Seven-year-old Camden Lewis walked into his kitchen, told his mother that his head hurt again, and threw up. Then he went to sleep. His mom, Stephanie, was alarmed, but she decided to see how Camden felt when he woke up. Though her son said that he was fine, Lewis called their pediatrician, who suggested she keep a diary of Camden's headaches. "That way we could see if there was a pattern or a trigger," says Lewis, who lives in Los Angeles. After about a month of weekly headaches, Camden was diagnosed with migraines by a neurologist, who recommended a plan to help control the pain and reduce the frequency.
This isn't an uncommon story. In 2009, researchers at Children's National Medical Center and George Washington University found that 17 percent of children age 4 and older had frequent or severe headaches. In fact, migraines are among the top five conditions that affect children, right up there with asthma, allergies, obesity, and depression. Even babies can get migraines, though it's difficult to determine this in nonverbal children (holding their head can be one sign). "The youngest person I've diagnosed was 10 months old," says Andrew D. Hershey, M.D., Ph.D., director of the Headache Center at Children's Hospital Medical Center, in Cincinnati.
The encouraging news about children's headaches is that your child's susceptibility may decrease as he grows. "Children's brains change as they get older, so it's possible that their pain will go away," says Alyssa A. Lebel, M.D., codirector of the Headache Clinic at Children's Hospital Boston. (Hormones also seem to have an effect. After puberty, boys often get better, though girls sometimes begin getting more headaches.) Also good to know: When a child gets a headache, it tends to go away more quickly than it does for an adult. But you can speed up the process even more -- and help reduce your child's risk of recurrent headaches -- if you're well versed in the condition.
Identify the Cause
Headaches can develop for lots of reasons. Of course they often come along with illnesses like a cold or the flu, but some kids continue to have daily headaches for weeks after the virus goes away. The cause is usually a migraine or tension-type headache, two recurring conditions. Either kind can last from 30 minutes to days at a time.
Migraines occur when overly stimulated brain cells cause blood vessels to dilate and the membranes covering the brain become inflamed, which then sets off pain signals in the head. Tension-type headaches, on the other hand, are related to muscles tightening in the neck or scalp. In children, both types of headaches tend to cause pain on both sides of the head (whereas adults generally feel migraines on only one side), so it can be difficult to tell one kind from the other. Migraines also frequently get misdiagnosed as sinus infections. "Even if the headache is around the sinuses and a child's eyes tear up and her nose runs, it's usually not a sinus infection; it's a migraine," says Mark W. Green, M.D., director of Headache and Pain Medicine at Mount Sinai School of Medicine in New York.
A tip-off that your child may be having migraines is his family history. Any relative can pass on the tendency to have migraines, although the more closely related the migraine sufferer is to your child, the greater the risk. Children who frequently get carsick or can't tolerate spinning are also prone to migraines.
Stress can be another factor. A 2009 German study, for instance, found that boys whose families quarreled often and who themselves had little free time were prone to headaches. A change in routine (such as going back to school after vacation), fluctuations in the weather, bright light, loud noises, lack of sleep, and skipping meals can all set off a migraine too. Food, though, generally isn't the culprit. Although often named as a trigger, research shows that foods like chocolate and cheese probably don't have much connection to headaches in kids.
Put an End to Pain
If your child is having headaches more than once a week or if his headaches are causing him to miss school or playdates, schedule an appointment with your pediatrician. She may decide to refer you to a neurologist or a headache specialist. You should also keep a headache diary, as Lewis did, so you're not relying on memory when you talk to your doctor. "Write down what the headaches are like -- does your child have nausea or vomiting? -- and whether they're increasing or are associated with things like weekends or breaks from school," suggests Ann Pakalnis, M.D., director of the Headache Clinic at Nationwide Children's Hospital in Columbus, Ohio. Whatever type of headache your child has, you can lessen the pain with these quick steps.
