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Headaches

Did you know that headaches are a common problem in children and adolescents? Or that headaches are generally more common in girls than boys, especially after puberty?

Kids, like adults, are prone to headaches. Depending on the cause, some types of headaches can disrupt a child's daily activities. Fortunately, the Headache Program team at Cook Children's is here to offer relief.

Most headaches in children are not the result of a serious illness. However, if your child's headache seems out of the ordinary, involves a high level of pain or occurs frequently, headaches could be a sign that something's wrong. If your child's headache symptoms include the following seek prompt medical attention:

  • One or more headaches per week
  • Are accompanied by dizziness or vomiting
  • Include a high fever with neck pain and/or stiffness
  • Are the result of head trauma

What causes headaches?

Headaches are thought to be caused by changes in chemicals, nerves, or blood vessels in the area. These changes send pain messages to the brain and bring on a headache. Some of the many potential headache triggers include:

  • Certain medications (headaches are a potential side effect of some)
  • Too little sleep or sudden changes in sleep patterns
  • Skipping meals
  • Becoming dehydrated
  • Being under a lot of stress
  • Having a minor head injury
  • Using the computer or watching TV for a long time
  • Vision problems
  • Menstruation and/or ovulation
  • Experiencing changes in hormone levels
  • Taking a long trip in a car or bus
  • Listening to really loud music
  • Smoking
  • Smelling strong odors such as perfume, smoke, fumes, or a new car or carpet
  • Drinking or eating too much caffeine (in soda, coffee, tea, and chocolate)
  • Consuming certain foods (such as alcohol, cheese, nuts, pizza, chocolate, ice cream, fatty or fried food, lunchmeats, hot dogs, yogurt, aspartame, or anything with the food additive MSG)

Those caused by infectious illnesses, such as a cold, flu, ear or sinus infection and strep throat are the most common and usually disappear as the illness runs its course. They can also be the result of more serious infections such as meningitis, but in most cases these infections will be accompanied by other symptoms such as high fever, neck pain and/or stiffness in the neck.

Most head injuries are minor but they can still cause a headache. However, if your child falls and hits their head or is hit on the head, or if your child's headache continues to get worse after a head injury, contact your pediatrician or family doctor to rule any serious injury.

Migraine may be chronic and can interrupt a child's life. In many cases, migraine is hereditary, or genetic, and tends to run in families. Migraine pain can last anywhere from a few hours to a few days.

Tension headaches can be brought by anxiety or other emotional stressors including peer pressure or bullying, test taking or problems at school with teachers or due to learning issues, as well as problems at home with parents or other family members.

Food allergies or sensitivities can trigger headaches. Many children and adults react to food preservatives and additives, as well as the caffeine contained in many foods.

More serious causes of headaches are brain tumors, aneurysms, abscesses or bleeding in the brain. Often times these types of headaches will include other symptoms such as vision problems and dizziness. Some children with brain conditions may also have trouble with balance, coordination, speech and other motor skills.

When is it more than a headache?

Although rare, headaches can signal a more serious neurological disorder or disease such as aneurysms or stroke, brain tumors, high or low blood sugar even Lyme disease or arthritis. A neurological disorder or condition may be considered if your child has any symptoms such as these:

  • Nausea or vomiting
  • Weakness
  • Dizziness
  • Loss of balance
  • Numbness or tingling
  • Paralysis
  • Speech difficulties
  • Mental confusion
  • Seizures
  • Loss of consciousness
  • Personality change/change in behavior
  • Vision changes
  • Sluggishness or sleeping too much

Our goal is to help patients determine the cause of their headaches and help them manage their pain so they can resume their normal daily activities.

What is a migraine?

Migraine is a chronic neurological disorder characterized by moderate to severe headaches. In children and adolescents migraine pain can affect the front or both sides of the head. A migraine headache can also include nausea, vomiting and sensitivity to light and sound. Migraine episodes can last from a couple of hours to a few days. The frequency of migraines and migraine episodes can vary a great deal depending on the person.

