Headaches in children

Your healthcare professional may collect some information from you to find the correct diagnosis and best treatment for your child's headache. Your appointment may include a:

• Headache history. Your healthcare professional will likely ask you and your child to describe the headaches in detail. They also may ask you to keep a headache diary to better understand headache triggers. A headache diary also helps identify whether there is a pattern to your child's headaches, such as headaches that happen when your child is overtired.
• Physical exam. This physical exam usually includes measuring your child's height, weight, head circumference, blood pressure, temperature and pulse and checking your child's eyes, neck, head and spine.
• Neurological exam. Your healthcare professional checks for any trouble with movement, coordination or sensation.

No further testing is usually needed to make a diagnosis if your child is otherwise healthy and headaches are the only symptom. Sometimes, imaging scans and other tests can help pinpoint a diagnosis or rule out other medical conditions that could be the cause of the headaches. These tests may include:

• Magnetic resonance imaging (MRI). MRI uses a powerful magnet to produce detailed views of the brain. MRI scans help healthcare professionals diagnose tumors, strokes, aneurysms, neurological diseases and other brain conditions. An MRI can also be used to look at the blood vessels that supply the brain.
• Computerized tomography (CT) scan. This imaging procedure uses a series of computer-directed X-rays that provide a cross-sectional view of your child's brain. This helps healthcare professionals diagnose tumors, infections and other medical conditions that can cause headaches.
• Spinal tap, also called lumbar puncture. Your child's care team may suggest a spinal tap, also called a lumbar puncture, if the team thinks an infection such as bacterial or viral meningitis might be causing the headaches. In this test, a healthcare professional uses a thin needle to collect a small amount of the fluid around the brain and spine.

Often, you can treat your child's headache at home with rest, a quiet environment, plenty of fluids, balanced meals and pain relievers you can buy without a prescription. These types of medicines also are called over-the-counter (OTC) medicines. If your child is older and has frequent headaches, having your child learn to relax and manage stress through different forms of therapy may help as well.

Medications

• Over-the-counter (OTC) pain relievers. OTC medicines such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) can often relieve children's headaches. These medicines work better if your child takes them at the first sign of a headache.

  Do not give children or teenagers aspirin. Aspirin has been linked to Reye's syndrome, a rare life-threatening condition, in children or teenagers who have the flu or chickenpox.

  For treatment of fever or pain, consider giving your child infants' or children's over-the-counter fever and pain medicines such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) as a safer alternative to aspirin.

• Prescription medicines. Triptans, which are prescription medicines used to treat migraines, are effective and can be used safely in children older than 6 years of age.

  If your child experiences nausea and vomiting with migraines, your healthcare professional may prescribe an antinausea drug. The medicines prescribed differ from child to child, however. Ask your healthcare professional or pharmacist about nausea relief.

Caution: Medication overuse headaches are the result of the long-term use of medicines needed to treat headaches such as migraines. It's OK to take pain relievers for headaches sometimes. But people who take them more than a couple of days a week may get medication overuse headaches, previously called rebound headaches. Over time, medicines for pain may stop working as well.

Also, all medicines have side effects. Be sure to tell your care team about all the medicines, including supplements, your child takes.

Therapies

While stress doesn't appear to cause headaches, it can be a trigger for headaches or make a headache worse. Depression also can play a role. For these reasons, your healthcare professional may recommend one or more behavior therapies, such as:

• Relaxation training. Relaxation techniques include deep breathing, yoga, meditation and progressive muscle relaxation. With progressive muscle relaxation, you tense one muscle at a time. Then you completely release the tension, repeating this for every muscle in the body. An older child can learn relaxation techniques in classes or at home using books or videos.

• Biofeedback training. Biofeedback is a type of mind-body technique you use to control some of your body's functions, such as your heart rate, breathing patterns and muscle responses. During biofeedback, your child is connected to electrical pads that help give information about the body's response to pain.

