Many parents worry that their child’s headache is a sign of a brain tumor or other serious medical condition. This is usually not the case. Stress and muscle tension or migraine cause most of the headaches seen in children and adolescents. Headaches can also occur with fever, colds, the flu, and other upper respiratory infections. However, only your doctor can evaluate your child’s headache to determine its cause.

When might a headache be a symptom of a more serious health problem?

A more serious problem may exist when a child’s headaches:

  • Increase in number (three or more a week), keep getting worse, or won’t go away.
  • Don’t respond to simple therapy.
  • Wake the child from sleep.
  • Are triggered by exertion, coughing, bending, or strenuous activity.
  • Occur along with balance problems, loss of muscle strength in the limbs, vision problems, dizziness, or loss of consciousness.
  • Occur along with a stiff neck or fever.
  • Occur along with projectile vomiting, blurred vision, and confusion.
  • Occur and there is no family history of similar headaches.
  • Occur and there is a family history of neurological disease.

Neurologic symptoms that may indicate a brain problem as the cause of the headache include:

  • Seizures — loss of consciousness.
  • Ataxia — loss of muscle coordination, especially of the arms and legs (for example, can’t walk, pick up objects, or maintain balance).
  • Lethargy — sluggish, sleepy, tiredness.
  • Weakness — especially on one side of the body.
  • Nausea and vomiting — especially if it occurs in the early morning or is becoming more frequent or more severe.
  • Visual problems — blurred vision, double vision, decreased vision, eye movement problems, blind spots.
  • Personality change — acting inappropriate or a change from previous behavior, feeling sad or depressed, rapid mood swings from happy to sad or sad to happy.
  • Slurred speech or numbness/tingling.

Other signs of a more serious health problem:

  • Abnormal temperature, breathing, pulse, or blood pressure.
  • Swelling (inflammation) of the optic nerve (this condition is also called papilledema). (The optic nerve is the nerve in the back of the eye.)
  • An enlarged head.
  • A noise, called a bruit, in the head heard through a stethoscope.
  • Coffee-colored spots on the skin.
  • An abnormal neurological exam.

What known serious medical conditions can cause a headache?

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 pressure in the brain)
  • Seizure disorders
  • Trauma (injury) to the head
  • Changes in metabolic functions, such as changes in blood sugar level, sodium level, or dehydration
  • Drinking chemicals or poisons

How do doctors determine if my child’s headaches indicate a serious health problem?

First, your doctor reviews the child’s headache history. Your doctor will ask how often the headaches occur, how long they last, and any signs and symptoms that occur before, during, or after the headaches. Your doctor will also perform physical and neurological exams to look for signs of an illness that may be causing the headache.

Tests your doctor may order include a MRI scan (magnetic resonance imaging) and a MRA scan (magnetic resonance imaging of the arteries). Both imaging tests show the tissues and arteries in the brain. Skull X-rays are not helpful. Unless the child has lost consciousness while having headaches or a seizure is suspected, an EEG (electroencephalogram) is not needed. If a patient arrives at a hospital’s emergency room, a CT scan is often ordered.

When should I call my doctor about my child’s headache symptoms?

Contact your health care provider as soon as possible if your child has experienced ANY of the symptoms or signs mentioned above. In addition, call if your child:

  • Needs to take a pain reliever more than two or three times a week for the headaches.
  • Needs more than the recommended doses of over-the-counter (nonprescription) medications to relieve headache symptoms.
  • Misses school due to the headaches.

Last reviewed by a Cleveland Clinic medical professional on 08/29/2017.

References

  • Cleves C, Rothner AD. Headache in Children and Adolescents: Evaluation and Diagnosis, including Migraine and its Subtypes. Chapter 6. In: Tepper SJ, Tepper DE, eds. The Cleveland Clinic Manual of Headache Therapy. New York: Springer 2011:81-92.
  • Rothner AD. Treatment of Pediatric and Adolescent Headaches. Chapter 15. In: Tepper SJ, Tepper DE, eds. The Cleveland Clinic Manual of Headache Therapy. New York: Springer 2011:209-24.

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