Headaches in Children: Causes, Types & When to Worry

What Are the Different Types of Headaches in Children?

The main types of headaches in children are tension-type headache (most common, feels like pressure on both sides) and migraine (intense, often one-sided, with nausea and light sensitivity). Children can also get headaches from infections, head injuries, or eye strain.

Children can experience different types of headaches, and understanding which type your child has is essential for proper treatment. Headaches in children are broadly classified into primary headaches (where the headache itself is the condition) and secondary headaches (caused by another underlying condition like infection or injury). The International Headache Society provides detailed classification criteria that help healthcare providers diagnose and treat childhood headaches effectively.

It's important to note that children may describe their headache pain differently than adults. Young children might say their head "hurts" without being able to specify the location or type of pain. They may also show behavioral changes like irritability, wanting to lie down, or avoiding activities they normally enjoy. Parents should pay attention to these subtle signs, especially in children who cannot yet articulate their symptoms clearly.

The patterns of headaches in children often differ from those in adults. For instance, migraine episodes in children tend to be shorter, and the pain may affect both sides of the head rather than just one side. Understanding these age-specific differences helps in accurate diagnosis and appropriate treatment planning.

Tension-Type Headache

Tension-type headache is the most common form of headache in children and adolescents. It typically feels like a tight band or pressure around the head, affecting both sides equally. The pain is usually mild to moderate in intensity and doesn't interfere significantly with daily activities. Unlike migraine, tension-type headache does not worsen with routine physical activity like walking or climbing stairs.

Children with tension-type headache often describe the sensation as wearing a tight hat or having a band squeezing their head. The headache may last anywhere from 30 minutes to several days if untreated. Associated symptoms are typically minimal – children usually don't experience significant nausea or sensitivity to light and sound, though mild forms of these symptoms can occasionally occur.

Common triggers for tension-type headaches include stress (academic pressure, social situations, family issues), poor posture (especially during computer or phone use), eye strain, inadequate sleep, and muscle tension in the neck and shoulders. Identifying and addressing these triggers is often more effective than medication for preventing recurrent tension headaches.

Migraine in Children

Migraine is a neurological condition that causes episodes of intense, often debilitating headaches. In children, migraine attacks typically last between 2 and 12 hours – significantly shorter than the 4-72 hour duration seen in adults. The pain is often described as throbbing or pulsating and may affect one or both sides of the head. Physical activity usually makes the pain worse, causing children to prefer lying still in a dark, quiet room.

Accompanying symptoms distinguish migraine from other headache types. Children commonly experience nausea and may vomit during migraine attacks. They often become sensitive to light (photophobia) and sound (phonophobia), seeking out dark and quiet environments. Some children may also experience sensitivity to certain smells. Younger children might show pallor (pale skin), dark circles under the eyes, or unusual sleepiness.

About 15-20% of children with migraine experience an "aura" – warning symptoms that occur before the headache begins. Auras typically last 5-60 minutes and can include visual disturbances (seeing spots, flashing lights, zigzag lines, or temporary blind spots), sensory changes (tingling or numbness, usually starting in the hand and spreading to the arm and face), or speech difficulties. Recognizing aura symptoms allows children to take preventive medication early and seek a quiet environment before the headache peaks.

Headache from Infections

Children frequently develop headaches during common infections like colds, flu, sinusitis, and other viral illnesses. These headaches are considered secondary headaches because they result from another condition. The headache typically accompanies other infection symptoms such as fever, runny nose, sore throat, or cough, and resolves as the underlying infection clears.

Sinus headaches specifically cause pain and pressure in the forehead, around the eyes, and in the cheek areas. The pain often worsens when the child bends forward. Nasal congestion, thick nasal discharge, and sometimes fever accompany sinus headaches. Proper treatment of the sinus infection usually resolves the headache.

Headache After Head Injury

Children can develop headaches after hitting their head or experiencing other head trauma. Post-traumatic headaches range from mild and short-lived to persistent and concerning. While many head bumps in childhood are minor and cause only temporary discomfort, some require medical evaluation to rule out more serious injuries like concussion.

What Causes Headaches in Children?

Common causes of headaches in children include infections (colds, flu), insufficient sleep, dehydration, skipping meals, stress, eye strain from screens, poor posture, and lack of physical activity. Most childhood headaches are not caused by serious conditions.

Understanding what triggers your child's headaches is the first step toward prevention. Most headaches in children have identifiable causes that can be modified through lifestyle changes. While parents often worry about serious underlying conditions, the vast majority of childhood headaches stem from common, manageable factors.

The developing brain and body of a child responds differently to various stressors than an adult brain would. Children are particularly sensitive to disruptions in their routine – irregular sleep schedules, skipped meals, and dehydration can quickly trigger headaches. This sensitivity is why establishing consistent daily routines is so important for headache prevention in children.

Environmental and lifestyle factors play a significant role in childhood headaches. Modern life presents unique challenges, including extended screen time, academic pressure, and sometimes inadequate physical activity. Addressing these modifiable risk factors often significantly reduces headache frequency without any need for medication.

Lifestyle Factors

Sleep: Inadequate or poor-quality sleep is one of the most common headache triggers in children. School-age children need 9-11 hours of sleep per night, while teenagers require 8-10 hours. Both insufficient sleep and oversleeping on weekends can trigger headaches. Maintaining consistent sleep and wake times, even on weekends, helps stabilize the body's internal clock and prevents sleep-related headaches.

