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What should I do if my child gets headaches?

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Although headaches often are associated with the stresses of adulthood, they are quite common in children and adolescents.

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By MARIA GIERON-KORTHALS

Tribune correspondent

Published: July 9, 2009

Your normally boisterous 7-year-old is curled up in a corner of her bedroom with the lights out. When you ask how she feels, she replies, "I hurt. It feels like my heart is pounding in my head!"

Although headaches often are associated with the stresses of adulthood, they are quite common in children and adolescents. About 50 percent of children by age 7 have occasional headaches, and as many as 3 percent of these suffer migraines. By age 15, 82 percent of adolescents report having had one or more headaches, and 6 percent have experienced migraines. Some girls may have more frequent headaches during puberty because of hormonal changes.

Parents often worry that their child's headache may be caused by a brain tumor or other serious illness, but fortunately, most headaches are benign and disappear as the child gets older. Danger signs that should alert the parent to bring their child to a pediatrician or neurologist include headache with fever, headaches following an injury, confusion, lethargy, seizures, weakness on one side of the face or body, changes in the frequency or severity of headaches and headache triggered by exertion.

The child's doctor will evaluate headache symptoms with a thorough medical history and perform physical and neurological examinations to rule out a brain or sinus infection, bleeding inside the brain or a tumor. Additional tests, such as a brain scan or a spinal tap, may be ordered.

The most common childhood headache is the tension headache, often brought on by stress, depression or anxiety. These headaches, usually with mild to moderate pain, may include tightness in the muscles of the head or neck. Some become chronic (daily or near daily) and frequent use of over-the-counter pain medications may aggravate the pain. Lifestyle measures, such as getting enough sleep, a healthy diet, exercise, and using behavior and relaxation therapies to manage stress, may be more beneficial than medications for relieving tension headaches.

A migraine is a recurrent, intense headache typically accompanied by other symptoms, such as nausea, vomiting, abdominal pain and sensitivity to light, noise or smell. Heredity plays a role in most migraines, so obtaining information about other family members' headaches is important.

Diagnosing migraines in children is more challenging than in adults because symptoms can vary with age. Younger children have difficulty describing their symptoms and expressing what the pain feels like. Children's migraine headaches can be shorter in duration than those in adults and are more likely to occur on both sides rather than one side of the head.

The key to medical treatment is tracking what triggers the migraines (certain foods, fatigue, changes in temperature, bright lights) whenever possible, so it can be avoided, and creating a plan of immediate treatment for attacks.

Nonsteroidal anti-inflammatory drugs - acetaminophen, ibuprofen or naproxen - can be effective in treating migraines in children if given at the appropriate dose shortly after the headache starts. More specific medications called triptans (not yet approved by the Food and Drug Administration for children younger than 18) were shown in clinical trials to be effective and well-tolerated in children 12 to 17.

For frequent migraines that interfere with school or other activities, your child's physician may recommend preventive medications to stop the headaches before they start.

Maria Gieron-Korthals is a professor of pediatrics, neurology and psychiatry and behavioral medicine at University of South Florida Health.

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