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Diseases & Conditions

Learn More About Pediatric Headaches

Informational Podcasts

Headaches are among the most problems encountered in adolescents; up to 30 percent of adolescents experience frequent migraine or tension headaches and half of those destined to suffer from migraines experience their first migraine before they turn 18. Listen to free audio files from Cleveland Clinic about headaches in children and adolescents.

Overview of Headaches in Children and Adolescents

Kids get headaches, too! Many adults with headaches started having them as kids – in fact 20% of adult headache sufferers say their headaches started before age 10, and 50% report their headaches started before age 20.

How Common Are Headaches in Children and Adolescents?

Headaches are very common in children and adolescents. In one study, 56 percent of boys and 74 percent of girls between the ages of 12 and 17 reported having had a headache within the past month. By age 15, 5 percent of all children and adolescents have had migraines and 15 percent have had frequent non-progressive or tension-type headaches.

Many parents worry that their child’s headache is the sign of a brain tumor or serious medical condition, but most headaches in children and adolescents are not the result of a serious illness. When to worry about your child's headaches.

What Are the Common Types of Headaches in Children and Adolescents?

A comprehensive headache classification guide was established by the International Headache Society and includes more than 150 diagnostic headache categories.

Based on research, a practical headache classification includes primary and secondary headaches. The Cleveland Clinic classification of headaches in children and adolescents is included below.

Primary Headaches

Primary headaches are those headaches that are not the result of another medical condition. They include:

Acute recurrent headaches or migraines — a migraine is a moderate to severe headache that lasts from 1 to 24 hours and usually occurs 2 to 4 times per month. The pain is often throbbing and affects the front or both sides of the head. Common symptoms of migraines in children and adolescents include paleness (pallor), decreased appetite, dizziness, blurred vision, fever, stomach upset, nausea and vomiting. The child may also be very sensitive to light, noise or smells and want to sleep.

A small percentage of pediatric migraines include “cyclic” or recurrent gastrointestinal symptoms of which vomiting is most common. Cyclic vomiting means that the symptoms occur on a regular basis – about once a month. These types of migraines are sometimes called abdominal migraines.

Chronic nonprogressive headaches or tension-type headaches — frequent or daily headaches or headaches that come and go over a prolonged period of time without causing neurological symptoms. These are the most common types of headache among adolescents. About 15% of children and adolescents suffer from tension-type headaches.

Secondary Headaches

Secondary headaches are those headaches that result from another medical condition. They include the following:

Acute headaches — headaches that occur suddenly for the first time with symptoms which subside after a relatively short period of time. Acute headaches most commonly result in a visit to the pediatrician’s office and/or the emergency room. If there are no neurological signs or symptoms, the most common cause for acute headaches in children and adolescents is a respiratory or sinus infection.

Chronic progressive headaches — headaches that get worse and happen more often over time. These are the least common types of headache, accounting for less than 2% of all children’s headaches, according to the National Headache Foundation.

What Causes Headaches in Children and Adolescents?

Acute headaches are usually due to an illness, infection, cold or fever. Other conditions that can cause an acute headache include sinusitis (inflammation of the sinuses), pharyngitis (inflammation or infection of the throat) or otitis (ear infection or inflammation).

Children or adolescents who go to the emergency room with acute headaches may have migraine or tension-type headaches. In some cases, the headaches may be the result of a blow to the head (trauma) or rarely, the sign of a more serious medical condition.

The exact causes of acute recurrent headaches or migraines are unknown, although they are related to changes in the brain as well as to genetic causes. For many years, scientists believed that migraines were linked to the expanding (dilation) and constriction (narrowing) of blood vessels on the brain’s surface. However, it is now believed that migraines are caused by inherited abnormalities in certain areas of the brain.

There is a migraine “pain center” or generator in the mid-brain area. A migraine begins when hyperactive nerve cells send out impulses to the blood vessels, causing constriction, followed by the dilation of these vessels and the release of prostaglandins, serotonin and other inflammatory substances that cause the pulsation to be painful.

Most children and adolescents (90%) who have migraines have a family history of migraines. When both parents have a history of migraines, there is a 70% chance that the child will also develop migraines. If only one parent has a history of migraines, the risk drops to 25% to 50%. Children and adolescents with migraines may also inherit the tendency to be affected by certain migraine triggers, such as fatigue, bright lights, weather changes and other triggers.

Some migraine triggers can be identified such as stress, anxiety, depression, a change in routine or sleep pattern, bright light, loud noises or certain foods, food additives and beverages. Too much physical activity or too much sun can trigger a migraine in some children or adolescents.

Common causes of chronic nonprogressive headaches or tension-type headaches include striving for academic excellence as well as emotional stress related to family, school or friends; tension and depression.

Other causes of tension-type headaches include eye strain and neck or back strain due to poor posture.

When chronic progressive headaches worsen over time and occur along with other neurological symptoms, they can be the sign of a disease process in the brain (organic cause) such as:

  • Hydrocephalus (abnormal build-up of fluid in the brain
  • Infection of the brain
  • Meningitis (an infection or inflammation of the membrane that covers the brain and spinal cord)
  • Encephalitis (inflammation of the brain)
  • Hemorrhage (bleeding within the brain)
  • Tumor
  • Blood clots
  • Head trauma
  • Abscess

How Are Headaches Evaluated and Diagnosed in Children and Adolescents?

