Pediatric Headache Red Flags and When to Seek Treatment

Learning about pediatric headache "red flags" can help you figure out if your child's head pain is from a minor cause—like common childhood illnesses, a mild bump on the head, lack of sleep, not getting enough to eat or drink, or stress.

Knowing how to spot headache "red flags" in kids can also help you determine if your child's pain could be from something more serious, or even alert you that it's time to go to the ER.

This article will go over the red flags of pediatric headaches, as well as the more common causes of headaches in kids, how they're diagnosed, and how you can treat and prevent them.

Pediatric Headache Red Flags

While headaches are not always a serious problem for kids, there are some cases where a child's headache could be a sign of something more serious.

You should call your child's pediatrician if you notice any pediatric headache red flag signs or symptoms, such as:

• Your child is very young (under age 6) and has headaches
• Your child is woken from sleep by the headache pain
• Your child's headaches start very early in the morning
• Your child's headache pain gets worse when they strain (such as with a cough or sneeze)
• Your child has recurrent episodes of vomiting and does not have nausea or other symptoms of a stomach virus
• Your child's headache pain comes on suddenly and they describe it as the "worst headache ever"
• Your child has a bad headache, a stiff neck, and a very high fever
• Your child's headache is getting more severe or has become continuous
• Your child starts to show personality changes
• 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 develops epilepsy

Is It Normal for Kids to Get Headaches?

Many children get headaches from time to time and some may have headache disorders. Headaches in kids and adults can be grouped into two types: primary or secondary.

Primary headaches are not caused by underlying health conditions. For example, migraines, cluster headaches, and tension headaches are primary headaches.

• Migraines are also called acute recurrent headaches. They are moderate-to-severe headaches that last from two to 48 hours. People may get two to four migraines a month.
• Tension headaches are usually triggered by stress and mental or emotional upset.
• Cluster headaches occur in a series lasting weeks or months and can come back every year or two.

Secondary headaches are less common than primary headaches. They are caused by another health condition or something wrong with the brain structure.

What Causes Pediatric Headaches?

We're not really sure what causes headaches, exactly. There are some physical health factors that we know contribute to headaches, such as:

• 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
• Communication problems in the parts of the nervous system that send pain signals
• Tumor or malformation in the brain
• Lack of sleep and poor sleep quality

Common Types of Pediatric Headaches

The signs or "red flags" of a pediatric headache as well as the symptoms will depend on which type of headache your child is having.

Migraines in Kids

If your child is having a migraine, they may become quiet or pale. Some kids have a warning sign that a migraine is coming on, such as seeing flashing lights, experiencing a change in vision, or detecting funny smells. This is called a migraine with aura.

Common symptoms of a migraine 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

Tension Headaches in Kids

Unlike migraines, tension headaches in children typically do not come with nausea, vomiting, or light sensitivity. Symptoms of a tension headache your child might experience include:

• Pain that comes on slowly
• Pain on both sides of the head
• 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, not severe
• Changes in sleep habits
  

Cluster Headaches in Kids

Kids can also get cluster headaches. Common symptoms of a cluster headache include:

• Severe pain on one side of the head (usually behind one eye)
• An affected eye with a droopy lid, small pupil, or redness and swelling of the eyelid
• Runny nose or congestion
• Swollen forehead
  

How Pediatric Headaches Are Diagnosed

To diagnose pediatric headaches, your child's provider will take a medical history, do a physical exam, and possibly run some diagnostic tests.

They will ask you about your child's health and the health of your family. They will also ask you about your child's headaches—for example, where the pain is, what it feels like, how long it lasts, and how often your child gets headaches.

Your answers to these questions may match up with the typical signs and symptoms of a migraine or tension-type headaches. If your provider does a neurological exam on your child and it is normal, they may not do any more tests.

If they do want to run more tests, try not to panic. You may think the worst—for example, that they are looking for a serious problem like a brain tumor—but that's not necessarily the case. They are just trying to get as much information as possible to make sure they find out what is causing your child's headaches.

Other tests that can be used to diagnose pediatric headaches include:

• Blood tests: Checking the levels of certain nutrients in the body, such as iron or ferritin (a blood protein that carries iron), as well as the function of the thyroid (a gland at the base of the neck that makes hormones) can help your child's provider figure out what could be causing their headaches. They can also run a complete blood count to get a better picture of your child's overall health.
• Brain scans: Magnetic resonance imaging (MRI) or computed tomography (CT) scans take pictures of your child's brain. The images can help your child's provider spot any abnormalities that could be causing headaches.
• Polysomnogram: Not getting enough sleep or getting poor sleep can trigger headaches. Your child may have a test in a sleep lab that records their breathing and muscle movements as they sleep. A polysomnogram might be done if your child's provider thinks they could have a sleep disorder such as sleep apnea (which causes breathing to repeatedly stop and start during sleep).

How Pediatric Headaches Are Treated

Over-the-counter (OTC) pain relievers like Tylenol (acetaminophen), Advil (ibuprofen)/Children's Advil; and Aleve (naproxen) can ease your child's headache symptoms. If your child has nausea with headaches, their provider might give them medication to help with that symptom as well.

Your child's provider might recommend specific prescription medications, depending on which type of headaches your child gets.

For example, triptans are a prescription medication for migraines. They act as a brain chemical to reduce pain signaling in the brain. They are usually only used when OTC medications have not helped your child's pain and other headache symptoms.

Examples of some other prescription medications that can be used to treat pediatric migraines include:

• Topamax (topiramate): This medication was originally used to treat epilepsy, but it can be used to prevent migraines.
• Beta-blockers: Beta-blockers reduce the widening of blood vessels that can contribute to the development of a migraine. Tenormin (atenolol) and Kerlone (betaxolol) are beta-blockers that can help prevent migraines.
• 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.
• Elavil (amitriptyline): This drug is most often used to treat depression. For migraines, it works by increasing the level of a neurotransmitter called 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. 

If your child is getting headaches from an underlying health condition, treating that condition will often help relieve their headache pain.

How to Prevent Pediatric Headaches

You can't always prevent pediatric headaches. There are some lifestyle changes and proactive steps you can take to help make it less likely that your child will get a headache and make it easier for them to cope when they do.

• Sleep: Not getting enough sleep can lead to a headache in people of all ages. Make sure that your child is getting enough good-quality sleep every night. Children typically need 7 to 9 hours of sleep per night.
• Diet: You might notice that foods such as processed meat, cheese, chocolate, nuts, and pickles seem to trigger your child's headaches. If you notice that your child gets headaches after eating certain foods, try cutting them out of their diet or at least limiting them to see if it helps reduce their headaches.
• Behavioral therapy: If stress is contributing to your child’s headaches, meditation, yoga, and other relaxation exercises can help them cope.

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

If your child is getting headaches often, talk to their pediatrician. Even if the cause turns out to be something that's not serious and easy to treat, your child's provider is the best resource for figuring out how to ease your child's pain and even prevent headaches in the future.