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Family Health Magazine
CHILDHOOD

Your Child's Headaches
What causes and how to treat them

When children complain of headaches, most parents become concerned. Mild headaches once in a while do not cause much alarm, but when they are severe or frequent, both parents and children are distressed. At these times, it is wise to see your family doctor.

The doctor can help most if the child or a parent can describe the headaches. The first step is to have the child indicate where the pain is worst by pointing with one finger to the painful area on the head. Next the child is asked to describe the pain. This is usually a difficult task for a child but, with encouragement, all but the youngest child can manage. It is important to learn how often the headaches occur. If they occur daily and week after week, they likely have a different cause from headaches that return only once every month or two.

The setting in which the headaches occur is also important. Do they start at school, after exercise, later in the day or first thing in the morning? The child or parent may be asked to identify things that make the headaches better or worse. Did the headache begin with a fever, an illness, or an injury? Two common types of headaches are seen in children, but they have very different causes. The treatment depends on the cause and a thorough description of the headaches is helpful in revealing the cause.

Migraine headaches often begin in childhood. Five per cent of school-age children suffer from these. Children with migraines usually have someone else in the family who is affected. (Eighty per cent of affected children have at least one parent who suffers from migraines). These headaches occur off and on but keep coming back. They are not daily. They have a clear pattern, often triggered by stress, fatigue, excitement, post-excitement let-down or abrupt weather changes. Some foods and drinks may trigger migraines but most of these culprits are not ones to which children are exposed.

Often parents notice a change in the child's appearance. The face may become pale, with dark circles under the eyes. The mood becomes subdued and the child complains of a severe, throbbing headache. The location of the pain is commonly one or both sides of the head but may be in the middle of the forehead or elsewhere on the head. The child may become nauseated and vomit.

Noise and bright light often make the headaches worse. The child usually wishes to go to a quiet dark room. If he or she can sleep, there is often eventual relief from the symptoms. In the younger child, migraine headaches usually last for several hours to half a day. The headaches tend to be longer in older children and adults.

Many anti-migraine medications used for adults are not tolerated by children and, in fact, can make the pain worse. Aspirin should never be used by children due to the risk of Reye's Syndrome. Ibuprofen is available in a childhood formulation that can also provides good relief. When taken early enough after the onset of headaches, and with the correct doses (adjusted for the weight of the child), relief from migraines is usually successful.

The other type of headaches often seen in childhood are Tension Type Headaches and are commonly called Muscle Contraction Headaches. These headaches differ in many ways from migraines, but the most obvious difference is that they occur very frequently, often daily.

When the headaches are at their worst, the child complains of constant headaches with no relief at any time during the day. The child is usually taken to the doctor after the headaches have gone on for weeks or months. This type of head pain is usually more difficult for children to describe and point to. Often they state that the pain is everywhere. Dull, constant, pressure may be described.

There may be no dramatic change in the child's appearance. Parents and friends are often unaware of the headaches unless the child complains about them. Their onset can sometimes be traced to a mild injury, such as a fall off a toboggan or on the ski slope, or to a bout of flu accompanied by muscular aches and pains. However, most often the symptoms have gone on so long that the child cannot remember clearly when they began. Usually, these headaches start in early or late afternoon, or early evening. They may last until the child goes to bed. Again, sleep is refreshing and relieving. In most cases, the headaches are gone in the morning. Pain relieving medications may 'take the edge off' the pain but usually not get rid of the headaches.

Treatment of these headaches is often directed at the muscles of the neck, shoulder and lower back. (These muscles may become tight and shortened over weeks or months and therapy may be helpful.) The pain from these headaches is usually less severe than that of migraines, but it can cause more family disruption. Children with this type of headache are more likely to be absent from school for long stretches, and their school results often suffer.

It is always important for the doctor to take a history about the headaches and do a thorough physical examination. In most cases, no physical problems will be found but the doctor is checking for abnormalities with the brain or general signs of disease.

A brain tumour can cause headaches but there are usually other signs when a tumour is present. These signs increase in number the longer the headaches persist. Overall, the percentage of childhood headaches caused by brain tumours is very small. Other, rarer causes of childhood headaches that have to be considered include acute brain infections (meningitis and encephalitis), sinusitis, head injury and seizure disorders.

Headaches are 'a pain in the neck.' The good news is that once the type of headache is correctly identified, treatment and relief are often easy and effective. If your child has headaches that are accompanied by other symptoms, are new or are longer, have your family doctor check your child.