • 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 Boston 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 Boston 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.

    Medications

    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.

    Acute treatment

    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.

    Preventive treatment

    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 Boston 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 Boston 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.

    Cognitive-behavioral therapy

    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 Boston 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

    Relaxation training

    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

    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.

    Psychological counseling

    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.

    Physical therapy

    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 Boston Children's or in your area.

    Complementary therapies

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

    Acupuncture

    We've found that for some patients, acupuncture can be very effective in relieving headache pain. At Boston 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 Boston Children's will take time to talk with you and discuss your questions.

    There are also a variety of resources available to families at Boston 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 Boston Children's For Patients and Families site, you can read all about:

    • getting to Boston Children's
    • accommodations
    • navigating the hospital experience
    • resources that are available to your family
    Boston Children's Neurology ranked #1

    Boston Children's has been ranked #1 in Neurology and Neurosurgery by U.S. News & World Report in their 2014-15 rankings of pediatric hospitals. Get all the details on the U.S. News website.

  • Research & Innovation

    Working with your primary care provider

    Since a patient may receive headache care from her pediatrician or with a neurologist, coordinating care can be a challenge. Neurologists at Boston Children’s Hospital work to develop effective plans of care for our patients and families and partner with primary care physicians so that together we can provide the best care possible.

    In order to make this collaboration even more effective, neurologists from Boston Children’s and primary care physicians from Harvard Vanguard Medical Associates (HVMA) have come together to develop new ways of working together. Our new team approach allows children to receive a larger portion of their ongoing headache care from their pediatricians, strengthening their connection with their primary care providers and providing for more comprehensive, well-coordinated care. This approach should also shorten wait times for appointments in the Children’s Neurology department and lower medical costs for families. Together with our partners at HVMA, we aim to deliver family-centered care to our patients in the most appropriate setting.

    We look forward to expanding this collaborative model to include other primary care provider groups, as well. We know that when we work closely with primary care doctors, it benefits our patients.

    Improving headache care through research

    There is a lot still to be learned about children’s headaches. So headache specialists at Boston Children’s are engaged in research to learn more about how headaches happen, their effects and how to best treat them.

    Boston Children’s neurologist and pain management specialist Alyssa LeBel, MD, and her colleagues are using a type of brain scan called functional magnetic resonance imaging (fMRI) to study how the brain activity of children and teens with migraines is different from the brain activity of kids who don’t have migraines. This information may lead to a better understanding of migraines—and, we hope, better treatments for them.

    Boston Children’s physicians and psychologists are also studying how effective non-drug therapies, such as biofeedback, are for children with chronic headaches including migraines. Research like this can help to improve treatment protocols for children with headaches—both at Boston Children’s and at other institutions.

    Clinical Innovation: Working together to improve headache care

    We value our interactions with our patients' primary care providers and are eager to make coordination and reporting of care as productive as possible. 

    In 2009, a group of specialists from Boston Children's Hospital, including Scott L. Pomeroy, MD, PhD, neurologist-in-chief, and Richard C. Antonelli, MD, MS, medical director for integrated care, sat down with primary care providers from Harvard Vanguard Medical Associates to develop new strategies of collaboration for the care of our patients. Drawing on feedback from patient families, we designed new, coordinated systems for PCPs and sub-specialists to work together.

    • Our neurologists provide information and support to primary care physicians assessing their patients for headaches. As needed, neurologists provide guidance to primary care doctors to ensure their patients see a neurologist for further evaluation when necessary and help determine what imaging might be most appropriate for individual patients on a case-by-case basis.
    • Whenever a child is seen in the Department of Neurology, we quickly report our findings and recommendations back to the referring provider so she can continue to coordinate care for her patients.
    • We support ongoing communication between neurologists and primary care providers, strengthening connections with pediatricians and providing for more comprehensive and convenient coordination of care.

    We look forward to expanding this collaborative model to include other primary care provider groups, as well.

     

    Clinical trials
    Find out more about the innovative clinical trials available at Boston Children’s.
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