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 child's 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.
How common are headaches in children and adolescents?
Headaches are common in children and adolescents. Among children ages 5 to 17 years of age, 20% have reported getting headaches. The most common types of headaches in this age group are tension headaches (reported by 15%) and migraine (reported by 5%). Many parents worry that their child’s headache is the sign of a brain tumor or serious medical condition. However, less than 3% of headaches are the result of these conditions. Many headaches in children and adolescents are the result of stress and lifestyle issues.
What types of headaches are seen in children and adolescents?
The International Headache Society lists more than 150 headache types. In general, headaches are broken down into four main categories:
- Migraine. These are episodic (occurs a few times a month) severe headaches with sensitivity to light and noise followed by nausea and vomiting. Migraine can be hereditary. About 60% of people who have a migraine also have an immediate family member (mother, father, sister, brother) who have migraine.
- Episodic tension (less than 15 days/month), chronic (more than 15 days/month) daily headache, or chronic non-progressive headache. These headaches occur daily or a few times a month, but patients do not experience the symptoms of migraine listed above.
- Mixed headache syndrome. These are a combination of migraine and chronic non-progressive (tension) headaches. Mixed headache syndrome is also called chronic migraine or transformed migraine. Patients with mixed headache syndrome have headaches more than 15 days/month.
- Traction and inflammatory headaches. These headaches may be due to an illness or brain disorder – for example, a brain tumor or bleeding within the
Cleveland Clinic classifies headaches in children and adolescents by when the headaches start, how long they last, and how often they occur. The general categories of headaches are:
- Acute headaches. These headaches occur suddenly for the first time with symptoms that may resolve within a short period of time. Acute headaches are a common reason for visits to a pediatrician’s office and/or an emergency room. Children or adolescents who go to the emergency room with acute headaches may have migraine or tension headaches. However, there are many other conditions that may cause acute headaches. These include simple illnesses (such as flu, infection, or fever), sinusitis (inflammation of the sinuses), pharyngitis (inflammation or infection of the throat), otitis (ear infection or inflammation), or be the result of a blow to the head (trauma). In athletes, exertion may cause headaches.
In rare cases, acute headaches can be a sign of a more serious medical condition, such as 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), or tumor. In addition to headaches, children and adolescents with these problems usually have neurological symptoms including stiff neck, seizures, morning vomiting, balance difficulty, vision problems, and weakness on one side of the body.
- Acute recurrent headaches or migraines. – Migraines are moderate-to-severe headaches with symptoms that last from 1 to 4 hours and usually occurs 2 to 4 times per month. The pain is often described as throbbing and affects the front or both sides of the head. Common symptoms of migraine in children and adolescents include pale color (pallor), nausea and vomiting, and irritability. The child may also be very sensitive to light, noise or smells, and want to sleep.
- Chronic nonprogressive headaches or tension headaches. – These are daily or frequent headaches or headaches that come and go over a prolonged period of time without causing neurological symptoms. Common causes include stress, tension, anxiety, and depression. This is the most common type of headache in adolescents. If it occurs more than 15 days/month along with frequent school absences and medication overuse, see a headache specialist.
- Chronic progressive headaches. – These are headaches that get worse and happen more often over time. These are the least common type of headache. When chronic progressive headaches occur along with other neurological symptoms (for example, weakness, balance problems, and visual disturbances), they can be the sign of such brain conditions as an abnormal build-up of fluid in the brain (hydrocephalus), inflammation of the brain, tumor, or other conditions brain.
What known serious medical conditions can cause a headache in children?
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
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.