Doctor, what can you tell me about headaches in children?
As a doctor I found that headaches are a very common complaint in the pediatric office. Because a headache is not a diagnosis but only a symptom, it is our goal to determine the reason and appropriate treatment.
A headache (cefalagia in medical terminology) is a condition of pain in the head; sometimes neck or upper back pain may also be interpreted as a headache. The vast majority of headaches are benign and self-limiting. Common causes are tension, migraine, eye strain, dehydration, low blood sugar and sinusitis.
Let me tell you more about migraines. Ancient Greek physicians recognized a specific type of recurrent head pain that was unilateral. The modern word migraine is a French modification of the term hemikrania.
Migraine is a periodic disorder with symptom-free periods that is characterized by headaches with a throbbing nature, unilateral location, relief after sleep, aura, associated abdominal pain, nausea or vomiting. Classic migraines are uncommon in younger children and may occur with a visual aura, irritability, pallor, nausea and vomiting that last hours to days. Migraine headaches without an aura are more common in children. The prevalence of migraines in childhood is about 4 percent and becomes more common in teenage girls and young women. About 20 percent suffer their first headache before the age of 10. There may be a history of recurrent vomiting or motion sickness. There is often a family history of migraine and the genetics may be multifactorial.
If your child has migraines you may want to find out what causes them or what makes them worse. It is known that some foods have been associated with the development of migraine headaches. These include tyramine-rich foods (cheese, red wine), foods with monosodium glutamate (Chinese and Mexican food), nitrate-rich foods (smoked meats, salami), marinated foods, alcoholic beverages, caffeinated beverages, chocolate, citrus and beans.
Remember not all headaches are migraines. Headaches in children can also be caused by:
- Stress about school, sports, relationships or peer pressure. Even fun activities can be overdone. Many times, just talking about a problem with your child may help.
- Hunger and low blood sugar are common causes of headaches. Make sure that your child has four healthful meals a day, and remember that breakfast is the most important meal.
- Eyestrain. Please have your child’s eyes checked.
- Dehydration can cause a headache. Please make sure that your child is well-hydrated.
- Lack of sleep. Keep in mind that a child needs nine to 10 hours of sleep! Set bedtimes and enforce them.
- Caffeine in the diet may exacerbate headaches.
- If your child has cold and sinus problems with associated headaches, talk to your doctor.
All of these recommendations will be appropriate for migraines. Also, you may include a migraine elimination diet, discontinuance of possible triggering medications (e.g. analgesic overuse), relaxation therapy, vitamins and some minerals.
- Some points on when to see your physician:
- If your child awakens from sleep at night;
- Severe headaches associated with vomiting, high fever or very low body temperature;
- Headache and vomiting in the morning, which are getting worse; and/or
- Headaches associated with any neurological or behavioral changes.
It is important to see a physician if you are concerned. Your pediatrician will evaluate the child, check blood pressure, perform a physical and neurological exam, and ask about family history. Be prepared to answer such questions as when the headaches started, how often they happen and if they are associated with certain food intake.
Your physician will decide the reason for the headaches and will devise a treatment plan and recommendations. We have several medications for migraines; some of them may be prescribed by a neurologist only and some just by a pediatrician.
If you have any questions, you may contact your pediatrician.
SMILE! Happy people have fewer headaches overall!