Kids' Headaches: The Diagnosis Is Difficult

Headaches aren't only for adults. Kids get them, too. By the time children reach high school age, most have experienced at least one headache, according to the National Headache Foundation.

There are two basic types of headaches: primary headaches, in which the headache is the only symptom and, when treated, will stop; and secondary headaches, which are caused by another condition and don’t usually go away until the condition is treated.

Primary headaches include tension-type and migraine headaches. Hundreds of conditions or circumstances can cause headaches. These can span the gamut from very benign to very serious and include dehydration, sleep deprivation, infections, head injury, meningitis, brain aneurysm, and tumor. Fortunately, the vast majority of headaches in kids are not caused by these problems, but by tension.

Your pediatrician can determine what kind of headache your child has. The doctor will need to talk to both you and your child to determine whether the headache has an emotional component. He or she may also do a neurological exam.

Tension-type headache

This is the most common type of headache in children, and the most likely causes are emotional upsets or stress. Your child may describe the pain as widespread or like a tight band around the head. This type of headache does not usually cause nausea and vomiting.

Tension headaches are almost always related to stressful situations at school, competition, family friction, or excessive demands by parents. The doctor needs to also determine whether anxiety or depression may be present.

Migraine headaches

A migraine headache is sometimes one-sided and throbbing and is occasionally accompanied by nausea and vomiting. Children who have a family history of migraines have a greater chance of developing migraines themselves.

Fortunately, migraines may disappear in some children several years after they appear. However, many children who develop migraine headaches will go on to have them during the rest of their lives. Research has shown that symptoms will have occurred in about a fourth of migraine sufferers before the age of 5 and in about half before the age of 20.

It is important to realize that migraine may occur after a head injury, especially after injury in sporting activities, such as football and baseball. The child will usually recover fully over time.

Immediate care

These headaches require immediate medical attention:

• A headache in a child who has had a blow to the head or a recent history of head trauma. This is especially true if the headache is steadily getting worse.

• A headache with fever, nausea or vomiting, confusion, significant sleepiness or loss of consciousness after the headache starts, stiff neck, or skin rash.

• A headache that comes on suddenly and seems to be the worst headache the child can possibly imagine having, especially if the child does not have any history of ever having headaches.