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Headaches - Primary Steps for Primary Care

Boy with headache

The start of the school year is just around the corner, and we frequently see an increase in calls regarding headaches around this time. We want to take this opportunity to review some basic steps in diagnosing and treating headaches. Nearly 10 percent of children have frequent or recurrent headaches. While this is a significant source of parental anxiety, the vast majority are benign and easily manageable by their primary care provider.

Tension type is the most common type of headache during childhood. Children report mild to moderate pain, usually do not have nausea or vomiting and they can typically continue normal activities.

Migraines are also quite common. The pain may be described as severe, throbbing and associated with nausea, vomiting, dizziness and sensitivity to light and sound. They may report visual changes before or during the headache, and they usually prefer to stop activities and lay down in a dark, quiet place.

Lifestyle modifications

The increase in headaches as the school year starts may be for a variety of reasons, many of which are treatable with lifestyle modifications:

  1. SLEEP: Children should aim for nine hours of sleep per night. The changing of schedule from summer to the school year can be difficult. Parents should instruct their child to start getting up at the time they will need to awake on school days for a few weeks prior to the start of the school year.
  2. HYDRATION: Many children don’t adequately hydrate, especially once the school year starts and opportunities for drinking water become limited. Children should drink water daily in a volume (fluid oz) equal to half their weight in pounds. They should also avoid caffeinated beverages.
  3. MEALS: Kids frequently begin skipping breakfast in a hurry to get ready for school each day. Others will skip lunch at school. It is important that children have three quality meals per day and avoid skipping meals. The meals should be balanced and contain protein to provide adequate energy.
  4. TREATMENT: Many children with recurrent headaches have medications they take at home, but don’t have treatment available to them at school. A school medication form for analgesic use should be completed with the appropriate dosing schedule. Parents should take this form and medication to the school nurse.
  5. STRESS: The start of the school year is stressful for children and their parents. Parents should encourage children to take time to relax and enjoy activities.
  6. EXERCISE: Encourage children to get daily periods of aerobic exercise through P.E. class, recess and playing outside when they get home from school.
  7. SCREEN TIME: With school comes more time on computer screens, in addition to the time kids spend on entertainment devices. Aim for at least 10 minutes of break time from screens each hour. Electronics should not be used after bedtime.

Helpful handouts from Cook Children's:

Lifestyle reminders for migraine patients
Sleep habit guidelines

Further investigation

While most headaches are benign, some symptoms warrant further investigation, including those that:

  1. Awaken a child from sleep
  2. Worsen with lying down or with toileting
  3. Are new or very severe
  4. Have a dramatic change from a previous pattern of headache
  5. Hurt always in the same location
  6. Cause clumsiness, focal weakness, change in personality or double vision
  7. Cause confusion or difficulty speaking
LEARN MORE: Recent abstract presentation on ketamine use for acute migraine treatment

If worrisome features are present, the primary care physician should consider ordering neuroimaging, preferably an MRI.

If a child needs analgesics consistently >three times per week in spite of adherence to lifestyle recommendations, he or she may be a good candidate for a neurology evaluation. The Cook Children’s Comprehensive Headache Program, led by Brian Ryals, M.D., offers a multifaceted approach to treatment, including medication, biofeedback, Botox and nerve blocks.

Comprehensive Headache Program
Dr. Brian Ryals

We're here to help.

If you would like to schedule an appointment, refer a patient or speak to our staff regarding your child's headaches, please call our offices at 682-885-2500.