Tension headaches and migraines are the most common types of headaches in children. These kinds of headaches are called primary headaches. Primary headaches are not a symptom of another, more serious disease. Certain genes make a person’s brain more sensitive to headaches. Most of the time, a child is more prone to headaches because of genes inherited from one or both parents. Even in these cases, other factors are usually needed to trigger headaches. Triggers include: There are other types of primary headaches besides tension headaches and migraines. An example is cluster headache. However, these are rarely seen in children. It is not fully understood why people get these other kinds of headaches. It is suspected that there may be an underlying genetic component. Sometimes, children have headaches stemming from other causes. These are called secondary headaches. Things that can cause secondary headaches include: For instance, the flu or a sinus infection can cause headache. Using medicine more than three days per week can cause headache. Specifically, acetaminophen or nonsteroidal anti-inflammatory drugs such as ibuprofen, used more than three times in a week, can cause “rebound headaches.” Many commonly used medicines list headache as a possible side effect. Examples include over-the-counter medicines like acetaminophen and diphenhydramine, as well as prescription antibiotics like amoxicillin. Congenital means “present at birth.” Examples of congenital differences in brain structure include cysts or Chiari malformations. Most people born with these differences do not know they have them. They usually don’t cause problems. However, in some cases they can cause headaches or other symptoms. In rare cases, a headache can be a symptom of a more serious illness. Examples include: Meningitis is an infection or inflammation of the brain lining. Children with meningitis usually have a fever and neck pain or stiffness. A mild traumatic brain injury (previously called a concussion) can cause headache. A more severe head injury can also cause headache. Brain hemorrhage refers to bleeding in or around the brain. This can cause headache. It typically causes a very severe headache, one unlike any that child has ever experienced. This is a term meaning high pressure in the head. It can cause headaches that get worse when the child lies down. It can also cause vision changes. Children with brain tumors can have headaches that worsen over time. They usually have other symptoms, too. They may suddenly be clumsier than usual. They may wake up with a very bad headache and continual vomiting in the middle of the night. Seek prompt medical care if: Children can get the same types of headaches adults do. The symptoms are often similar, but it can be hard for younger children to describe them. Children’s headaches are often briefer in duration and thus dismissed. The child may not complain of headache pain initially, but may become quiet and withdraw from their usual activities. This can make it difficult to tell exactly what type of headache they have. Most children have either tension headaches or migraines. Even infants and very young children can get migraines or experience migraine-like conditions. Symptoms of migraine headaches in children include: This can feel like a heartbeat in the head. Pain can be on one or both sides of the head. Both light and noise worsens the pain. These may include seeing black spots, jagged lines, or colored halos. This appears commonly in young children with migraine. Having the genes for migraines can cause brain sensitivity. Many children with these genes will have migraines when they grow older. The genes can bring about different symptoms as a child grows: Migraine genes may make a baby more prone to infant colic. Migraine genes can lead to cyclic vomiting in younger children. Cyclic vomiting is frequent vomiting that happens on an almost predictable schedule. The vomiting might occur every few weeks or months. Migraine is also associated with vertigo in younger children. In rare cases, migraine genes can cause older children to experience abdominal migraine. Instead of headache, the child has dull pain all over the belly. This may or may not be accompanied by vomiting, including cyclical vomiting. Other disorders must be ruled out before a diagnosis of abdominal migraine. The other common type of childhood headache is a tension headache. The symptoms of a tension headache differ in important ways from those of a migraine: The pain is not throbbing, and usually feels like tightness or pressure. Pain tends to be on both sides of the head or neck. Unlike a migraine, a tension headache does not cause nausea or vomiting. Either light or sound may worsen pain in tension headaches, but not both. Unlike a migraine, the pain in a tension headache does not get worse with activity. Trigeminal autonomic cephalalgias (TAC) is a category of headache that happens only rarely in children. One common type of TAC is cluster headache. Cluster headaches appear as a series of short but painful headaches. They appear alongside other symptoms on one side of the head or face. They happen