Headaches / migraines

Facts about headaches in children

• Headaches can be single or recurrent in nature, and localized to one or more areas of the head and face.
• Five to 29 percent of children complain of headaches.
• Three percent of children suffer from migraine headaches.
• Forty percent (or more) of all children have had a headache by the age of 7.
• Among 7-year-olds, approximately 4 percent have frequent headaches.
• By the age of 15, 75 percent of children have had a headache.
• About 2 to 10 percent of headaches are due to an underlying brain abnormality.
• Only one child in 40,000 is found to have a brain tumor causing the headache.

Causes

The exact cause of headaches is not completely understood, but it is thought that many are the result of tight muscles and activation of some of the nerve control centers around the head and face. The way a child exhibits a headache may be related to many factors, which include but are not limited to, age, gender, developmental stage, and culture. Many life style factors also impact a child's headache including nutritional and fluid intake, sleep pattern, responses to stress, and other health issues. It has been found that many type of headaches can also be accompanied by school difficulties, behavioral problems and/or depression/anxiety. There are other headaches that may be caused by actual abnormalities in the brain, however these are much less common in children.

Different types of headaches:

There are many different ways to classify headaches. One method divides headaches into two categories:

Secondary headaches

An organic cause in the brain (Problems in the structure of the brain - such as brain tumors, chiari malformation, and are the least common type of headaches.)

Primary headaches

These are usually caused by tight muscles or activated nerve control centers around the head or face. Three of the most common types of headaches are:

Tension headaches

Tension headaches are the most common type of headache. This type of headache occurs most often between 9 and 12 years of age. Tension headaches are also known as stress headaches and can be chronic daily headaches or chronic non-progressive headaches. These headaches cause mild to moderate pain and they come and go over time. Stress often is a factor in tension headaches. While every child may experience symptoms differently, the following are the most common symptoms of a tension headache:

• Slow onset of the headache.
• Head usually hurts on both sides.
• Pain is dull or feels like a band around the head.
• Pain may involve the posterior (back) part of the head or neck.
• Pain is mild to moderate, but not severe.
• Change in the child's sleep habits.
• Children with tension headaches typically do not experience nausea, vomiting or light sensitivity.

Migraine headaches

Migraines can last from a few hours to a few days and usually occur one or more times a month. They may start early in childhood with the average age of onset between 5 to 8 years of age. There often is a family history of migraines. Some females may have migraines that correlate with their menstrual periods. While every child may experience symptoms differently, the following are the most common symptoms of a migraine:

• Pain on one or both sides of the head (some younger children may complain of pain all over)
• Pain may be hot/cold, sharp/dull, throbbing, pounding, aching, pulsating, stabbing in quality (although young children may not be able to describe their pain)
• Sensitivity to light or sound or smell
• Nausea and/or vomiting
• Loss of appetite
• Abdominal discomfort
• Sweating
• Child may become quiet or pale
• Dizziness
• Some children have an aura before the migraine, such as visual changes (blurry, fuzzy), seeing objects (spots, stars, colors, sparkles, glitter), hearing buzzes/beeps, and/ or funny taste in mouth.

Cluster headaches

Cluster headaches are one of the most severe, but least common type. Usually start in children older than 10 years of age and are more common in adolescent males. Cluster headaches usually occur in a series that may last days, weeks or months. This series of headaches may return every year or two. While every child may experience symptoms differently, the following are the most common symptoms of a cluster headache:

• Severe pain on one side of the head, usually behind one eye
• The eye that is affected may have a droopy lid, small pupil, or redness and swelling of the eyelid
• Runny nose or congestion may be present
• Swelling of the forehead may be present

Symptoms

The child may exhibit varying degrees or severity of associated headache symptoms which may be related to his/her age, gender, developmental stage, and culture upbringing.

• Sensitivity to light, sound, smell
• Nausea and/or vomiting
• Change in appetite
• Fatigue
• Eye irritation/pain
• Change in energy level
• Change in emotions and/or behaviors

The symptoms of a headache may resemble other conditions or medical problems. Always consult your child's physician for further evaluation. Symptoms that may suggest the need to seek medical help include the following:

• Awakened from sleep by the pain of a headache.
• Headaches that start very early in the morning.
• Pain that is worsened by strain, such as a cough or a sneeze.
• Headaches that cause vomiting without nausea.
• Sudden onset of pain and/or the "worst headache" ever.
• Headache that is becoming more severe or continuous.
• Personality changes.
• Persistent changes in vision with or without headache.
• Persistent weakness in the arms or legs with or without headache.
• Seizures or epilepsy.

Diagnosing:

Fully understanding a child's headache may not happen immediately at the first visit. It will require the headache team and the family working together to find these answers.
At the first appointment in the Headache Clinic, there will be a comprehensive medical & psychological evaluation of the child, which includes details of the child's headaches, questions of life style topics found to contribute to headaches, family medical history, and a neurologic exam. The details will include the following:

Commonly asked questions:

• When do the headaches occur?
  
  • Daily, weekly, monthly, or related to menstrual cycle?
  • Awaken with, during the day, in the evening, wake from sleep?
• What part of your head hurts with the headache?
• What do the headaches feel like?
• How long do the headaches last?
• Is there a warning before the headaches begin – vision changes, hearing sounds, odd tastes?
• Are there triggers that cause the headaches?
• What makes the headaches better? Worse?
• What has been done or tried for the headaches?

Treatments:

Medical management relies on the proper identification of the type of headache. The ultimate goal of headache treatment is to reduce the frequency and intensity of the headaches. For some, the headaches may not completely go away, but every effort is made to minimize any and all headaches. Specific treatment for headaches will be determined by your child's provider based on:

• Your child's age, overall health and medical history
• Extent of the headaches
• Type of headaches
• Your child's tolerance for specific medications, procedures or therapies
• Your opinion or preference

Important contributing life style choices which are important and helpful to avoid and/or reduce headaches:

• Healthy nutritional habits
• Eating three meals a day
• Adequate fluid (water) intake daily
• Healthy sleep habits
• Stress management skills and techniques
• Routine exercise
• Avoiding known triggers, such as certain foods and beverages, lack of sleep, and fasting
• Medications, as recommended and instructed by your child's provider
  
  • Break through: (take when you know a headache is starting) prescribed by your child's provider which can stop a headache as it starts or while it is present
  • Preventative: prescribed by your child's provider, that are taken daily to reduce the onset of headaches