Kids and headaches: When is it more serious?

Today's guest blogger is Tara Pezzuto, APRN, Advanced Practice Nurse, Division of Pediatric Neurology, Nemours/Alfred I. duPont Hospital for Children.

Everyone gets headaches, even children.  But parents often don't treat their children's headaches as seriously as they might treat their own.

Kids' headaches are often easily explained.  Some common causes include stress, staying up too late (not getting enough rest), dehydration, not eating enough, playing too long in the sun, too much screen time or getting a bump on the head. Children can also get headaches as a side effect of taking certain medications or if they are suffering from a viral infection or the flu.

But children get migraine headaches, too. These headaches are severe and are classified as a type of vascular headache, referring to the pain receptors in the area of the head and scalp.  Migraines can occur even at a very young age.  Young children may experience migraine variants, such as cyclic vomiting or unexplained episodes of dizziness or loss of balance. Children and adolescents may experience an aura, which can be changes in vision, ringing in the ears, vertigo or numbness and tingling which may precede the headache pain or happen at any time around the headache. Many children have migraine headaches that are fairly incapacitating, causing them to miss school.

Migraines sufferers describe their symptoms variously:  some children compare their pain to the jab of an ice pick or stabbing, but most report a throbbing, pounding sensation. Although we do not know precisely why they occur, several factors are associated with migraines, including family history, anxiety, sleep deprivation, screen time, and poor dietary habits.  When food is a factor, common offenders include preserved meats (hot dogs, baloney), artificial colors, and monosodium glutamate (MSG).  Children who are allergy-prone often tend to be headache-prone, too.

Through puberty, the number of children who suffer from chronic headaches is about evenly divided between boys and girls.  Gradually, the scales begin to tip.  Following onset of the menstrual period, girls have migraine headaches in greater proportion to boys, and this follows into adulthood.

Consulting a Professional

A visit to your child's primary care provider for headache complaints will have two parts: a medical history and a physical exam. During history taking, they will ask about the severity and frequency of your child's headaches, whether they occur in a pattern and whether the pattern has changed over time.  They will also want to know if anything helps or worsens the headaches. You may be asked to keep a headache diary to document when your child gets headaches and what the possible causes may be. The medical exam can help identify physical disorders that may be the cause of your child's headaches.

The eyes are checked for evidence of abnormalities. An exam can also uncover warning signs that indicate the need for a specialist's attention. Some of these signals include:  headaches that awaken the child from sleep or worsen with lying down; severe headaches that come on suddenly accompanied by unexplained vomiting; muscle weakness, such as the inability to grip a pencil; blurred or double vision, or tingling sensations. These symptoms should be taken seriously and followed up with a neurologic evaluation. The neurology specialist may order diagnostic tests, including blood tests, EEG (electroencephalogram) or MRI (magnetic resonance image) to provide detailed readings of the  brain.  These tests give providers more information for diagnostic purposes.

Treatment

Providers can help migraines by identifying triggers and suggesting ways to avoid them. Sometimes, treatment can be as simple as eliminating certain foods from the diet, eating more fresh foods and drinking more water. We may also prescribe medications to alleviate headaches or as a preventative for chronic migraines. Working with psychologists, we often search for nonmedicinal treatment for headaches by teaching relaxation techniques, such as meditation, deep breathing and visual imagery. Physical and occupational therapy can sometimes be helpful, too.

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