Headaches & Migraines

Headaches are thought to be caused by changes in the nerve endings, chemical messengers (called neurotransmitters), and blood vessels of the head and face. These changes send pain signals to the brain, resulting in a headache.

Headaches can be either primary or secondary. Primary headaches are not caused by an underlying medical condition, and are very common in children. Secondary headaches are triggered by another medical condition, such as a sinus infection, head injury, infection, illness, dental problem, or increased pressure inside the skull (intracranial hypertension).

Most children who experience headaches are otherwise healthy, and the headaches are usually NOT a sign of a more serious neurological problem.

Possible headache triggers are:

• Skipping meals or dehydration
• Sleep deprivation or fatigue
• Side effects from medication
• Stress
• Prolonged screen time
• Head injury
• Allergies or a sinus infection
• Vision problems
• Certain foods
• Alcohol
• Caffeine
• Strong smells
• Menstruation or hormonal changes
• Long car rides
• Loud music
• Smoking
• Illness or fever

A handful of kids report experiencing physical or visual symptoms at the onset of a migraine known as an “aura.” Migraine pain is described as a pounding or throbbing on one or both sides of the head. Some children also describe a stabbing or shooting eye pain during a migraine.

Migraines can cause a variety of associated symptoms including:

• Nausea and vomiting
• Sensitivity to light, sound, and smell
• Visual disturbances (seeing spots or colored lights)
• Dizziness or tingling in the limbs

Diagnosing headaches and migraines in children can sometimes be difficult. A young child, for example, may not have the vocabulary to accurately describe what he or she is feeling other than simply saying “my head hurts.”

The more specific a child can be in describing the pain, and exactly when and where they are experiencing it (front, back, left or right side of the head), the better our chances are at pinpointing the cause.

Initial visits at our office will include a thorough review of patient history, as well as any family history of headaches and migraines, a physical exam, and blood tests. If necessary, other testing will be ordered, and may include imaging such as such CT and MRI scans.

It is also important to determine if a pattern exists to your child’s headaches.

• What time of day do they occur?
• How long do they last?
• Are there any identifiable triggers that set off the headaches?
• How quickly after reporting the pain are they able to recover and return to normal activity?

Keeping a headache journal is a helpful way for you to gather this information, and it can greatly assist our child neurologists with diagnosis and treatment.

Usually headaches can be treated easily at home. A child with a headache should rest in a cool, dark, quiet room. A cold washcloth or ice pack to the forehead or neck may also be soothing. Over-the-counter medicines such as ibuprofen or acetaminophen can provide relief. However, if the headaches are frequent and severe, prescription medications may be more effective. Avoiding certain triggers, if any have been identified, is also a key component.

In addition, behavioral and dietary modifications (such as regular exercise, improved sleep, and stress reduction) can go a long way in helping to manage the pain.

Other complementary treatments may include physical therapy, massage, or acupuncture to help with head, neck, and back pain. Counseling or talk therapy may also help children whose anxiety or stress levels are contributing factors.

• Headache Medications

(Adapted from KidsHealth, National Institute of Neurological Disorders and Stroke, and National Headache Foundation.)

Website Resources

• American Headache Society
• American Migraine Foundation
• Association of Migraine Disorders
• The Migraine Trust

Tips/Handouts

• Headache Action Plan