A Pain in the Head

Most kid’s headaches have a benign cause. They are usually related to various stresses in the child’s life, and usually do not have an underlying vascular cause.

Headaches can occur as one episode or be recurrent. They are defined as being of daily occurrence when they occur on 15 days in one month.

Treatment with simple analgesics and the child’s will usually resolve within a few hours.

Some medicines useful in adults, such as aspirin and specific migraine treatment sumatriptan, should be not given to children.

A child’s headache requires a holistic approach. It can be due to the age of the child is at. Headache may be a symptom of growth, puberty or the inability to deal with daily stresses unique to their development stage.

Recurrent headache warrants further investigation and sometimes referral. Referral to a neurologist is recommended if there are complicated pattern of headache, the pain doesn’t respond to treatment or there is the suspicion of structural involvement as a cause.

Headache should never be ignored. It may indicate an underlying sinister condition, so it is important to identify the cause.

The doctor will take a history of the headache and perform a physical exam and this will usually preclude the necessity for further investigation.

Early diagnosis of a serious illness underlying headache is very important.

Headache symptoms that require further investigation include:

  • Changes in the severity or position of the pain and the frequency of occurrence.
  • Headaches that occur in the morning or cause the child to wake in the night.
  • Constant headaches or ones that recur daily.
  • Pain doesn’t respond to treatment with simple analgesics and is aggravated by sneezing, coughing or straining.
  • Vomiting with no nausea.
  • No family history of headache or migraine.
  • Loss of appetite.
  • Changes in the child’s mental state including performance in school, inability to concentrate, mood swings, irritability, visual disturbances.
  • Problems with gait, motor weakness or symptoms of ataxia.
  • Recent onset of visual disturbances such as double vision or squint or seizures.

Imaging of the brain is performed if there is a suspicion of some structural problem. Getting the all clear from these investigations provides reassurance that there is no sinister underlying cause.

Episodic headaches in children are usually tension headaches or migraines. Most recurrent primary headaches in children are caused by migraines and they are the most common reason for referral to a neurologist.

Paediatric migraines are often bilateral occurring on both sides of the head and the pain is often difficult to locate. Both types of migraine, with and without aura, occur in children, but it is less common to have an associated aura. Migraines can remit spontaneously in children but they can recur later in life at times of stress.

Drug treatment options for headache are limited. Treatment with simple analgesics can be successful in tension headaches and some migraines. Managing migraine in children is more difficult because sumatriptan is not recommended for children. Ergotamines may help treat migraines with aura if administered at onset of the aura.

Prophylactic, just in case prevention, medicines for recurrent paediatric headaches includes the use of beta-blockers and tricyclics, and anticonvulsants if there is associated seizure.

If neuroimaging excludes the possibility of an underlying serious condition, then several simple strategies can be used to reduce pain. These include reducing and tackling the source of any stress or anxiety in the child’s life. During a migraine attack, rest or sleep in a darkened quiet room will usually help. Regular relaxation, exercise and healthy eating are also useful lifestyle strategies that can help.

Certain dietary or behavioural triggers should be avoided. Some common triggers of migraine include some drugs or too much alcohol, caffeine, MSG, salt or alcohol. Stress or anxiety, lack of sleep or hunger, menstruation and over-exercise are also common triggers.

Psychotherapy may be warranted when the child has regular headaches that are triggered by particularly stressful life events, such as bullying in school, or problems in the home, such as a recent parental divorce.

Conor Caffrey is a science and medical writer.


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