Headaches are a common health problem that can affect people of all ages, including children. There are many causes of headaches in children.

Headache types can be described as primary or secondary:

• Primary headache is diagnosed when no other health problem is causing the headache. Migraine and tension-type headaches are common examples.
• Secondary headache is diagnosed when another health problem is causing the headache, such as a brain injury or sinus infection.

Tension-Type Headache

Tension-type headache is a recurrent headache that is mild to moderate in intensity with a pressing / tightening type of pain. Tension-type headache does not usually change a child's activity level and is not associated with nausea or vomiting.

Migraine

Migraine is a common., disabling neurological disease that occurs in people of all ages, including about 10% of school-age children and 15-27% of teenagers.

Migraine is hereditary. This means it is passed down in families through a gene. A child has a 50-75% chance of developing migraine if one or both parents has migraine.

Migraine attacks in children can look different than in an adult.

Migraine attack symptoms in children include:

• Pain lasting 2-72 hours
• Pain location: one or both sides of the head, most commonly across the forehead and / or both temples. As children get older, the pain can start to occur on one side of the head.
• Pain quality: throbbing / pounding / pulsating (younger children may have trouble describing their pain).
• Pain severity: moderate or severe
• Pain worsens with normal activity or keeps a child from participating in activities.
• Associated symptoms: nausea and / or vomiting, light and sound sensitivity (a child may want to rest in a dark and quiet room)
• Other symptoms can include sensitivity to smells, dizziness, stomach pain, decreased appetite, trouble with concentration
• Aura: visual (flashing lights, spots, blind spot in vision), speech (difficulty talking), and sensory (numbness, pins and needles feeling) symptoms that begin before head pain starts and can last from five-60 minutes. Migraine with aura occurs in 20% of people with migraine.

Chronic migraine is diagnosed for headache occurring on 15 or more days per month for more than three months, which, on at least eight days a month, has the features of a migraine attack.

Diagnosis

Migraine is diagnosed by a healthcare provider based on the child's medical history and current headache symptoms, along with a physical and neurological exam. There is not a specific medical test to diagnose migraine. Keep a headache diary (written or use a headache / migraine app) to track the frequency, duration and severity of the headaches and share this with your healthcare provider.

Treatment for a Migraine Attack

Specific medication recommendations for treatment of a migraine attack will be discussed at time of diagnosis.

Limit use of pain medication to no more than 3 days a week to prevent development of Medication Overuse Headache.

Teach your child to tell an adult as soon as they feel head pain begin. Early treatment stops the migraine attack quicker and allows your child to return to normal activities without having to leave school early or miss playtime with their friends.

Drinking fluids with electrolytes (like sports drinks or water with a salty snack) during a migraine attack can help it go away faster.

Ask your healthcare provider to provide a medication letter allowing your child to receive headache treatment at the school nurse’s office as well as to carry a water bottle and use the restroom as needed.

How to prevent a Migraine Attack

Good health behaviors—called the "SMART" approach—can decrease the frequency and severity of migraine attacks:

S - Sleep

Maintain regular sleep patterns. Go to sleep and wake up at the same time each day, even on weekends.

Ages 6-12 years: 9-12 hours of sleep a night

Ages 13-18 years: 8-10 hours of sleep a night

If falling asleep is an issue, try to start a low-stimulation routine 30 minutes before bedtime. This means avoiding computers, smartphones and television before bed. Try reading a book, using relaxation skills, taking a bath, or stretching/yoga before bed.

M - Meals / Fluids

Eat regularly and avoid skipping meals. Take a snack to school in case you get hungry before lunch.

Avoid caffeine

Drink 64 oz. of caffeine-free fluids daily. Take a water bottle to school. Increase fluid intake with exercise.

A - Activity

Exercise regularly. For example, aerobic exercise for at least 30 minutes three times a week will reduce the frequency/severity of headaches.

R - Relaxation

Manage stress and anxiety. Practicing deep breathing, focusing the mind on a relaxing image or scene, trying soft relaxing sounds / lighting, reading a book, taking a bath, and exercise are some ways to reduce stress.

T - Triggers / Treat Early

Treat the migraine attack as quickly as possible to allow your child to continue to function normally.

Identify if there are triggers for a migraine attack and track these in a headache diary.

Common triggers include caffeine, not drinking enough fluids, skipping meals, too much / too little sleep, extreme heat / cold, perfumes, bright light, noise, school tasks / projects, and menses.

When to Call Your Child's Healthcare Provider:

• A headache consistently wakes your child from sleep
• Your child experiences early morning vomiting
• The headaches are worsening or occurring more often
• Your child experiences personality changes
• Your child complains that it is "the worst headache they've ever had"
• The headache is different than previous headaches
• The headache occurs with a fever or stiff neck
• The headache happens after an injury
• Your child is not headache-free after two doses of pain medication
• Your child is frequently using medications for headaches
• The headaches are causing your child to miss school or social activities
• Your child is having more than three to four headaches per month