Headaches

Headaches in children are very common, with 20 percent of kids—preschoolers through teenagers— reporting frequent or severe headaches each year. They are more common in children who have family members with headaches. Headaches can impact quality of life including school attendance, school performance, and ability to play or socialize.

Most of the time, headaches can be managed at home.  In rare cases, chronic headaches that interfere with activities of daily living for your child may require a referral to a pediatric neurologist.

What causes headaches?

There are many different causes of headaches in children. Fortunately, most headaches are not caused by anything serious. Some common causes include:

• Most of the time, chronic headaches are migraines
• 90 percent of sporadic (not migraine) headaches are caused by a viral upper respiratory tract infection or sinus infection and will go away with time
• Head trauma or concussion
• Medication side-effects (including using pain-relieving medication too frequently)
• Very rare possibilities include tumors or nervous system infections 

What are the symptoms of migraine?

• Can affect one or both sides of the head
• Frequently occurs with nausea, vomiting, dizziness, blurred vision, sensitivity to noise or light, and can last one hour to more than one day
• Can be accompanied by an “aura,” which has temporary symptoms that can precede headache symptoms including spots, lights, lines, or blind spots in vision, difficulty moving or with balance, or tingling of a body part.
• Stress, mood changes, dehydration, and lack of sufficient sleep may contribute to headaches

What is different about headaches in children than adults?

• Young children may not be able to tell you where it hurts. They may rock, cry, or hide.
• Migraines can look like other problems in children. Sometimes, vomiting or arm pain may actually be migraines.
• Attacks of dizziness in younger children without head pain can be migraines, called Benign Paroxysmal Vertigo of Childhood
• Changes in perceiving the size of body parts, such that they appear bigger or smaller, may be a migraine variant called Alice in Wonderland Syndrome

How do I treat my child’s headaches? 

• Try having your child lie down in a dark, quiet room with a cool or warm compress
• Tylenol or Motrin are first-line headache medications
• Give pain medication as soon as a headache develops, as long as appropriately limited. Pain medications are most likely to work when given early in the course of a headache.
• If ineffective, talk to your doctor to make sure you are using the right dose
• Know that narcotic medication (e.g. Norco, morphine) is NOT recommended for headaches
• See your doctor if your child frequently requires more than two doses per week. Using Tylenol or Motrin too often can cause an “overuse headache.”  
• Frequent headaches more than 2–3 times per week on average may be helped by a daily preventative prescription medication or supplement.
• Frequent headaches can be prevented by a daily supplement of magnesium oxide and/or riboflavin (vitamin B2). Doses are 200mg per day for children and 400mg per day for adolescents and adults, usually divided into two daily dosages. MigreLeif is a combination supplement available online that also contains a natural analgesic feverfew. 
• The supplements are very well tolerated. The most common side effect of magnesium is diarrhea or upset stomach, and riboflavin can turn urine a bright yellow color.
• Migraines usually won’t get better with medications alone. Treatment depends on reducing triggers, reducing stress or helping your child improve how he or she copes with stress or pain.
• Encourage daily exercise, plenty of fluids, good nutrition, and a consistent bedtime schedule with a good night’s rest.
• Meals: Do not skip meals, including breakfast. Carry snacks
• Sleep: Set consistent bed and wake times, even on weekends, aiming for the same amount of sleep each night (the goal is 9–10 hours in most kids and adolescents); avoid night awakenings; restrict food and fluids a few hours prior to bedtime; read or relax prior to sleep with a set bedtime routine; avoid television in the bedroom
• Start a headache journal, and look for patterns while avoiding these common headache triggers:

• It is important for children not to miss school because of chronic headaches. If needed, your child can go to the nurse’s office for 15 minutes once a day. He or she may use earplugs or sunglasses if sensitive to sound or light.
• Relaxation therapy
• See a psychologist for help with progressive muscle relaxation, breathing exercises, visualization techniques, and biofeedback
• If depression exists alongside headaches, treatment of depression is important to in treating headaches

When should I worry about my child’s headaches?

• Headaches that are accompanied by other symptoms such as seizures, weakness, balance difficulties, personality changes, or other problems affecting the nervous system
• Headaches that awaken your child in the middle of the night or headaches when your child first wakes up
• Pain that worsens when lying down, coughing, urinating, or passing a bowel movement
• Headaches that do not improve with pain medication
• Increase beyond expected in the size of your child’s head
• New headaches in a young child (< 6 years)
• Neck stiffness and/or fever that accompanies a headache may be concerning for meningitis
• Very severe or unusual type of headache
• Rapid increase in frequency of headaches
• Severe headache in a child with other health conditions such as bleeding disorders, immune system problems, cancers, or high blood pressure
• Continuing or worsening headache for more than a few days after a head injury or if accompanied by changes with nervous system symptoms such as level of consciousness
• If you are concerned about your child’s headaches, make an appointment to discuss with your pediatrician.

Additional resources:

• Migraine Headache in Children (eMedicineHealth)
• What Should I Do for My Child’s Headaches? (WebMD)
• Children’s Headache Disorders (National Headache Foundation)
• What to Do When Your Child Has a Headache (Michigan Medicine Health Blog)

Written by Kelly Orringer, MD
Updated October 2017