Common symptoms of migraines

Often triggered by things like stress, sleep deprivation, and menstruation, migraines are complex and there are many symptoms. During a migraine, the patient may experience one or more symptoms. The following is a list of the most common symptoms:

  • Pounding, throbbing pain or dull, steady pain on one or both sides of the head
  • Dizziness
  • Stomachaches
  • Nausea and/or vomiting
  • Seeing spots or halos
  • Sensitivity to light, noise, and/or smells
  • Most migraines last anywhere from 30 minutes to several hours. Some can last as long as a couple of days.
  • Nausea and upset stomach
  • Loss of appetite
  • Fatigue
  • Blurred vision
  • Sensation of being warm or cold

For some people with migraines:

  • Light, smell, or sound may bother them or make them feel worse.
  • Sometimes, if they try to continue with their usual routine after the migraine starts, they may become nauseated and vomit.
  • Trying to perform physical activities can make the pain worse.
  • get auras, a kind of warning that a migraine is on the way (usually about 10 to 30 minutes before the start of a migraine). The auras may only be seen in one eye. Common auras include blurred vision, seeing spots, jagged lines, or flashing lights, or smelling a certain odor.
  • They may experience a migraine premonition hours to days prior to the actual headache. This is slightly different from auras and may cause cravings for different foods, thirst, irritability, or feelings of intense energy.
  • Muscle weakness occurs causing them to lose their sense of coordination, or stumble

Unfortunately, parents of an infant or toddler who are unable to say what hurts may not be able to tell if their little one is having migraines. Young kids with headaches may be cranky, less active, may vomit, or look pale or flushed.

Migraine variants that are thought to happen only to kids and are precursors to the more common migraines of adulthood include paroxysmal vertigo and cyclic vomiting.

Paroxysmal vertigo is described as a sensation of spinning or whirling that comes on suddenly and disappears in a matter of minutes. Kids who experience this may momentarily appear frightened and unsteady, or unable to walk. The vertigo typically goes away by the time a child is 5 years old.

Cyclic vomiting also occurs in young kids and involves repeated episodes of vomiting. The episodes can last for hours or days and are not usually associated with headache. Cyclic vomiting usually goes away by the time kids grow into teens.

Migraine triggers

There is much to be learned about the cause of migraines. And while we aren't sure as to why, we do know that certain things can trigger them. Common migraine triggers include:

  • Emotional stress
  • Caffeine
  • Medications
  • Ovulation or menstruation
  • Changes in eating patterns
  • Weather changes
  • Sensitivity to chemicals or preservatives in foods

Knowing these triggers can help you and your child identify any that may contribute to your child's migraines and thus avoid certain triggers and talk with your doctor about treatment and preventive measures for those that can't be avoided such as weather changes, ovulation, menstruation or other hormonal changes that occur in children, teens and young adults.

Testing and diagnosis

If your child's pediatrician is concerned about your child's headaches or feels the symptoms may signal a more serious issue, he or she will refer you to a pediatric neurologist for testing and diagnosis. Prior to your appointment, your doctor may also ask you to keep a log of your child's headaches and symptoms including, when they occur, how often, how long the last, and any activities, foods, or life events that may have occurred just before the headache began.

The Cook Children's neurological team will review your child's medical history, perform a physical examination and medical testing to determine the cause of your child's headaches and any accompanying symptoms.

Medical history

Your neurological specialist will ask questions about your child's medical history, as well as your family's medical history. If you and/or your child have been keeping a headache log, your doctor will go over that with you also. He or she will also ask for a list of any medications your child may be taking: prescriptions, vitamins, herbal medications, supplements and any over-the-counter medications such as aspirin or other pain relievers, decongestants, antihistamines, etc.

Physical exam

The doctor will perform a physical examination, checking height, weight, blood pressure and pulse. He or she will also examine your child's eyes, neck, head, shoulders and spine.

Testing

Depending on your child's symptoms, the doctor may perform certain neurological testing which may include:

  • Computerized tomography (CT) scan to create cross-sectional images of your child's brain in order to detect possible tumors, blockages, blood leakage, infection or swelling in the brain
  • MRI is a powerful tool that let's doctors detect tumors, aneurysms and stroke as well as see detailed images of the blood vessels in your child's brain.

Lumbar puncture, or spinal tap, is a common medical test that involves taking a small sample of cerebrospinal fluid (CSF) to detect or rule out suspected viral or bacterial infections in your child's brain and central nervous system.

How are headaches treated?

We partner with the patient to provide a treatment plan that includes knowledge, understanding, and tools to manage their pain and return to an active life. Each patient is seen by a neurologist who specializes in diagnosing and managing headaches. Based on your child's diagnosis, treatment may include:

We also coordinate our patient's treatment plan with their primary care provider.

We're here to help.

If your child has been diagnosed, you probably have lots of questions. We can help. If you would like to schedule an appointment, refer a patient or speak to our staff, please call our offices at 682-885-2500.