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What to do if your child complains of a headache
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What to do if your child complains of a headache

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HEADACHES

Most headaches are treatable, but if your child complains of head pain, take it seriously. Ibuprofen and ice can be effective at-home treatments.

It’s not uncommon for a child to complain of a headache. But what should a parent do? When should you worry? What are features that are cause for concern and should prompt a call to a pediatrician, or even a trip to the emergency room? For kids with headaches, do they necessarily need to take medication, or are there nondrug treatments that may be just as effective?

When to call your pediatrician

The cardinal rule for evaluating headaches is “first or worst.” In practical terms, if your child has never had a headache before, you need to evaluate carefully.

  • Did they have recent head trauma, such as a fall or a sports injury?
  • Were they sick with a bad virus?
  • Are they vomiting or feverish?
  • Are they unable to walk, talk and eat normally?

If the answer to any of these questions is “yes,” it’s time to call a pediatrician. A concussion, a severe infection or even a rare but more ominous cause for a headache could be the trigger. Many people worry about a brain tumor, but this is very unlikely. You should never be alone with worry about your child’s headache, and your pediatrician can help to steer you toward the best treatment.

Kids can experience migraine headaches

Children do get migraine headaches. Only about 5% of kids get them, but think about migraine in particular if a parent has migraines, as there is a genetic link.

With kids’ migraines, pain can be on both sides of the head and not last as long as adult migraines. But kids can also be totally incapacitated, with profuse nausea and vomiting and the need to lie in a dark room. A migraine diagnosis is possible only after two episodes.

Ibuprofen and ice can be very effective treatments once a headache hits. A bag of frozen peas is lightweight, and the child can position it comfortably over their head.

There is a migraine-specific class of drugs called triptans that is used to stop migraines when they start. One formulation called zolmitriptan is approved for use in children. It comes in a nasal spray, so it can be used for kids who can’t swallow pills.

For children with frequent migraines, it may be necessary to try to prevent them. Certain medications are used for both children and adults, such as amitriptyline and topiramate. A recent study found that combining amitriptyline with a form of cognitive behavioral therapy (a type of mind-body work that helps to change a person’s response to pain and anxiety) can be more effective than the drug alone. And some children will respond to cognitive behavioral therapies alone as preventives.

The more typical kid headache

Tension-type headaches are more common. Also known as “hat band headaches,” that’s often what the pain is like. Kids describe pressure around their forehead or entire head. Often they can function, eat, go to school and even play sports although they don’t feel well. Ibuprofen may help, and relaxation and fluids may be adequate to treat a tension-type headache.

Lots of parents are concerned about screen time triggering headaches, and it’s a valid concern.

Bright lights and screens definitely can trigger migraines in susceptible children and adults, but staring at a computer, phone or iPad can trigger a headache for anyone if used for too long. Encourage limits on screen time, taking breaks and getting up to stretch when working or playing games.

It’s important to ask about stress and anxiety when evaluating your child’s headache. School-avoidance headaches can be tough to diagnose. Careful questions and discussion with teachers and guidance counselors may help a parent figure out if a headache is actually a way for a child to avoid bullying or a difficult situation at school. This can lead to intervention and resolution of the triggers.

The bottom line

If your child complains of a headache, take it seriously. Ask questions about type of pain, other symptoms and recent events. Enlist your pediatrician to help make the right diagnosis.

If the child has a fever, can’t stop vomiting, or tells you they have double vision or trouble moving their arms or legs, go directly to the emergency room, though chances of this are rare.

Carolyn A. Bernstein, M.D., F.A.H.S., is a neurologist and contributor to Harvard Health Publications.

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