Headaches are a frequent occurrence in children and adolescents. Up to eight percent of 3-year-olds and greater than 50 percent of teenagers complain of headaches. Migraine headaches occur in five to six percent of school children, and that number increases after puberty, particularly in girls, reaching about 10 percent. How can you tell the difference between a migraine and a tension headache? More importantly, when do you need to worry that a headache represents something more serious like a brain tumor?
Tension, Migraine or Sinus
Most children or adolescents are experiencing either tension headaches or migraines. What is the difference between the two? Migraines tend to be more severe and have other symptoms that accompany the headache, such as nausea and/or vomiting, light sensitivity, sound sensitivity and dizziness. Often, the headache will be described as pounding, and in children is most often felt across the forehead. Only about 10 percent of pediatric migraine patients will describe an aura (usually a visual disturbance that precedes a migraine), so this is not a reliable way to diagnose a migraine. Tension headaches tend to be less severe, have none of the associated symptoms and are usually described as a steady feeling of pressure around the head.
Sinuses are rarely the cause of headache. In general, sinuses only cause pain if they are infected. Patients with sinus infections will generally be congested with significant persistent nasal drainage and fever, and may not have a headache at all.
Brain Tumor?
Almost every parent who comes to my office is worried that their child has a brain tumor, but the overwhelming majority (99+ percent) of kids with headaches do not have tumors. It is very rare that an intermittent headache is the only sign of a tumor. Usually, there will be some other neurologic sign present. More often than not, the headache of a brain tumor is a headache that is constant and slowly worsening over time. For example, headaches that are worse in the morning and worsen with having a bowel movement can represent signs of increased pressure in the head and should be evaluated further. When we examine our patients, we do a thorough neurologic exam and look at the back of the eyes with an ophthalmoscope. Increased pressure in the head often will cause changes in the eyes that we can see during an exam. If the back of each the eye looks normal, and the neurologic exam is normal, we can generally reassure our patients and further workup may not be needed.
What to Do
What can you do for a child suffering from headaches? Most children, even those suffering from migraines will note significant improvement if given acetaminophen, ibuprofen or naproxen. Especially with migraines, it is important that medication be given as soon as possible for best results. If your child is requiring pain medication for headaches more than three days a week, they should be seen by their pediatrician. Pain medications, from acetaminophen to barbiturates and almost everything in between, if taken too often, can make headaches worse instead of better, something called a Medication Overuse Headache. If these medications do not successfully treat the headaches, there are prescription medications that your child’s pediatrician or a headache specialist can prescribe.
Prevention
More importantly, the best way to treat a headache is to prevent it from happening. Often relatively simple measures can accomplish this. There are five keys to preventing headaches.
- 1. Stress management. Headaches, both tension and migraine, are brought on or worsened by stress. While we can’t eliminate stress, we can learn better ways to deal with it. Helping your child work through stressful situations is very important. If help is needed, a psychologist can work with your child.
- 2. Diet management. Headache sufferers need to eat three meals a day, every day. The brain requires energy. An insufficient diet is a stress to the brain, which results in more headaches. I rarely suggest elimination diets to my patients. I do recommend eliminating caffeine. Though caffeine has been used in the past to treat migraines, it often causes a medication overuse headache.
- 3. Sleep. Young children need 12 hours, school-age children need 10 hours and high school students should be getting eight hours of sleep a night. The brain needs rest!
- 4. Good hydration. Staying well hydrated improves energy delivery to the brain.
- 5. Exercise. It has been shown that regular exercise improves headaches.
If you are unable to control your child’s headache or are concerned that it represents something worse, contact your child’s physician for further assistance or referral to a specialist, if needed.
Howard Jacobs, M.tD., FAAP, FAHS, is a pediatric headache specialist in the Division of Neurology at Nationwide Children’s Hospital.