Give her ibuprofen (which in general has been shown to be more effective than acetaminophen) as soon as the pain begins. Never give aspirin to kids under age 15 because it can lead to Reye's syndrome, a life-threatening disease that affects the liver and brain. Some children with migraines can feel a headache coming on. If your child has an early warning sign -- she may, for instance, see lights or lines (called an aura), feel tingling in the arms or face, or have a stomachache -- don't wait for the headache to start. Have her take the ibuprofen immediately. But avoid giving it more often than three times a week, because overuse of headache medication can make the pain worse.
Serve eight ounces of a sports drink. "Part of what happens during a migraine is the blood vessels dilate and leak," explains Dr. Hershey. "The sugar in these drinks helps the salt and water get absorbed, and the salt helps keep the water inside the blood vessels." You can also serve water or juice, or even give your child a few sips of cola, which may help because caffeine constricts the blood vessels.
Encourage her to nap in a cool, dark, quiet place. "A nap doesn't always help when you get older, but in kids it works like a charm," says Dr. Green.
If he doesn't sleep, distract him from the pain with toys, games, or books. Unless he's having a migraine attack, don't keep your school-age child home from school because it sets up a bad pattern. "This can start a cycle where a child misses school, then it becomes more stressful to return and that leads to more headaches," says Dr. Lebel.
Try to take away the fear. Tell your preschooler, "I know what's happening to your head, and I don't want you to worry. I know how to fix it." Reassure an older child by reminding him that treatments for his headaches have worked before, and they'll work again.
When headaches are frequent and disabling, or ibuprofen doesn't work, your doctor may prescribe headache medication. Most children don't experience the warning signs of a migraine, but if they do, drugs called triptans can often stop the attack. The FDA has not approved the use of most triptans in children, but physicians do regularly prescribe them as needed. Certain other drugs, like calcium channel blockers and cyproheptadine, are given to children too.
Prevent Future Episodes
One of the most important ways to avoid more headaches is getting adequate sleep. In a study published last year, Dr. Pakalnis and her colleagues found that adolescents with headaches had significantly more sleep problems (like trouble falling asleep and middle-of-the-night awakenings) than those without headaches. She believes these findings apply to younger children too. "It's hard to sort out which comes first, the headaches or the sleep problems, but we know that a lack of sleep exacerbates headaches significantly," says Dr. Pakalnis. "Kids who have allergies or large tonsils -- which can cause snoring and interfere with sleep -- also tend to have more severe headaches," she says.
Her study also found an association between headaches and caffeine, largely because caffeine can interfere with sleep. So while a little cola can help stop headaches when they start, in general avoid giving your child any caffeinated foods or drinks.
Beyond good sleep, headache prevention comes down to healthy living. Making sure your child is hydrated, doesn't miss meals, and stays active can all help stave off head pain. Taking a multivitamin may also help. Research has shown that deficiencies in riboflavin and vitamin D can increase headache frequency. School-age children also do well with biofeedback, a treatment that teaches them to use imagery -- something kids are particularly good at -- to gain control over what's happening in their body.
Recently, after a six-month reprieve, Camden Lewis felt a headache coming on just before an outing with friends. His mother gave him a dose of ibuprofen, and he was out the door. As he sped away on his scooter, his mom watched a different boy from the one who, two years ago, couldn't have ventured any farther than his bedroom.
When to Get Help -- Fast
It's uncommon, but a headache, especially a very bad one, can be a sign of a significant illness or injury. Go to the emergency room if?...
- Your child's terrible headache is accompanied by a fever or a stiff neck, both of which can be a symptom of meningitis.
- Your child has had a head injury and begins to vomit, has difficulty with balance, or becomes confused, all possible signs of bleeding in the brain.
- Your child has difficulty speaking, numbness, and/or eye-movement problems, all of which are symptoms of a stroke (new research shows that up to 10 percent of all strokes occur in children and young adults).
Originally published in the August 2010 issue of Parents magazine.
All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.