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What is a headache?

A headache is pain or discomfort in the head or face area. Headaches vary greatly in terms of pain location, pain intensity, and how frequently they occur. As a result of this variation, several categories of headache have been created by the International Headache Society (IHS) to more precisely define specific types of headaches.

According to the American Academy of Pediatrics, almost two out of three teens will complain of a headache each month.

What aches when your child has a headache?

There are several areas in the head that can hurt when your child has a headache, including the following:

  • A network of nerves that extends over the scalp
  • Certain nerves in the face, mouth, and throat
  • Muscles of the head
  • Blood vessels found along the surface and at the base of the brain (these contain delicate nerve fibers)

The bones of the skull and tissues of the brain itself do not hurt because they do not have pain-sensitive nerve fibers.

What causes a headache?

Headaches may be caused by a number of conditions, such as disorders of the neck, eyes, brain, jaw, or teeth. Headaches with an underlying medical condition are classified as secondary headaches because they are related to the condition. An example of this would be a headache due to neck injury or sinus infection.

The majority of headaches experienced by children and adolescents are not due to serious underlying problems. Both physical and emotional factors must be considered when evaluating headaches.

Headaches classified as primary indicate that the headache itself is the main medical problem, although underlying nonmedical causes, such as muscle tension or foods, may be identified. Other contributing factors may include medications, dehydration, or changing levels of hormones. These factors that influence headaches are sometimes called headache triggers.

What are the most common types of primary headaches in children?

  • Migraines
    This type of headache is distinguished by the fact that symptoms other than pain occur as part of the headache. Nausea and vomiting, lightheadedness, sensitivity to light (photophobia), and other visual symptoms typically occur, and some children may have all of these symptoms without head pain. This is known as an abdominal migraine.

    Children tend to have migraines that last for a shorter period of time than adult migraines, but the same medications used for adults are typically used for children.

    Migraines are also unique in that they have distinct phases. Not all children experience each phase, however. The phases of a migraine headache may include:
    • Premonition phase - a change in your child’s mood or behavior that may occur hours or days before the headache.
    • Aura phase - a group of visual, sensory, or motor symptoms that immediately precede your child’s headache. Examples include hallucinations, numbness, changes in speech, and muscle weakness.
    • Headache phase - period during the actual headache. Throbbing pain on one or both sides of the head. Sensitivity to light and motion are common, as are depression, fatigue, and anxiety.
    • Headache resolution phase - pain lessens during this phase, but may be replaced with fatigue, irritability, and difficulty concentrating. Some children feel refreshed after an attack, while others do not.
  • Tension headaches
    Tension headaches are the most common type of headache. Stress, muscle tension, and mental or emotional conflict are often factors in triggering pain related to tension-type headaches. While symptoms may differ, the following are common symptoms of a tension-type headache:
    • Slow onset of the headache
    • Head usually hurts on both sides
    • Pain is dull or feels like a band or vice around the head
    • Pain may involve the back (posterior) part of the head or neck
    • Pain is mild to moderate, but not severe

    Tension-type headaches typically do not cause nausea, vomiting, or sensitivity to light (photophobia).

What are some important points to consider regarding your child’s headache?

Headache symptoms depend upon the type of headache. The frequency of headaches and the intensity of the symptoms may vary as well. Symptoms and situations that may suggest the need to contact your child’s physician include any of the following:

  • When a headache follows a head injury
  • Pain that is worsened by strain, such as a cough or a sneeze
  • Vomiting without nausea
  • Sudden onset of pain and the "worst headache" ever
  • Headache that is becoming more severe or continuous
  • Changes in vision
  • Weakness in the arms or legs
  • Seizures or epilepsy

The symptoms of a headache may resemble other conditions or medical problems. Always consult your child’s physician for a diagnosis.

How are headaches diagnosed?

The full extent of the problem may not be understood immediately, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a headache is made with a careful history, physical examination and diagnostic tests.

Questions commonly asked during the exam may include the following:

  • When do headaches occur?
  • What is the location of the headache?
  • What do the headaches feel like?
  • How long do the headaches last?
  • Have there been changes in behavior or personality?
  • Do changes in position or sitting up cause the headache?
  • Does your child have trouble sleeping?
  • Does your child have a history of stress?
  • Is there a history of recent head injury?

If the history is consistent with migraine or tension type headaches and the neurological exam is normal, no further diagnostic testing may be necessary. However, if it is not a primary type headache, then other tests may be needed to determine the cause.

Tests used to determine the cause of your child’s headache may include:

  • Blood tests - various blood chemistry and other laboratory tests may be run to check for underlying conditions.
  • Sinus x-rays - a diagnostic imaging procedure to evaluate for congestion or other problems that may be corrected.
  • Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
  • Computed tomography scan (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Treatment for headaches:

Specific treatment for headaches will be determined by your child’s physician based on:

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

The ultimate goal of treatment is to stop headaches from occurring. Adequate headache management depends on the accurate identification of the type of headache and may include:

  • Avoiding known triggers, such as certain foods and beverages, lack of sleep, and fasting
  • Changing your child’s eating habits
  • Exercise
  • Resting in a quiet, dark environment
  • Medications, as recommended by your child’s physician
  • Stress management

Migraine headaches may require specific medication management including:

  • Abortive medications - medications, prescribed by your child’s physician, that act on specific receptors in blood vessels in the head and can stop a headache in progress.
  • Rescue medications - medications purchased over-the-counter, such as analgesics (pain relievers), to stop the headache.
  • Preventive medications - medications, prescribed by your child’s physician, that are taken daily to reduce the onset of severe migraine headaches.

Some headaches may require immediate medical attention including hospitalization for observation, diagnostic testing, or even surgery. Treatment is individualized depending on the underlying condition causing the headache. Full recovery depends on the type of headache and other medical problems that may be present.

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