in clusters that can last weeks or months. After the clusters stop, the headaches may not happen again for months or years. It can be hard to tell which type of TAC a child has. It can also be hard to tell a TAC apart from migraine. Signs that suggest a TAC include: Pain and symptoms only occur on one side of the head or face. This can include tearing. It can include red, inflamed eyes (called conjunctival injection). The eyelid may also swell or droop. Forehead or facial sweating are a sign of TAC. Childhood headaches are usually easy for a doctor to diagnose after a child describes their headaches. It is helpful to work with the child to create a diary of symptoms to bring to the appointment. This diary should include: It can also help to track other details, such as: A pediatric examination for headaches should include: During this exam, the head and neck will be carefully checked for signs and symptoms of infection. The doctor will look for otitis media, tooth abscess, acute pharyngitis, and more. The doctor will also look carefully at vital signs to check for high blood pressure. The general physical exam can help determine if the headache is primary or secondary. During this exam, the child’s strength, reflexes, and coordination will be tested. The doctor will also check the cranial nerve by examining the optic nerve at the back of the child’s eyes. A pediatric exam for headache might occasionally include: Blood tests are usually not needed. However, if a child has frequent headaches, it can help to check blood vitamin levels. If they are low, taking certain vitamin supplements can help prevent headaches. Imaging is usually not needed. However, in some cases, a doctor may recommend it. This might be because the child is too young to describe the headaches well. Or it might be that the symptoms suggest a structural or more serious cause of headache (secondary headache). There are two primary types of brain imaging used for headache: In rare cases, a test called a lumbar puncture may be recommended. In an LP, a needle is inserted in the middle of the spine at about hip level. This allows doctors to measure the pressure inside the head to see if it is too high or low. If the pressure is high, fluid can be drained to lower the pressure to normal. A sample of the spinal fluid can also be taken to check for infection or inflammation. Treatment depends on whether headaches are primary or secondary. For most primary headaches, the treatment depends on how frequent and how severe the headaches are. There are two parts to most primary headache treatment plans: Acute Treatment Most headaches can be treated with over-the-counter medications such as ibuprofen, naproxen, or acetaminophen. Drinking lots of water or sports drinks together with the medicine can also help. It is important to treat a headache as soon as possible. This is because the medicines work best if given early, when the pain is not as bad. Medicines should be used no more than two to three days per week. If headaches do not respond to over-the-counter medicines, a doctor may recommend prescription medicines, such as triptans. The doctor may also recommend a medicine like ondansetron to treat any nausea or vomiting the child may have with a headache. If the headache is very severe or lasts a long time, it may be necessary to take the child to urgent care or the emergency room for further treatment. IV pain medicines, together with IV fluids, can be used to stop the headache. Headache Prevention Healthy Daily Habits Many children can achieve good control of their headaches by practicing healthy habits every day. These healthy habits include: Controlling Stress and Worry Most children feel worried or stressed from time to time, just like adults. Since worry and stress can trigger headaches, it’s important for children to learn healthy ways to deal with these feelings. It can help to start by practicing simple breathing exercises every night before bedtime. For children who need more help with managing worry, counseling and special types of therapy can be useful. These special therapies include cognitive behavioral therapy (CBT) and biofeedback relaxation therapy. Both CBT and biofeedback have also been shown effective at preventing headaches. Controlling Frequent or Severe Headaches If a child has very frequent headaches or if the headaches are very severe, a daily prevention medication may be needed. There are many different medicines used to prevent headaches. Most of them were developed to treat other conditions first. The medicines are usually started at a low dose and increased slowly to reduce the chance of side effects. Examples of common groups of medicines used to prevent headaches are: An example is amitriptyline. Common side effects of amitriptyline include sleepiness and dry eyes or mouth. An example is topiramate. Common side effects of topiramate include sleepiness and tingling in the fingers or toes. There is a risk of birth defects if a person is pregnant at the same time as they take topiramate. An example is cyproheptadine. These are often used in younger children. Common side effects of cyproheptadine include