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Headache Health Article

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When to call the doctor

The parent or caregiver should call the child's pediatrician or neurologist when the child has these symptoms or conditions:

headache pain that interrupts sleep
early morning vomiting without an upset stomach
worsening headache symptoms
headaches that prevent the child from participating in usual activities
frequent headaches, occurring three or more times per week
headache characteristics that are completely different or new
headache caused by strenuous activity, bending, coughing, or exertion
headaches that become more severe and/or frequent over time
family history of neurological disease
headache pain requiring a pain reliever daily or almost every day
headache pain requiring more than the recommended dose of over-the-counter pain relievers

The parent or caregiver should seek prompt medical attention when the child has these symptoms or conditions:

Headache is described as the "Worst headache of my life." This may indicate an aneurysm or other neurological emergency.
Headache accompanied by weakness, numbness, paralysis, visual loss, speech difficulty, loss of balance, falling, seizures, shortness of breath, mental confusion, or loss of consciousness. These symptoms could indicate a pending stroke.
Sudden onset of headache, especially if accompanied by a fever and stiff neck. These symptoms could indicate meningitis.
Visual changes, including blurry vision, "blind spots," or double vision.
Headaches that persist after a head injury or accident.
Personality changes or inappropriate or unusual behavior.
Headaches accompanied by severe nausea or vomiting.
A fever, rash, or stiff neck that occurs with a headache.

Diagnosis

All children who experience headaches on a relatively regular basis should be evaluated. Since headaches arise from many causes, a physical exam assesses general health and a neurological exam evaluates the possibility of neurological disease that is causing the headache. The doctor will look for signs of illness, including fever, high blood pressure, muscle weakness, difficulties with balance, or visual problems.

If the headache is the primary illness, the doctor elicits a thorough history of the headache to help classify the headache, including:

age of onset
duration and frequency
types of headaches experienced
when the headaches occur
pain intensity and location
accompanying symptoms or warning signs of headache onset
possible triggers or causes of the headaches
types of headache treatments used and their effectiveness
presence of any prior symptoms
impact on school and activities

The child's medical and family history help the physician determine if the child has any conditions or disorders that might contribute to or cause the headache. A family history of migraines or neurological disease might suggest a genetic predisposition to the condition.

The diagnostic evaluation for headache may include blood tests and urinalysis to rule out other medical conditions that may be causing the headaches. Neurological imaging tests such as computed tomography (CT) scan or magnetic resonance imaging (MRI) may be performed to rule out the presence of neurological diseases or disorders. Other tests may include a sinus x ray and ophthalmology examination. If a condition affecting the brain and spinal cord is suspected, a lumbar puncture or spinal tap may be performed.

A psychological assessment is not part of a routine headache evaluation but may be performed to identify stress triggers.

Treatment

The specific treatment prescribed will depend upon the type and frequency of the headache, its cause, and the child's age.

Headache diary

A headache diary can be used to record the characteristics of headaches, including possible triggers, such as foods, weather changes, odors, mood, stressful situations, emotions, or menstrual phases. It also can help the doctor identify the appropriate treatment.

Lifestyle changes

Making certain dietary and lifestyle changes can significantly improve the child's headache symptoms. Exercise is an important part of a healthy lifestyle. It aids in stress reduction and improves circulation, which may help reduce headache symptoms. Relaxation and stress management techniques may help the child cope with headache symptoms. Getting enough sleep is equally important; most children and adolescents need at least eight to 10 hours of sleep per night. Counseling can help the child identify stressful situations or events that cause the headaches. It also can teach the child various coping strategies.

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