Red Flags, Causes, Treatment, and More

“Mommy, my head hurts!” Your stomach may drop when you hear your child say these words. Is it a simple headache? Could it be something more? The answer to these questions is maybe and possibly.

Familiarizing yourself with symptoms of different types of headaches, their frequency, and certain “red flags” may help you understand what’s wrong and when you might need to see your child’s doctor.

First, the good news: Most headaches — or primary headaches — are not necessarily serious. However, sometimes headaches may be a sign of another issue that needs immediate attention. These are called secondary headaches because they result from other conditions and their effects on the head.

Contact your pediatrician if any of the following apply:

  • Your child has hit their head or had a recent fall. This may mean they have a concussion or some other injury leading to pressure in their head that needs to be checked out.
  • Your child has a stiff neck or fever. These may be signs of meningitis, which is inflammation of certain membranes that surround the brain and spinal cord.
  • Your child’s pain isn’t responding to over-the-counter (OTC) pain relievers. Very severe or sudden-onset pain is worth taking your child to the emergency room or at least calling the pediatrician.
  • Your child is lethargic or acting off. The same goes with a headache where your child is also acting unusual.
  • Your child is vomiting without other signs of illness. Vomiting may be a sign of increased intracranial pressure. This can be caused by a number of things, like injury, arachnoid cysts, hydrocephalus, or tumors.
  • Your child’s headache woke them out of sleep. If the pain wakes your little one from their slumber, it may be pretty severe and out of the norm for standard headaches.
  • Your child has a headache as soon as they wake up in the morning. This might also be a sign of increased intracranial pressure.
  • Your child’s pain gets worse when they lie down. Pressure or pain in the head when lying down is another possible sign of increased intracranial pressure.
  • Your child’s headaches happen more than twice a week. Frequent headaches or headaches that regularly interfere with play, school, or other aspects of life are also worth bringing up to your pediatrician.

Pay attention to your parental intuition as well. If your child’s headaches seem like they may need further attention, it’s a good idea to get them checked out.

You may be able to figure out what type of headache your child has by the symptoms they’re experiencing. If your child is having frequent headaches, consider jotting down the signs and symptoms so you can discuss them with a doctor.

Migraine

The pain from migraine headaches may last between 4 and 72 hours total. Some children may experience something called an aura before their migraine headache starts. An aura may present as seeing lights flashing or zigzags or temporarily losing vision.

Other symptoms include:

It’s important to note that there are different types of migraine headaches that kids may experience. Some, like abdominal migraine, may not present as head pain at all. Instead, your child may complain of an upset stomach or loss of appetite.

Basilar-type migraine is another type of migraine that primarily affects teenage girls around their periods. Symptoms include vision changes, balance changes, dizziness, slurring of speech, and tinnitus — not necessarily head pain.

Tension headaches

The pain from tension headaches is generally mild to moderate. These headaches are not linked genetically or with hormones. Instead, they tend to begin during periods of stress and anxiety. They may go away when the stress or anxiety fades.

Features include:

  • pain that wraps around the head like a band
  • pain that is felt on both sides of head (bilaterally)
  • Tight muscles in the face, neck, jaw, or scalp
  • may involve sensitivity to light or noise
  • may be directly related to clenching the jaw, missing meals, not getting enough sleep, or some other stressor
  • no aura
  • no nausea or vomiting
  • doesn’t get worse with activity

Cluster headaches

Cluster headaches are very painful. They tend to feel the worst after just 5 to 10 minutes and persist for around 3 hours. Cluster headaches are not as common in children. The average age of onset is when a person is 20 to 50 years old, but kids can still be affected by them.

Symptoms usually include:

  • pain that occurs in certain areas of the head
  • pain that happens at the same time of day or night for weeks at a time (“clusters”)
  • swelling or redness of the nose, eye, or both on affected side of head
  • sweating

Other possible symptoms include:

  • aura
  • naughty
  • pain on one side of the head
  • sensitivity to noise or light

Occasional headaches may not need any diagnosis. If your child has frequent headaches (more than two in a week), severe headaches, or headaches that interfere with everyday life, you’ll want to let your pediatrician know.

Your child’s doctor will likely ask you:

  • what symptoms your child has been experiencing
  • how often your child experiences symptoms
  • what may be triggering the symptoms
  • questions about your child’s health history
  • Questions about any family history of headache or related conditions

In a physical exam, your child’s doctor will look for any signs of illness, injury, or infection that might be to blame. If nothing stands out, your child may need further testing depending on specific symptoms or concerns.

For example, blood and urine tests may help identify infections. Imaging, like CT scans and MRIs, helps visualize the structures of the brain.

You might be surprised to learn that headaches are common in kids. They tend to occur more often as kids grow into their teen years.

There are lots of reasons why your child may have a headache, such as:

Causes of secondary headaches may include things like:

Be sure to pay attention to any symptoms and “red flags” associated with your child’s head pain.

There are a variety of ways you might treat your child’s headaches. It’s best to discuss the options with your pediatrician to find the right fit for your specific child and type of headache.