sleepiness and increased appetite. In older children, cyproheptadine may be more likely to cause weight gain. It can also cause constipation. Examples are riboflavin (vitamin B2) and magnesium. Riboflavin can cause bright yellow urine. Magnesium can cause diarrhea and stomach cramps. Treatment with daily prevention medicines is usually continued until the goal of one headache or less per week has been met for several months. Injection Medicines for Headaches Most headaches are controlled easily with an oral medicine treatment plan and healthy habits. If oral medicines don’t work, injection medicines may sometimes be used instead. These are rarely used in children because they are only FDA approved for adults. Ask your doctor about using this treatment option for your child. A child’s doctor can provide a letter to the child’s school to explain a headache diagnosis and treatment plan. In the United States, a child’s school and teachers can work with parents and caregivers to create what is called a 504 plan. This plan will help the child manage headaches at school without help from parents. The plan can include permission for children to keep their own medicine (if appropriate), to have access to water during class, and to rest during a headache. For secondary headaches, it is most important to treat the problem causing the headache. For example, if the headache is caused by infection, then the infection needs to be treated. In the meantime, over-the-counter or prescription pain medicines can be used for the pain. Most headaches do not seriously affect a child’s function at school or play. Tension headaches usually affect function less than migraine headaches. But if either type of headache is very frequent or severe, it can start to cause problems. If untreated, this can eventually cause severe disability and affect the whole family. This is why it is important to work with a child’s doctor to come up with an effective treatment plan as soon as possible. Headaches can become more difficult to control the longer they go untreated. In addition, studies have shown that early treatment leads to a better lifelong outcome. Headaches are common throughout life. Many people notice that headaches are not as serious or frequent in adulthood. Still, most people will have headaches at least every so often in adulthood. An effective treatment plan can reduce the impact of these headaches on a person’s daily function. The mission of the National Headache Foundation is to cure headache, and to end its pain and suffering. In support of that mission, the NHF looks to achieve these key goals: Please see the Children’s Headache Disorders page and Pediatric Headache for information specific to children. Coalition for Headache and Migraine Patients The mission of the Coalition for Headache and Migraine Patients (CHAMP) is to improve the lives of people with migraine, cluster, and other headache diseases by aligning coalition organizations and empowering patient voices. Exploring treatment, navigating insurance options, and connecting with others can all be found on their website. For students, parents, and teachers learn about resources through the Migraine at School program. Headache doctors created the Headache Relief Guide website to help teens and their families to gain better control of headaches, get appropriate medical care and limit the disability caused by headaches. The website provides resources, education material, ways to control, share your experience, and prepare for headaches. JCN: What Your Pediatric Neurologist Wants You to Know – Headaches Child Neurology Foundation (CNF) solicits resources from the community to be included on this webpage through an application process. CNF reserves the right to remove entities at any time if information is deemed inappropriate or inconsistent with the mission, vision, and values of CNF. 
DESCRIPTION AND CAUSES
Primary Headache
Secondary Headache
Illness
Medicine overuse
Medicine side effects
Congenital differences in brain structure
Meningitis
Head trauma
Hemorrhage
Intracranial hypertension
Brain cancer or tumors
SIGNS AND SYMPTOMS
Migraine Headache
Pulsing or throbbing head pain
Nausea or vomiting
Pain that worsens with or limits activity
Light and sound sensitivity
Vision changes
Facial pallor
Babies
Younger children
School-age children
Tension Headache
Painful tightness or pressure
No nausea or vomiting
Light or sound sensitivity
Pain that does not worsen with activity
Trigeminal Autonomic Cephalalgias
Only one side affected
Eye symptoms
Congestion or runny nose
Sweating
Restlessness or agitation
DIAGNOSIS
General physical examination
Neurological examination
Blood tests
Brain imaging
Lumbar puncture (LP)
TREATMENT AND THERAPIES
Primary Headache
Antidepressants
Anti-seizure medications
Allergy medicines
Vitamins
School Involvement
Secondary Headache
OUTLOOK
Resources
ORGANIZATIONS/GROUPS
PUBLICATIONS
Podcast from SAGE Neuroscience and Neurology/Journal of Child Neurology (JCN). JCN’s Residents and Fellows Board Director, Dr. Alison Christy, interviews Dr. Samantha Irwin of UCSF on headaches.
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