What’s Causing your Child’s Headaches?

By Dr. Nancy Shan, pediatric resident at CHOC Children’s

Headache complaints can be bewildering and frightening to many parents. Most are caused by a benign (simple) problem or primary headache disorder. Very rarely are headaches a sign of a serious underlying condition. Headaches are more common in boys than girls under 7 years of age, but the gender prevalence changes around puberty.

Headaches are often referred to as either primary or secondary. Primary headache disorders include migraines, tension headaches and chronic headaches. Tension headaches are the most commonly diagnosed type in children. Chronic daily headaches are defined as at least 15 days of headache in one month.

Secondary headaches are those caused by an underlying medical issue. Of children who are seen in the emergency department for headaches, the most common culprit is an acute febrile illness, like the common cold, the flu, or sinusitis. Typically, these headaches will go away when the illness resolves. Rare causes of secondary headaches occur when there is elevated pressure in the brain, which can be due to increased cerebrospinal fluid (CSF), a space occupying process (infections and brain tumors), pseudotumor cerebri, and low intracranial pressure (from leakage of CSF). Medication overuse headaches are due to excess use of medication to manage headaches. It is recommended that patients use medications such as ibuprofen or acetaminophen no more than three times per week to help prevent overuse headaches.

Children with uncorrected vision can experience headaches due to prolonged eye strain. After age 6, children with vision screens worse than 20/30 should be referred to an optometrist, who can conduct an evaluation to see if the child requires glasses. If it is recommended that your child wears glasses, make sure they do so regularly!

Other possible causes of recurrent headaches are listed below, and can be remembered with the mnemonic “SMART,” which was created by pediatric neurologist Dr. Heidi Blume:

  • S is for sleep. Not enough sleep and too much sleep (or any disruption to a regular sleep schedule) can cause headaches. Children in school should get between 8-10 hours of sleep every night
  • M is for meals and eating at least three full meals a day. As children get older and school starts earlier, many begin to skip breakfast. If there is no time for a sit-down breakfast, having a granola bar, a cup of yogurt or even some fruit on the go is better than nothing. Hydration is also important. A simple way to check hydration is to look at urine color: it should be clear.
  • A is for activity, and believe it or not, too little or too much activity can lead to headaches, although typically it is the former that ails children. Children should be getting at least one hour of physical activity (outside of school regulated gym class) every day.
  • R is for relaxation. High schoolers begin to experience an exponential amount of stress from schoolwork, peer pressure, and post-high school planning.
  • T is for avoiding any known triggers, which can be specific foods, smells or environments.

Typically, the cause of headaches will not be found at the initial doctor’s visit. After a careful history and a thorough physical exam to exclude any causes of secondary headaches, children and families are encouraged to keep a headache diary. Entries should be as specific and descriptive as possible regarding each headache episode.  The diary should then be brought to follow-up appointments, usually within 2-3 weeks of the initial examination. Between visits, patients are encouraged to use the “SMART” mnemonic to optimize their daily routines.

Related articles:

  • Migranes: Not Just an Adult Ailment
    Think only grown-ups get migraines? Think again. This painful neurological condition is also common among children. In fact, one in 20 children – or about 8 million children nationwide – experience ...
  • Kids and Headaches
    Headaches in children are not uncommon. Learn what to do if your child has a headache and how to establish good habits that can help keep headaches at bay.

Migranes: Not Just an Adult Ailment

Think only grown-ups get migraines? Think again. This painful neurological condition is also common among children.

In fact, one in 20 children – or about 8 million children nationwide – experience migraine headaches. While migraines may be very painful, the good news is that kids can take steps to help prevent the ache.

Dr. Sharief Taraman, a CHOC Children’s neurologist, explains a migraine’s symptoms and causes, treatment methods, and what patients and their families can do to minimize migraines.

Head pain, other symptoms
Migraines are a specific type of headache, Dr. Taraman says. Sufferers endure throbbing, pulsating or pounding pain, either on one side of the head or both. Migraines may also impose a host of other symptom:

• Abdominal discomfort
• Nausea and/or vomiting
• Light sensitivity
• Noise sensitivity
• Dizziness or lightheadedness

But even with these symptoms, it might not always be clear that a child is suffering from a migraine because symptoms are often disconnected in children, Dr. Taraman says. For example, a child might have a stomachache but no headache, or perhaps light sensitivity but no nausea.

Children also might have difficulty expressing what exactly is bothering them, he explains. Parents should work with children to help them describe their symptoms and keep a close eye on behaviors. For example, a child might seek out a dark, quiet room but not specifically complain that lights or noises are bothering them.

The trigger factor

Migraines start when blood vessels in the brain constrict. This limits the amount of blood and oxygen flowing into the brain, which causes other blood vessels to expand. These dilating blood vessels become inflamed and result in a pounding headache or the other associated symptoms.

Certain environmental factors can often trigger migraines and the causes can differ among sufferers.

Triggers vary, but they can be linked to diet, hormones or even too much screen time, Dr. Taraman says. Common edible migraine culprits include chocolate, cheeses, and foods treated with nitrates, like lunch meat and pepperoni.

