Pediatric Headaches: Red Flags and When to Seek Treatment

Headaches are common in children. They are usually a result of minor illnesses, a mild head injury, lack of sleep, not getting enough to eat or drink, or stress. However, some headaches in children could indicate something more serious, especially for those under 6 years old. This article will discuss the top red flags of pediatric headaches, as well as when to seek professional treatment for your child.

a young boy with a headache

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An Overview of Pediatric Headaches

The majority of headaches children experience are not a cause for concern. There are many ways to classify headaches, and one way to do that is to divide them into primary or secondary headaches.

Primary headaches are not caused by underlying conditions, and include migraines, cluster headaches, and tension headaches. Migraines are moderate-to-severe headaches that last from two to 48 hours, and usually occur two to four times per month.

Tension headaches are usually triggered by stress and mental or emotional conflicts, while cluster headaches occur in a series lasting weeks or months and they may return every year or two.

Secondary headaches are driven by problems in the structure of the brain due to another health condition. Secondary headaches are less common than primary headaches.

How Common Are Migraines Among Children?

Migraine, also called an acute recurrent headache, occurs in about 3% of preschool children, 4%–11% of elementary school-aged children, and 8% to 15% of high school-aged children.

What Are the Causes of Pediatric Headaches?

The exact cause of headaches is not completely known. Causes may include:

  • Tight muscles in the head or neck
  • Blood vessels that become dilated or widened in the brain
  • Changes in chemical or electrical signaling in the brain
  • Alteration in the communication between parts of the nervous system that relay information about pain
  • Tumor or malformation in the brain
  • Lack of sleep and poor sleep quality

Pediatric Headache Symptoms and Red Flags

Symptoms vary depending on what type of headache your child has.

Migraines

For migraines, symptoms may include:

  • Pain on one or both sides of the head or all over
  • Pain may be throbbing or pounding
  • Sensitivity to light or sound
  • Nausea and vomiting
  • Abdominal discomfort
  • Sweating

Your child may become quiet or pale. Some children have an aura, a warning sign that a migraine is coming on, such as seeing flashing lights, experiencing a change in vision, or detecting funny smells.

Tension Headaches

If your child has tension headaches, they may have these symptoms:

  • Headache comes on slowly.
  • Head usually hurts on both sides.
  • Pain is dull or feels like a band around the head.
  • Pain may involve the back of the head or neck.
  • Pain is mild to moderate, but not severe.
  • You may notice changes in your child's sleep habits.

Children with tension headaches typically do not experience nausea, vomiting, or light sensitivity.

Cluster Headaches

Common symptoms of cluster headaches include:

  • Severe pain on one side of the head, usually behind one eye
  • A droopy lid, small pupil, or redness and swelling of the eyelid if your child's eye is affected
  • Runny nose or congestion
  • Swollen forehead

Red Flags

Symptoms that may suggest a more serious underlying cause of the headache may include:

  • Your child is very young.
  • Your child is woken by the pain of their headache.
  • Your child's headaches start very early in the morning.
  • Your child's pain is worsened by strain, such as a cough or a sneeze.
  • Your child has recurrent episodes of vomiting without nausea or other signs of a stomach virus.
  • The onset of pain is sudden and your child describes it as the "worst headache" ever.
  • Your child's headache is becoming more severe or continuous.
  • Your child starts to show personality changes as the headache syndrome evolves.
  • Your child has changes in their vision.
  • Your child has weakness in the arms or legs or balance problems.
  • Your child starts to have seizures or epilepsy.

If your child has any of these red flags, you should take your child to see their pediatrician as soon as possible.

Diagnosis and Treatment of Pediatric Headaches

The diagnosis of a headache is made with a careful history, physical exam, and diagnostic tests. During the exam, the doctor will take a complete medical history of the child and family. The doctor will want to know when the headaches occur, the location of the headache, what it feels like, and how long it lasts.

If the history is consistent with migraine or tension type headaches and the neurological exam is normal, no further diagnostic testing may be necessary. In other cases, the pediatrician will order other tests, including:

  • Blood tests: A blood test will be taken to check for levels of certain nutrients such as iron or ferritin, a blood protein that carries iron, and the function of the thyroid, which is a gland at the base of the neck that makes hormones for various bodily functions. Your child's pediatrician will also order a complete blood count to determine your child’s overall level of health. 
  • Brain scans: An magnetic resonance imaging (MRI) or computed tomography (CT) scan can capture images of the brain. Your child's doctor can get a better look at your child's brain and find any abnormalities that could be causing the headaches.
  • Polysomnogram: This is a test that is usually done in a sleep lab. It involves recording breathing and muscle movements. A polysomnogram is generally done if your child's doctor suspects a sleep disorder, such as sleep apnea, in which breathing repeatedly stops and starts.