  Your child then learns how to reduce muscle tension and slow the heart rate and breathing to reach a more relaxed state. The goal of biofeedback is to help your child enter a relaxed state to better cope with pain.

• Cognitive behavioral therapy. This therapy can help your child learn to manage stress, painful headaches, and frequent headaches. During this type of talk therapy, a counselor helps your child learn ways to view and cope with life events more positively.

Pain medicines you can buy without a prescription, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others), often work to reduce headache pain. These are also called over-the-counter (OTC) pain medicines. Before giving your child pain medicine, keep these points in mind:

• Read labels carefully and use only the dosages recommended for your child.
• Don't give doses more often than recommended.
• Don't give your child an OTC pain medicine more than two or three days a week. Daily use can trigger a medication overuse headache, a type of headache caused by using pain medicines too often.
• Do not give children or teenagers aspirin. Aspirin has been linked to Reye's syndrome, a rare life-threatening condition, in children or teenagers who have flu-like symptoms or chickenpox. Talk with your healthcare professional if you have concerns.

In addition to giving OTC pain medicines, you can help ease your child's headaches with:

• Rest and relaxation. Encourage your child to rest in a dark, quiet room. Sleeping often helps headaches in children.
• Use a cool, wet compress. While your child rests, place a cool, wet cloth on the child's forehead.
• Offer a healthy snack. If your child hasn't eaten in a while, offer a piece of fruit, whole-wheat crackers or low-fat cheese. Not eating can make headaches worse.

Although studies in children are limited, research suggests that some dietary supplements may help with headaches. These include:

• Riboflavin.
• Magnesium.
• Coenzyme Q10.
• Vitamin D.

Check with your child's healthcare professional before trying any herbal products or dietary supplements to be sure they won't interact with your child's medicines or have harmful side effects.

Several alternative treatments also may be helpful for headaches in children, including:

• Acupuncture. During acupuncture, extremely thin, disposable needles that generally cause little pain or discomfort are placed in the skin at specific spots on the body. Some research suggests that this treatment may help relieve headache symptoms.
• Massage. Massage can help reduce stress and relieve tension. It also may help ease headaches.
• Physical therapy. This treatment can help headaches caused by muscle tension around the head, neck and spine.

Typically, you make an appointment with your family healthcare professional or your child's pediatrician. Depending on how bad your child's headaches are and how often they happen, your care team may refer you to a doctor who specializes in conditions of the brain and nervous system, called a neurologist.

Here's information to help you get ready for your child's appointment and to know what to expect.

What you can do

• Write down your child's signs and symptoms. It may help to keep a headache diary, listing each headache, when it happens, how long it lasts and what might have caused it.
• Make a list of all medicines, vitamins and supplements your child takes.
• Write down questions to ask your care team.

For headaches in children, some basic questions to ask your care team include:

• What's the most likely cause of the symptoms?
• Are tests needed to confirm the diagnosis?
• What are the available treatments and which do you recommend?
• Does my child need prescription medicine, or would an OTC medicine work?
• What follow-up, if any, is needed?
• What can we do at home to help with the pain?
• What can we do at home to prevent headaches?

What to expect from your doctor

Your healthcare professional is likely to ask you several questions, including:

• When did the symptoms start? Have they changed over time?
• How often does your child have these symptoms?
• How long does the headache usually last?
• Where does the pain occur? If your child is young, can the child draw a picture of what the headache looks and feels like?
• Are the symptoms constant or do they come and go?
• Does your child have other symptoms, such as nausea or dizziness?
• Does anything make your child's symptoms better?
• Does anything make the symptoms worse?
• What treatments have you tried?
• What medicines does your child take?
• Do other family members get headaches?

What you can do in the meantime

Until you see your child's healthcare professional, if your child has a headache, place a cool, wet cloth on your child's forehead and encourage the child to rest in a dark, quiet room.

Consider giving your child OTC medicines such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to ease headache pain.

Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because in these children, there is a link between aspirin and Reye's syndrome, a rare but potentially life-threatening condition. Talk with your healthcare professional if you have concerns.