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Headaches: When Should I Worry?

Everyone has experienced a headache and knows how terrible they can be. As a parent, it can be tricky knowing when to worry and do something about symptoms that your child complains about. Headaches are no exception. As parents, our minds go to the worst scenario. What if I’m ignoring or minimizing my child’s complaints and my child has a brain tumor? Here are the headache basics with kids.

Common headache types in kids:

  1. Migraines: Relatively common (reportedly 10% of teens experience migraines). Attack-like in nature, severe pain, and often characterized as “pounding.” Usually on one side of the head and can be preceded by an “aura” (visual disturbance that clues the patient into the impending migraine). There is often a genetic tendency to migraines.
  2. Tension headaches (stress related): Common in teens. Occurs over the progression of the day, typically in response to stress. The pain is “viselike” pressure on the sides of the head and can go down the neck. It happens from the scalp muscles tightening around the skull.
  3. All the others: There are tons of other types/causes of headaches. They are just much less common. For the sake of completion, there are: cluster headaches, sinus headaches, intracranial mass headaches (these are the brain tumors), meningeal headaches, rebound headaches.

Diagnosing headaches:

  1. History: When the complaint is headaches, a good portion of the visit should be spent obtaining a history. A good history (or story of the headaches) tells the doctor a lot about what is likely going on. Common questions include topics of duration, circumstances that make the headaches better or worse, recent stresses, other associated symptoms, and the nature of the pain.
  2. Exam: A headache exam will often include checking out other parts of the body to look for signs of other causes of the headaches (e.g., is the nose inflamed with facial pain indicating a sinus infection as a cause of the headaches?)
  3. Neurological exam: This exam checks various parts and functions of the brain. Many seemingly simple questions and instructions are given to the patient to assess if there is a problem with the brain.
  4. Work up: Sometimes, the first three items clue the doctor into a cause of the headaches that require further workup. Depending on the cause, lab work or imagining may be required. Lab work typically involves a blood draw, but sometimes even warrants a spinal tap. Imaging may involve a CT (computerized tomography scan) or MRI (magnetic resonance imaging).

Causes of headaches:

Many things can cause or trigger a headache. If your child is plagued with frequent headaches, it may be worth keeping track of the headaches (in a “headache journal”) and record associated factors to see if a cause can be identified and limited.  It is generally believed that headaches are caused by changes to the chemicals, nerves, and/or blood vessels in the brain. The following list includes common causes of these changes:

  1. Illnesses (like ear infections or sinus infections)
  2. Irregular or insufficient sleep
  3. Poor diet, nutritional deficiencies, and/or skipping meals
  4. Dehydration (it’s amazing to me how often just increasing fluid intake solves recurrent headache problems in patients
  5. Specific foods: Common offenders are eggs, hard/aged cheese, chocolate, processed meats, juice, and foods with additives (e.g., nitrites and dyes)
  6. Stress
  7. Eye strain/fatigue or vision problems
  8. Hormonal fluctuations (e.g., there is an entity called menstrual migraines that happen from hormonal changes)
  9. Drugs and alcohol
  10. Weather/temperature changes
  11. Teeth grinding or jaw clenching (some people don’t realize they do this at night)
  12. Medications (prescription and over-the-counter)

When to worry:

Some headache signs are more worrisome than others. If your child exhibits one or more of the following, it would be worth having your child evaluated by his/her pediatrician; it could be a sign of one of the more serious causes of headaches.

  1. Headaches that wake the child in the middle of the night.
  2. Headaches that happen first thing in the morning.
  3. Headaches that cause vomiting.
  4. Associated loss in a developmental milestone (your child could walk before but now isn’t, etc.)
  5. Headaches that are worsening in intensity or frequency.
  6. Headaches that won’t go away.

How to treat headaches

  1. Prevent, prevent, prevent. In real estate, the phrase is “location, location, location.” In medicine, it’s all about prevention. It’s much easier to prevent the problem, than treat it. If you can identify a trigger, than eliminate the trigger (get more rest, don’t skip meals, drink enough water, etc.)
  2. Removal from the aggravating situation (e.g., if light and noise are making the headache worse, go to a dark, quiet room).
  3. Correct the cause, if identifiable (e.g., eat if blood sugar is low, rest if sleep deprivation).
  4. Medications:
    1. Over-the-counter medications: Common over-the-counter options include Tylenol (generic: acetaminophen) and Motrin (generic: ibuprofen). In general, the response is best if medication is started at the onset of the headache. As a side note, don’t give your child asprin (it can cause Reye’s syndrome.
    2. Prescription medications: If your child is experiencing frequent or significant headaches, your pediatrician may prescribe a prophylactic (to prevent them) or abortive (to stop them once started) prescription medications.

Sometimes despite doing all you can to help prevent them, headaches just happen. I personally suffer from frequent headaches, so I truly empathize with the kiddo who is suffering from headaches.