Welcome to Kids Korner

By A. David Rothner, M.D.
Director of the Pediatric Headache Clinic and Director Emeritus of Child Neurology at the Cleveland Clinic Foundation in Cleveland, Ohio

Welcome to Kids Korner—a new column in which healthcare providers, patients and families can exchange information regarding headaches in children and adolescents. We have assembled a panel of experts who will be sharing information about headache types that affect children, including evaluation, diagnostic testing and treatment. We also hope to hear from parents discussing their children’ problems, children describing their own problems, and others who have information that they feel would be helpful. Please email us at NHF1970@headaches.org with your questions and comments and put Kids Korner in the subject line.

For this first column, I’d like to briefly answer some of the most common questions asked about kids’ headaches:

How common is headache in children?
About 6 out of 10 children have an occasional headache. Approximately 1 in 6 will have recurring tension-type headaches and 1 in 10 will have migraine.

How do I know what kind of headache my child has?
The most common recurring headaches are tension-type headaches. Many doctors use different words for this headache, including chronic daily headache, tension-type headache, muscle contraction headache and regular headaches. They’re usually a band-like sensation around the head of medium severity and are not associated with nausea or vomiting. Headaches experienced once a week are usually not a problem. Only when children have these headaches very frequently, or are using over-the-counter medications (OTCs) more than twice a week, or the headaches are interfering with school attendance and/or extra curricular activities, should they be evaluated.
Migraine is a more intense pounding headache that usually occurs two to four times per months and frequently runs in families. Younger children often get them after school while teens may get them early in the morning. Patients look pale, become quiet or grouchy, are bothered by light and noise, and want to lie down. Many lose their appetite and become nauseated and some may vomit. Attacks may last anywhere from one to four hours and are often relieved by sleep.

I’m concerned my child’s headache could be caused by something bad like a brain tumor.
The overwhelming majority of children’s headaches are not serious. Most headaches encountered in the primary care physician’s office are due to physical factors such as the flu, fever, minor trauma or emotional issues. These are typically one-time events in which the healthcare provider can make a diagnosis and potentially treat the underlying condition without the patient needing to be seen again.
However, if the headaches are getting more frequent and more severe over time, or if they awaken the child from sleep, or if they are associated with neurologic symptoms such as seizures, balance difficulty, very frequent vomiting or visual problems, the child should see a healthcare provider.

What tests are needed to diagnose children’s headaches?
In most situations the only evaluation that is needed is a medical history and physical evaluation. Tests like MRIs are not usually necessary.

What’s the best way to treat children’s headaches?
In my experience, the most important aspect of treatment is the ability to confidently reassure the patient and parents that there isn’t a serious problem. Family education is critical—the family that understands as much as possible about the headache type is going to feel more confident about being able to deal with it. Then they need to address lifestyle issues. Some of most frequent contributors to kids’ headaches are lack of sleep, being overscheduled, skipping meals, poor diet and not knowing how to handle stress. In most cases, headache can be managed by addressing these issues. It’s also important to avoid overtreatment with OTC medications. They shouldn’t be used more than twice per week.