Most Headaches not Cause for Serious Concern

Head pain has plagued people since the time of Hippocrates and is probably our most commonly experienced pain. Although we usually think of headaches as an adult disease, they are quite common in youngsters. 80% of children by age 14 have experienced headaches and one in five suffers at least one headache a month!

Our own experience with headaches reassures us that the pain will disappear in time, is not caused by serious disease, and is treatable with over the counter medications. What worries parents and pediatricians alike is the child whose headache is so frequent or so severe that the youngster’s daily activities seem to be affected. And then there is a parent’s silent fear that the real cause of their child’s headache is a brain tumor.

In order to help determine the reason for a child’s headache, pediatric neurologist Dr. David Rothner of the Cleveland Clinic has classified them into four groups: The first represents the child with a sudden, first time headache, usually seen with infections, such as sinusitis, sore throats, or the flu. The second would be headaches that suddenly flare up, last less than a day, and then go away only to reoccur weeks later without changing in severity. These headaches usually represent childhood migraine. Dr. Rothner’s third group is the chronic headache which occurs every day to once a week, each headache as painful as the one before, never any better or any worse. Otherwise healthy, these children suffer muscle contraction headaches. Headaches that begin over a short time and become increasingly worse in both frequency and intensity represent the fourth group. These children will have other neurological symptoms and need evaluation to rule out serious brain disease.

Evaluating the child with headache is much like detective work, and parents can supply valuable clues by keeping a record of the following information: How long has the headache been present? Are they getting worse or staying the same? How often do they occur? How long do they last? What brings them on (food, heat, riding in the car, exercise, etc.)? Where is the pain? What does it feel like? Does the headache make the child go to bed? Does the child have nausea or vomiting? Does the headache occur at any particular time of day? Is there a warning before the headache strikes? What makes the headache better? What makes it worse? Any family history of headaches? Frequently a good history can make an accurate diagnosis for the physician, thereby eliminating the need for expensive laboratory tests, x-rays, brain scans, and hospitalization.
Many parents bring their child to the eye physician before their pediatrician to find the cause of their youngster’s head pain. Visual problems and eyestrain are rarely an adequate explanation for headaches in children and correcting any refractive errors do not stop the recurrent head pain.

Migraine is the most common cause of recurrent headache in children. These headaches usually begin during the early school years and there is frequently a history of migraine in immediate family members. The pain is often reported as throbbing or pounding in nature restricted at times to one side of the head. Migraine occurs several times a week or as infrequently as twice a year. An aura occasionally begins a migraine headache in which the child sees spots (visual “fireworks”), complains of abdominal pain, or gets cranky and appears pale. During the attack the child may experience nausea, vomiting and abdominal pain. The youngster wants to be left alone and usually voluntarily goes into their bedroom, closes the blinds to make the room dark, and falls asleep. On waking, the child feels better, although a dull headache pain may last for days. On examination these children have no abnormal findings.

Muscle contraction or tension headaches usually begin between ages 8 to 12 years and are more common in girls. The non-throbbing pain is usually localized to the back of the skull but can be felt over the forehead. Usually the pain lasts most of the day, remaining constant or gradually increasing in severity. There is no warning period like in migraine, but tension headaches can be associated with vomiting. These children are healthy and have a normal neurological examination.
Parents must walk a fine line in dealing with this type of headache because some children use the problem as an escape from responsibility or as a way of getting attention. The pain is real and must be treated with respect, yet parents should teach their child how to cope so that the headache does not disrupt their lives. Insist on school attendance and arrange with the school to receive medication as prescribed. At home, minimize the attention given the headache and reward the youngster when they maintain a daily routine despite the pain.

Headaches caused by brain tumors and other serious medical problems occur at any age. The pain usually progresses in frequency and severity over a short time. Thus, headaches of recent onset (two to three weeks) are worrisome while headaches of more than three month’s rarely are serious. A headache caused by an intracranial problem is made worse by sneezing, coughing, or straining, usually comes on without warning, and may wake the child at night. “Serious” headaches are made worse by body movements (especially bending forward) and are relieved by a change in position. For example, when the headache occurs in the early morning, it is relieved by the child getting out of bed. Parents should also watch out for coordination problems, blurred vision, one sided muscle weakness, speech impairment, seizures, or minor intellectual or behavioral changes. The neurological examination is almost always abnormal.

Fortunately, the overwhelming majority of headaches during childhood are transitory and bearable. In most cases, time heals the discomfort The child’s physician should be consulted, however, since a correct diagnosis is essential to determine the best treatment. In the meantime, parents can help their child by never doubting that the pain is real and being as understanding as possible.