The good news for pediatric and adolescent headache sufferers is that once a correct headache diagnosis is made, an effective treatment plan can be started.

If your child has headache symptoms, the first step is to take your child to his or her family physician. The family physician will perform a complete physical examination and a headache evaluation. During the headache evaluation, your child’s headache history and description of the headaches will be evaluated. You and your child will be asked to describe the headache symptoms and characteristics as completely as possible.

A headache evaluation may include a CT scan or MRI if a structural disorder of the central nervous system is suspected. Both of these tests produce cross-sectional images of the brain that can reveal abnormal areas or problems. Skull X-rays are not helpful. An EEG (electroencephalogram) is also unnecessary unless the child has lost consciousness or has abnormal muscle contractions or other abnormal symptoms with a headache.

If your child’s headache symptoms become worse or become more frequent despite treatment, ask your family physician for a referral to a specialist. Children should be referred to a pediatric neurologist, and adolescents should be referred to a headache specialist. Your family physician should be able to provide the names of headache specialists. If you need more information, contact one of the organizations in the resource list for list of member physicians in your state.

How Are Headaches Treated in Children and Adolescents?

The family physician may recommend different types of treatment to try. You should establish a reasonable time frame with the family physician to evaluate your child’s headache symptoms.

The proper treatment will depend on several factors, including the type and frequency of the headache, its cause and the age of the child. Treatment may include education, stress management, biofeedback and medications.

Headache Education

Headache education includes identifying and recording what triggers your child’s headache, such as lack of sleep, not eating at regular times, eating certain foods or additives, caffeine, environment or stress. Helping your child keep a headache diary can help you and your child record this information. Avoiding headache triggers is an important step in successfully treating the headaches.

Stress Management

To successfully treat tension-type headaches, it is important for kids and their parents to identify what causes or triggers the headaches. Then they can learn ways to cope or remove the stressful activities or events.

Biofeedback

Biofeedback equipment includes sensors connected to the body to monitor your child’s involuntary physical responses to headaches, such as breathing, pulse, heart rate, temperature, muscle tension and brain activity. By learning to recognize these physical reactions and how the body responds in stressful situations, biofeedback can help your child learn how to release and control tension that causes headaches to better cope.

Medications

There are three categories of headache medications for children, including symptomatic relief, abortive and preventive medications. Many of the medications used to treat adult headaches are used in smaller doses to treat headaches in children and adolescents. Many of the medications used to treat pediatric headaches have not been specifically approved for use in children. However, research is ongoing to study the effects of these headache medications on children.

Aspirin should not be used to treat headaches in children under age 15 to reduce the risk of Reye’s syndrome, a rare disorder that kids get when they are recovering from childhood infections such as chicken pox or the flu.

What Happens After My Child Starts Treatment?

When your child’s physician starts a treatment program, keep track of the results by using a headache diary, and record how the treatment program is working. Keep your child’s scheduled follow-up appointments so your child’s doctor can monitor your child’s progress and make changes in the treatment program as needed.

Do Children Outgrow Headaches?

Headaches may improve as your child gets older. The headaches may disappear and then return later in life. By junior high school, many boys who have migraines outgrow them, but in girls, migraine frequency increases because of hormone changes. Migraines in adolescent girls are three times more likely to occur than in boys.

When to Worry About Your Child’s Headaches

Fortunately, less than 2% of pediatric and adolescent headaches are the result of a serious disease or physical problem.

When should a more serious problem be considered?

Medical History

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

  • New headaches that have been occurring for less than 6 months, are worsening and do not improve after treatment
  • Progressive headaches: headaches that are becoming more severe and frequent over time
  • No family history of similar headaches
  • A family history of neurological disease
Physical Exam

A more serious problem should be considered when your child’s physical exam reveals any of the following:

  • Abnormalities of temperature, breathing, pulse or blood pressure
  • Inflammation of the optic nerve, the nerve in the back of the eye
  • An enlarged head
  • A noise or bruit in the head heard through a stethoscope
  • Coffee-colored spots on the skin
Neurological Symptoms

A more serious problem should be considered when your child has any of these neurological symptoms:

  • Nausea or vomiting
  • Weakness
  • Dizziness
  • Sudden loss of balance or falling
  • Numbness or tingling
  • Paralysis
  • Speech difficulties
  • Mental confusion
  • Seizures
  • Loss of consciousness
  • Personality changes/inappropriate behavior
  • Vision changes (blurry vision, double vision or blind spots)
  • Lethargy: being indifferent, apathetic or sluggish, or sleeping too much

A structural disorder of the central nervous system, as listed below, may be suspected in the development of serious headaches:

  • Tumor
  • Abscess
  • Hemorrhage (bleeding within the brain)
  • Bacterial or viral meningitis (an infection or inflammation of the membrane that covers the brain and spinal cord)
  • Pseudotumor cerebri (increased intracranial pressure)
  • Hydrocephalus (abnormal build-up of fluid in the brain)
  • Infection of the brain
  • Encephalitis (inflammation of the brain)
  • Blood clots
  • Head trauma