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Headaches in Children and Adolescents: When Should a More Serious Problem be Suspected?

Headaches are very common in children and adolescents. In fact, one study reported that 56% of boys and 74% of girls between the ages of 12 and 17 have a headache within any given 30-day period.

Most headaches in children and adolescents are the result of stress and muscle tension or migraine. Headaches are also common symptoms of colds and the flu. Many parents worry that their child’s headache is a sign of a brain tumor or serious medical condition. This is usually not the case, but only your doctor can evaluate your child’s headache to determine the underlying cause.

Headache evaluation

During the headache evaluation, your child’s headache history will be taken. This involves asking your child or you about your child’s current and previous headaches -- their frequency, duration, and associated symptoms. Your doctor will also perform physical and neurological exams to look for signs of an illness that may be causing the headache.

What information might indicate a more serious health problem?

A more serious problem should be considered when the child’s general or neurological history and exams reveal any of the following:

Symptoms

  • Headaches that are progressive in frequency or severity
  • Headaches that don’t respond to simple therapy
  • Headaches that awaken the child from sleep
  • Problems with balance, motor movement strength, vision; or loss of consciousness
  • Headaches that are accompanied by a stiff neck or fever
  • Headaches that are accompanied by symptoms such as projectile vomiting, blurred vision and confusion
  • No family history of similar headaches
  • A family history of neurological disease

Neurologic symptoms (which may indicate a problem in the brain as the cause of the headache) include:

  • Seizures—loss of consciousness
  • Ataxia — impaired ability to coordinate movement, loss of balance
  • Lethargy — sluggish, sleeping way too much
  • Weakness — especially on one side of the body
  • Nausea and vomiting — especially very frequent, early morning, or progressive vomiting
  • Visual problems — blurred vision, double vision, blind spots
  • Personality change — inappropriate behavior or a change from previous behavior, feeling sad or depressed, rapid mood swings from happy to sad or sad to happy

Signs

  • Abnormalities of temperature, breathing, pulse or blood pressure
  • Inflammation of the optic nerve (the nerve in the back of the eye); a condition also called papilledema; decreased vision, double vision, or eye movement problems
  • An enlarged head
  • A noise or bruit in the head heard through a stethoscope
  • Coffee-colored spots on the skin
  • Any abnormality on the neurological exam
  • Problems with balance, motor movement or strength, or vision (eye movements or double vision)

Serious medical conditions that may cause a headache include:

  • Brain tumor
  • Abscess (infection of the brain)
  • Intracranial bleeding (bleeding within the brain)
  • Bacterial or viral meningitis (infections)
  • Hydrocephalus (excess cerebrospinal fluid in the brain)
  • Pseudotumor cerebri (increased intracranial pressure)
  • Other causes -- such as trauma to the head or ingestion of toxins (chemicals/poisons)

Diagnosis

A MRI scan (magnetic resonance imaging) and a MRA scan (magnetic resonance imaging of the arteries) are two types of tests your doctor may use to help determine if a serious medical problem is the cause of your child’s headaches. Both of these imaging tests allow the tissues and arteries within the brain to be seen and evaluated. Skull X-rays are not helpful. An EEG (electroencephalogram) is unnecessary unless the child has lost consciousness with his or her headaches. Frequently, a CT scan is ordered if a patient arrives at a hospital’s emergency room.

When to call the doctor

Contact your health care provider if your child:

  • Has a stiff neck or a fever in addition to the headaches
  • Is short of breath, dizzy, has slurred speech, or numbness/tingling with the headaches
  • Has blurred vision, double vision or blind spots with the headaches
  • Has three or more headaches per week
  • Has headaches that keep getting worse and won’t go away
  • Needs to take a pain reliever more than 3 or 4 times per week for the headaches
  • Needs more than the recommended doses of over-the-counter (nonprescription) medications to relieve headache symptoms
  • Has headaches that are triggered by exertion, coughing, bending or strenuous activity
  • Has headaches that wake him or her up in the middle of the night
  • Misses school
  • Has any other symptoms or signs listed in this document.

Important

Children and adolescents who experience headaches that progress -- that is, become more severe and/or frequent over time -- and particularly those who also have the symptoms mentioned on this page and/or have an abnormal neurological exam may have a more serious health problem. Children and adolescents fitting this description should be seen by their doctor as soon as possible.

© Copyright 1995-2009 The Cleveland Clinic Foundation. All rights reserved.

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/1/2009...#9642