Headaches in Children

Children get the same types of headaches as adults, but symptoms differ

Headaches are divided into benign primary headache disorders or secondary causes of a headache.

• Benign primary headaches include migraine, tension, trigeminal autonomic headaches, and other headache disorders.
• Secondary headaches are caused by head injuries, infection, intracranial mass, and other abnormalities.

Types of Headaches

Migraines in children are often shorter in duration than in adults (typically 2 hours or more instead of 4 or more hours). Children are also more prone to visual aura or visual illusions with their migraines than adults. Recurrent abdominal pain in children is often a form of a migraine. Migraines are characterized by moderate to severe headache pain that is on one side (unilateral), more commonly on both sides in children (bilateral), and include pulsating, which may be worsened by physical activity, light or sound sensitivity, or nausea or vomiting.

Tension-type headaches typically are bilateral pressing/tightening type of pain which is mild to moderate and not worsened by routine activity such as walking, playing, or climbing stairs. Nausea/vomiting does not occur with these headaches, but either light or sound sensitivity can.

Cluster headaches are less common in children under 10. They are characterized by sharp, stabbing pain with either tearing, congestion/runny nose, red eye, or restlessness/agitation. A rebound headache can occur if taking over-the-counter pain medications more than 2-3 times a week.

Chronic headaches can also occur in children and include chronic migraine, new onset daily persistent headaches, and chronic tension headaches.

Are headaches a cause for concern?

Concerning headaches include positional headaches, meaning the pain is affected by body position. Positional headaches are typically due to changes in intracranial pressure. Headaches due to high intracranial pressure are generally worse when lying down and get better when sitting up. Children or adults with high intracranial pressure often prefer to sleep elevated or wake up with headaches in the morning that get better when they get up and move around. Low intracranial pressure is the opposite. Headache pain is better lying down, and headache pain starts later in the day. High and low intracranial pressure headaches can be accompanied by nausea/vomiting and double vision.

Symptoms

It can be challenging to diagnose headaches in children because they often have difficulty describing what they are experiencing. The younger the child, the more behavior has to be relied on to help with diagnosis.

Worrisome signs include headaches that wake a child from sleep, changes in personality, persistent headache after trauma to the head, persistent nausea/vomiting, or a headache accompanied by fever and neck pain. Many people also assume that eye problems cause headaches. Eyestrain can trigger a headache, but contrary to popular belief, eye problems do not typically cause headaches.

High intraocular pressure can trigger a headache, but the eyes are generally red and painful with a mid-dilated unreactive pupil, blurry vision, and nausea/vomiting. If your child suffers from headaches, seeking medical care to determine the etiology (benign primary headache disorder vs. secondary) is always a good idea.

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