• Dr Andy Raffles

My head hurts! - headaches explained

Updated: Oct 11, 2019

Headaches in children are common and usually aren't serious. Similar to adults, children can develop different types of headaches, including migraines or stress-related (tension) headaches. It's important to pay attention to your child's headache symptoms and consult a doctor if the headache worsens or occurs frequently.


What is a headache? A headache is pain or discomfort in the head or face area. Headaches can be single occasional events or can be recurrent in nature, and localised to one or more areas of the head and face.


It is suggested that anything up to 40% (or more) of all children have had a headache by the ages of 5-7. Among 5-7 year-olds, approximately 4 in every 100 will have frequent headaches. By the age of 15, 75% of children have had a headache.


3% of children suffer from migraine headaches throughout childhood, a fact often unrecognised by health care workers, teachers and indeed parents.


The exact cause of headaches is not completely understood. It is thought that many headaches are the result of tight muscles and dilated, or expanded, blood vessels in the head. Only one child in 40,000 is found to have a brain tumour causing the headache, making this a very rare cause of the headache. About 2-10% of headaches are due to an underlying brain abnormality other than a brain tumour.


The way a child exhibits a headache may be related to many factors, such as genetics, hormones, stress, diet, medications and dehydration. Recurrent headaches of any type can cause school problems, behavioural problems and/or depression.


Migraines

Migraines may start early in childhood. The average age of onset is between 5 to 8 years of age. There is often a family history of migraines. Some females may have migraines that correlate with their menstrual periods. While every child may experience symptoms differently, the most common symptoms of a migraine are:

  • Pain on one or both sides of the head (some younger children may complain of pain all over). The pain may be throbbing or pounding in quality (although young children may not be able to describe the pain).

  • Associated with the pain may be sensitivity to light or sound, nausea and/or vomiting, tummy pain - which often starts many years before the headache and is referred to as abdominal migraine, sweating and the child may become quiet or pale.

  • Some children have a weird visual or smell sensation - called an aura - before the migraine, such as a sense of flashing lights, a change in vision, or funny smells.


Tension Headaches

Tension headaches are probably the most common type of headache, with approximately 69% of males and 88% percent of females experiencing this type of headache. This type of headache occurs most often between 9 and 12 years of age. Stress is often a factor in tension headaches. While every child may experience symptoms differently, the following are the most common symptoms of a tension headache:

  • a slow onset of the headache,

  • the head usually hurts on both sides,

  • the pain is dull or feels like a band around the head and the pain may involve the posterior (back) part of the head or neck.

  • The pain is usually mild to moderate, but not severe and is relieved by sleep.

Children with tension headaches typically do not experience nausea, vomiting, or light sensitivity. Migraine and Tension headaches may frequently occur together.


Cluster Headaches

Cluster headaches usually start in children older than 10 years of age and are more common in adolescent males. Cluster headaches usually occur in a series that may last weeks or months and this series of headaches may return every year or two. While every child may experience symptoms differently, the following are the most common symptoms of a cluster headache:

  • severe pain on one side of the head, usually behind one eye (the eye that is affected may have a droopy lid, small pupil, or redness and swelling of the eyelid)

  • runny nose or congestion

  • swelling of the forehead

The child may have varying degrees of symptoms associated with the severity of the headache depending on the type of headache. Some headaches may be more serious.


Red Flag or serious symptoms that may suggest a more serious underlying cause of the headache may include the following:

  • a very young child with a headache

  • a child that is awakened by the pain of a headache

  • headaches that start very early in the morning

  • pain that is worsened by strain, such as a cough or a sneeze

  • vomiting without nausea

  • sudden onset of pain and the "worst headache ever"

  • headache that is becoming more severe or continuous

  • personality changes

  • changes in vision

  • weakness in the arms or legs

  • seizures or epilepsy

The symptoms of a headache may resemble other conditions or medical problems. Always consult a doctor for assessment and possible diagnosis.


How is the cause of the headaches diagnosed?

The full extent of the problem may not be completely understood immediately. The diagnosis of a headache is made with a careful history and physical examination and on occasion, diagnostic tests.




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