Headaches are very common in children, but usually are not dangerous and do not disrupt their lives. However, in some children, headaches become severe or frequent. On rare occasion, they may be the symptom of an underlying disease. The Headache Clinic at the University of Michigan is designed to provide consultation services to help pediatricians and family practitioners in diagnosing and managing headaches. Our team of experts provides comprehensive, compassionate care for children of all ages. The Headache Clinic is part of the Pediatric Neurology service.
Children can have two categories of headaches:
- A primary headache is diagnosed when the headache is the primary problem, and once the headache is controlled, the problem has been solved. Most primary headaches in children are migraines or tension-type headaches (which many believe to be mild migraines).
- A secondary headache is diagnosed when the headache is due to an underlying condition. Both the headache and the other condition need to be addressed and treated. Some of these conditions are dangerous (such as brain tumors, bleeding in the brain, or meningitis), but these are very rare. Other common problems that can result in secondary headaches include viral illnesses, depression, sleep deprivation, and caffeine withdrawal.
Migraines can affect both sides of the head or just one side, sometimes going from one side to the other. Most are located in the forehead area, but they can also occur on the sides or back of the head. The severity of a migraine ranges widely and varies from headache to headache. A headache need not be severe to be a migraine. Many children with migraines have loss of appetite, nausea, and sometimes vomiting. Many are very sensitive to light and sound. In 80 to 90 percent of children with migraines, one or both parents also have or had migraines, though they often do not realize that their headaches are in fact migraines.
Some children have an aura associated with their migraine. An aura occurs when part of the brain does not function correctly on a temporary basis. This can occur before, during, or after the headache. Vision changes such as blurred vision, loss of vision (either seeing holes or completely losing vision), or seeing things that are not real (spots, sparkles, zigzag lines) are most common, but many children develop numbness or tingling, a sense of spinning, loss of balance, ringing in the ears, double vision, and even fainting as part of a migraine aura.
Some symptoms can be warnings of more dangerous conditions. If your child has any of these symptoms, contact your primary care provider right away:
- A headache that happens with a high fever or stiff neck
- Headaches that consistently wake your child up at night
- Headaches that most frequently happen immediately upon waking up in the morning
- A severe headache that happens extremely suddenly
- A headache that happens after a head injury
- A headache associated with difficulties in walking, balance problems, double vision, severe confusion, or fainting
If your child needs urgent evaluation and treatment, your primary care provider may evaluate your child, send you to an emergency room, or refer you to us, as appropriate.
Even if the symptoms above are not present, if your child’s headaches are worrisome to you or disrupting his or her life, discuss the headaches with your child’s primary care provider.
A first visit to our Headache Clinic includes a comprehensive evaluation, including a thorough patient history. Keeping a diary or calendar of the headaches and noting the dates of their occurrence and associated features is helpful. We will perform a physical examination on your child and review any prior medical records that you or the primary care doctor provides. We will discuss any other testing that may be needed to diagnose the cause of your child’s headaches. For the vast majority of children with migraines, CTs and MRIs are not needed. Finally, we will discuss individualized treatment options and follow-up plans.
Treatment of migraines can consist of:
- Avoiding things that provoke migraines (including inadequate sleep)
- Lifestyle changes
- Pain medications given to stop a migraine
- When appropriate, medications to be taken every day to prevent the migraines from occurring
- When appropriate, behavioral management of the headaches, including relaxation therapy and a technique known as biofeedback (by which children learn how to control body responses to reduce pain). For these treatments, we work closely with the pediatric psychologists in our department.
Scheduling Your Appointment
The Headache Clinic is a referral subspecialty clinic. This means that all new patients must have a referral from their primary physician. Depending on your insurance, you may need a referral for return visits as well. Fax your referral to 734-615-2298. Once we receive the referral, we will mail you a headache calendar and headache questionnaire. The questionnaire needs to be completed and returned to us before we can schedule your appointment. The calendar need not be mailed back; it should be filled out and brought to the appointment.
To make your visit as useful and productive as possible, we would like you to gather the following information in advance and bring it to the clinic appointment:
- For all scans of the brain (CT, MRI scans): Please bring actual copies on computer disk (if the tests were not done at the University of Michigan). You will need to contact the radiology department of the hospital or clinic where the test was done to obtain these copies.
- We also need to review medical records (related to neurological issues including headaches) before we schedule the appointment. Please ask your child’s doctor’s office to mail or fax them to us.