Just because your child's doctor wants to investigate further does not mean that the doctor is looking for a brain tumor or another equally serious condition. Instead, they are often trying to get answers. Try to help your child be as relaxed and stress-free as possible during the process.

You can help your child with over-the-counter (OTC) pain relievers, such as Tylenol (acetaminophen), Advil (ibuprofen), and Aleve (naproxen). Children’s Advil is commonly used because most children respond well to the medication. If nausea is present, anti-nausea medications can also be given.

Triptans, which are migraine medications, may also be used if your child has migraines. They act as a brain chemical that can reduce pain signaling in the brain. They are available as a prescription, and are typically only used if OTC medications don’t work.  

Treatment for secondary headaches caused by underlying conditions depends on the specific issue.

How Often Can I Give My Child Pain Medication for Headaches?

Medications designed to treat primary headaches, both OTC and prescription ones, should be used sparingly so they don’t cause rebound headaches, which are brought on by the overuse of pain relievers. OTC drugs such as Advil should be given no more than three days a week, and triptans should be used a maximum of nine times per month.

Ways to Prevent Pediatric Headaches

Although not all headaches can be prevented, you can manage certain lifestyle factors that contribute to your child's headache. Some lifestyle changes you can help your child make include:

  • Sleep: Not getting enough sleep can lead to a headache, so it is crucial to make sure that your child has adequate, good-quality sleep every night. Children typically need seven to nine hours per night.
  • Diet: Watch for potential connections between certain foods such as processed meat, cheese, chocolate, nuts, and pickles and your child's headaches. If your child eats pickles, for example, and gets a headache, you could limit or get rid of pickles from their diet once you know there’s a connection.
  • Behavioral therapy: If stress is contributing to your child’s headaches, you can help them manage it through meditation, yoga, and other relaxation exercises. Managing their stress if it is causing headaches will go a long way to help prevent headaches in your child.

If your child has migraines that occur frequently, preventive medications may be used. They could include:

  • Topamax (topiramate): This medication was originally used to treat epilepsy, but it can be used in the prevention of migraines as well.
  • Beta-blockers: Beta-blockers work by reducing the widening of blood vessels that can contribute to the development of a migraine. Examples include Tenormin (atenolol) and Kerlone (betaxolol).
  • Arlevert (cinnarizine): This medication is an antihistamine and calcium channel blocker. It stops muscles on the walls of blood vessels from contracting, which can help prevent a migraine from happening.
  • Elavil (amitriptyline): Typically, amitriptyline is used to treat depression. For migraines, it works by increasing the level of serotonin in the brain. Higher levels of serotonin change the way that certain nerves in the brain get pain signals, which results in less pain from the migraine.

Summary

Headaches are common in children, and most cases are mild and not something you need to worry about. However, sometimes headaches in children can be a result of a serious underlying condition. Look for symptoms that may suggest that your child's headache is caused by a serious underlying condition, including personality changes, seizures, and balance issues in your child.

A Word From Verywell

It can be difficult to watch your child going through a headache. The good news is that most of the time that children get headaches, the cause is manageable through various lifestyle changes and over-the-counter treatments.

If you suspect your child’s headache is caused by a health condition and you noticed some red flags, you can make an appointment with your doctor to get a proper diagnosis. The quicker you find out what the cause behind your child’s headache is, the quicker you can help them get it treated.

Frequently Asked Questions

How do I know when a pediatric headache turns into a migraine?

The symptoms of a migraine are specific in nature, so it can be easy to tell when a headache becomes a migraine. One such symptom that may alert you to a migraine is pain that worsens with physical activity. Some children have a difficult time relaying their symptoms, especially if they are young, so if you notice any symptoms of worsening head pain like crying, your child likely has a migraine.

When should I be concerned about my child’s headache?

There are many red flags that are a cause for concern. If symptoms such as vomiting without nausea, balance issues or weakness in the legs and arms, and a fever with a stiff neck are present with your child’s headache, you should go them to their doctor as soon as possible. These symptoms, along with personality changes, early morning headaches, and fainting or seizures are all indications that an underlying condition may be causing your child's headache.

Will screen time impact pediatric headaches?

Research has shown that overuse of electronics and spending too much time staring at a screen can trigger or exacerbate (worsen) a headache in children. To help reduce the risk of your child getting a headache from too much screen time, you can limit their electronic use to less than two hours per day.

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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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