Medications

Many medications that adults use to treat headaches aren’t approved for kids. Some may be approved for teens, though. Always check with your pediatrician first before giving your kids medication for headaches.

OTC pain relievers like acetaminophen (Tylenol) and ibuprofen (Advil) should usually be your first line of treatment for your child’s headache.

If your child doesn’t respond to Tylenol or Advil, a doctor might give them ketorolac. This is sometimes used in emergency departments to treat children’s migraine headaches. It’s usually given intravenously but can also be taken as a pill at home.

Triptans shrink swollen blood vessels in the brain and can help relieve migraine headaches or cluster headaches. They are not often prescribed for children, but a few are approved by the Food and Drug Administration (FDA). They are:

  • rizatriptan (Maxalt), for ages 6 to 17
  • almotriptan, for ages 12 and up
  • sumatriptan/naproxen, for ages 12 and up
  • zolmitriptan (Zomig) nasal spray, for ages 12 and up

If your child’s headache comes along with nausea or vomiting, a pediatrician may give them an antiemetic. Prochlorperazine and metoclopramide are the most common Drugs used to help relieve nausea and vomiting in emergency departments.

Children with frequent headaches, particularly migraine headaches, may have to take medication to prevent them. Some options include:

  • Propranolol, a beta-blocker, is effective but should not be used by kids with asthma, diabetes, or depression.
  • Topiramate, an anti-seizure drug, was found to be just as effective as propranolol in preventing migraine headaches, according to a 2013 study.
  • Cyproheptadine, an antihistame, can be given at bedtime. It’s not approved by the FDA to treat migraine, but doctors do sometimes prescribe it off-label.
  • Amitriptyline, an antidepressant, can help prevent migraine and tension headaches. Doctors might prescribe a single dose at bedtime.

Interestingly, a 2020 study revealed that migraine medications were no more effective than a placebo in treating migraine headaches in children and adolescents.

If your child has headaches often, you may also want to speak with your doctor about how frequent use of medications may actually increase headaches.

Therapies

The same 2020 study found that cognitive behavioral therapy (CBT) might be particularly effective in treating migraine for both children and teens. Physical therapy may also help kids who have headaches triggered by tight neck muscles or similar issues.

Other helpful therapies might include:

Home remedies

If your child already has a headache, try:

  • letting them rest in a dark room
  • placing a cool cloth or ice pack on their forehead
  • having them drink plenty of fluids

You may be able to help lower the frequency of headaches with lifestyle changes and other home remedies. These may be particularly helpful if your child has tension headaches, which are caused by stress to the body or mind.

For example:

  • Drinking the recommended 7 to 10 (for girls) or 7 to 14 (for boys) cups of water per day may help with headaches caused by dehydration.
  • Getting the recommended hours of sleep each night (9 to 12 for elementary school aged kids; 8 to 10 for teens) may also help prevent headaches.
  • Avoiding known migraine triggers may keep migraine headaches at bay. To identify triggers, try keeping a diary of different foods, activities, or lifestyle habits that may be contributing.

Eating certain functional foods may also help prevent migraine in children.

Most commonly used supplements include:

However, more research on these supplements is needed in kids. Always speak with your doctor before starting your child on a supplement to make sure it’s safe for them.

Recent research suggests that about 3 in 5 children across all age groups report having headaches. But pre-pubescent kids are less likely to have headaches than adolescents.

Adolescents tend to get more frequent or severe headaches, too. Less than 5% of children ages 4 to 6 report frequent or severe headaches compared to 27% of adolescents ages 16 to 18.

In pre-pubescent kids, headaches were more common in boys, researchers found. At the onset of puberty, though, girls more commonly dealt with headaches.

According to the National Institute of Neurological Disorders and Stroke, children may be more likely to develop migraine if there’s a history of migraine in the family. They also tend to affect more females than males. And migraine is also more common in kids who deal with:

  • Certain mood disorders, such as depression, anxiety, and bipolar disorder
  • sleep disorders
  • epilepsy

Cluster headaches are more common in males than in females. They may also be associated with prior head trauma or even a family history of cluster headaches.

Headaches are uncommon in children of preschool age (5 years or younger), reports a 2018 study. Talk with your child’s pediatrician if you have a very young child who is getting headaches.

You may not be able to stop your child from getting headaches entirely. Following healthy habits (eating well, sleeping enough, drinking plenty of water) may help ward off tension-type headaches. Similarly, identifying and avoiding triggers may tame some migraine activity.

Otherwise, it’s important to work with your child’s doctor to determine the root cause of the headaches and what might be triggering them. From there, you can develop a personalized plan that includes:

  • lifestyle changes
  • stress management
  • preventive . medications
  • rescue . medications
  • other therapies

Occasional headaches are no reason for alarm.

But if your child is getting frequent headaches or has any “red flags” associated with head pain, consider making an appointment with their pediatrician or getting more urgent care as needed.

Your child’s doctor can help identify any underlying medical issues and offer possible medications, therapies, or lifestyle changes to give your child more headache-free days.

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