Dr. Taraman recommends that children keep a diary to help uncover migraine triggers. Document when migraines occur and what the child ate, did or experienced in the days prior. Be sure to build in some extra time: Often a certain food or behavior might lead to a migraine the next day.

Migraine diagnosis, treatment
There’s no blood test that can diagnose migraines and imaging is seldom needed, Dr. Taraman says. Instead, physicians rely on a physical examination and family history.

“Family history is huge,” he says. “Migraines run in families.”

Once a child knows he or she is experiencing migraines, over-the-counter pain relievers can help dull the ache. However, Dr. Taraman reminds parents to follow directions and avoid overuse.

Overusing over-the-counter pain relievers, more than twice a month, can result in “rebound headaches,” or head pain that develops even more intensely after medication wears off.

Finding a dark, quiet place to rest can help a child battle a migraine, as can warm or cold compresses, Dr. Taraman says. However, each person responds to temperature differently, so families can experiment with warmth or cold to see what method works best for their child, he advises.

Parents of chronic migraine sufferers should alert their child’s teacher and school nurse to the condition. The school, parents and child can work together to ensure that the student can leave class if necessary and find a quiet place to rest until the pain subsides.

Finally, if a headache is ever accompanied by weakness or numbness in one side of the body or slurred speech, parents should take the child to the emergency department immediately, Dr. Taraman cautions. This could be a symptom of stroke, which do occur in children.

‘Headache hygiene’ aids prevention
Because environmental factors can trigger migraines, kids can take measures to help keep migraines at bay, Dr. Taraman says. After keeping a diary and determining trigger foods or behaviors, avoiding these red flags can help tremendously.

In addition, general healthy habits can also stave off migraines. These steps are part of good “headache hygiene.”

• Get enough sleep
• Eat a balanced diet
• Stay properly hydrated
• Cope with stress
• Get plenty of exercise

Learn more about CHOC Children’s Neuroscience Institute.

More articles about headaches:

  • What’s Causing your Child’s Headaches?
    By Dr. Nancy Shan, pediatric resident at CHOC Children’s Headache complaints can be bewildering and frightening to many parents. Most are caused by a benign (simple) problem or primary headache disorder. ...
  • Kids and Headaches
    Headaches in children are not uncommon. Learn what to do if your child has a headache and how to establish good habits that can help keep headaches at bay.

Kids and Headaches

girl_headacheWHAT IS A HEADACHE?

A headache is pain or discomfort in the head or face area. It can be acute (sudden) or chronic (recurrent). “For a child with an acute headache, you want to make sure there are no other problems that need to be addressed, such as an infection,” says Fernandez. If a child has chronic headaches, but their neurological (nervous system) exams are normal, migraines may be the problem.

MORE ABOUT MIGRAINES

Although there are no blood tests to determine if a child has a migraine, family history usually helps physicians pinpoint the diagnosis. Migraines can be brought on by food triggers, such as chocolate, cheeses and foods with preservatives such as nitrates. Nitrates can be found in favorite childhood foods including hot dogs and bologna, says Fernandez. Environmental elements including glare and sun exposure can also set them in motion. So how can you tell if your child has a migraine? Pay attention to these common symptoms:

  • Abdominal discomfort
  • Nausea and/or vomiting
  • Pain on one or both sides of the head
  • Facial pallor (paleness) during headache
  • Relief of headache pain with sleep

PAIN RELIEVERS

Responding quickly is key to treating headaches and migraines. Over-the-counter pain relievers such as ibuprofen should be taken right away. “If you wait too long, nothing is going to help,” says Dr. Fernandez. Letting your child rest in a dark room or applying cold compresses are other ways parents can help ease the pain.

How can children practice proper headache hygiene?

Establishing good habits can help keep headaches at bay. These headache hygiene measures can help:

  • Regulate your child’s sleep
  • Find ways to help them cope with stress
  • Avoid triggers
  • Eat nutritious meals consistently
  • Drink at least 8 glasses of fluid per day for adequate fluid intake
  • Exercise at least 5 times per week for 30 minutes or more. This can help with stress and depression as well.

FAST FACTS

  • When tension headaches occur most often: 9-12 Years Old
  • When migraines may start: 5-8 Years Old
  • When cluster headaches usually start: 10 Years Old

View the full feature on Kids and Headaches

Dr. Amanda N. Fernandez
Dr. Amanda N. Fernandez
CHOC Neuroscience Institute

PHYSICIAN FOCUS: DR. AMANDA N. FERNANDEZ

Dr. Fernandez completed her pediatric residency at Kings County Hospital in Brooklyn, NY and her fellowship in Pediatric Neurology at the University of Miami/Jackson Memorial Medical Center. She is a member of the American Academy of Neurology, American Epilepsy Society and the Child Neurology Society.

Dr. Fernandez’s philosophy of care: “My philosophy is family-centered; looking at the child’s whole picture of health. It’s not just treating the pain or headache, but understanding the other psycho-social reasons for their pain.”

EDUCATION:
University of the East, Ramon Magsaysay Memorial Medical Center, Philippines

BOARD CERTIFICATIONS:
Pediatrics and Child Neurology

More about Dr. Fernandez | More about the CHOC Neuroscience Institute

This article was featured in the Orange County Register on September 9, 2013 and was written by Shaleek Wilson.