Hydration: Children are particularly susceptible to dehydration, which commonly causes headaches. Active children may not recognize thirst signals, especially during play or school activities. Encouraging regular water intake throughout the day – not just when thirsty – helps prevent dehydration headaches. A good guideline is for children to drink water at every meal and during breaks at school.

Nutrition: Skipping meals, especially breakfast, frequently triggers headaches in children. The brain requires a steady supply of glucose to function properly, and long gaps between meals cause blood sugar drops that can lead to headache. Regular, balanced meals and healthy snacks help maintain stable blood sugar levels and prevent hunger-related headaches.

Physical activity: Regular exercise helps prevent headaches by reducing stress, improving sleep quality, and promoting overall health. However, children should avoid sudden intense physical exertion without proper warm-up, as this can sometimes trigger headaches. Encouraging consistent, age-appropriate physical activity rather than sporadic intense exercise is most beneficial.

Stress and Psychological Factors

Stress is a major headache trigger in children and adolescents. Academic pressure, social challenges, family conflicts, bullying, or major life changes (like moving or parents' divorce) can all contribute to stress-related headaches. Children may not always be able to articulate that they're feeling stressed, so parents should watch for signs like changes in behavior, sleep patterns, or appetite.

Anxiety and depression are increasingly recognized as both triggers for headaches and conditions that can worsen existing headache disorders. Children with frequent headaches should be screened for these conditions, as treating underlying mental health issues often improves headache frequency and severity.

Environmental Triggers

Screen time: Prolonged use of computers, tablets, phones, and video games can cause headaches through multiple mechanisms – eye strain, poor posture, and the stimulating effect of bright screens. The American Academy of Pediatrics recommends limiting recreational screen time and ensuring children take regular breaks (the 20-20-20 rule: every 20 minutes, look at something 20 feet away for 20 seconds).

Lighting: Both very bright light and flickering lights (including fluorescent lighting) can trigger headaches, especially in children prone to migraines. Some children are also sensitive to bright sunlight and benefit from wearing sunglasses outdoors.

When Should You See a Doctor for Your Child's Headache?

Seek immediate medical care if your child has severe headache with fever and stiff neck, sudden intense headache with unusual drowsiness, headache after head injury, morning headaches with vomiting, or headache with weakness or vision changes. These could indicate serious conditions requiring urgent evaluation.

While most childhood headaches are benign and manageable at home, certain warning signs require prompt medical attention. Parents should trust their instincts – you know your child best, and if something seems seriously wrong, it's always appropriate to seek medical care. Healthcare providers would rather evaluate a child with a concerning headache and find nothing serious than miss a condition that needs treatment.

The distinction between urgent and non-urgent symptoms helps parents make appropriate decisions about seeking care. Non-urgent symptoms can usually wait for a scheduled appointment with your child's regular doctor, while urgent symptoms warrant same-day evaluation, and emergency symptoms require immediate care.

Keep in mind that young children may not be able to describe their symptoms accurately. In infants and toddlers, signs of headache may include excessive crying, irritability, holding or rubbing the head, sensitivity to light, and changes in sleep or eating patterns. Any concerning symptoms in young children warrant medical evaluation since they cannot communicate what they're experiencing.

Contact a Healthcare Provider If

• Your child has headaches that don't respond to over-the-counter medication
• Headaches occur frequently (more than once a week)
• Your child needs headache medication several times a week
• The headache pattern or character has changed from previous headaches
• Your child has headache with prolonged nasal congestion and pain over the forehead or cheeks (possible sinusitis)
• Your child has headaches and has experienced personality changes
• Your child has headaches and has lost weight
• Your child has an underlying medical condition and develops new headaches

How Are Headaches in Children Treated?

Treatment for children's headaches includes over-the-counter pain relievers (acetaminophen, ibuprofen) for occasional headaches, lifestyle modifications (sleep, hydration, meals), stress management, and sometimes prescription medications for frequent or severe headaches. Non-medication approaches are often preferred.

The treatment approach for childhood headaches depends on the type, frequency, and severity of headaches, as well as the impact on the child's daily life. For most children with occasional headaches, simple measures like rest, hydration, and over-the-counter pain relief are sufficient. However, children with frequent or severe headaches may benefit from a comprehensive treatment plan developed with their healthcare provider.

Modern headache treatment emphasizes a multimodal approach that combines medication (when needed) with lifestyle modifications, behavioral strategies, and sometimes complementary therapies. This approach is often more effective than medication alone and helps children develop skills for managing their headaches throughout life.

Before starting any treatment, it's important to have a proper diagnosis. Different types of headaches respond to different treatments, so knowing whether your child has tension-type headaches, migraines, or another headache type guides treatment decisions. Your healthcare provider can help determine the appropriate diagnosis and treatment plan.

Over-the-Counter Pain Medication

For occasional headaches, over-the-counter pain relievers like acetaminophen (paracetamol) and ibuprofen are generally safe and effective when used appropriately. These medications work best when taken early in the headache, before the pain becomes severe. Always follow age-appropriate dosing guidelines on the package or as directed by your healthcare provider.

Important caution about medication overuse: Using pain medication too frequently can actually cause more headaches – a condition called medication overuse headache (previously called rebound headache). To prevent this, limit pain medication use to a maximum of 2-3 times per week and no more than 9 days per month. If your child needs medication more often, consult a healthcare provider about preventive strategies.

Keep a record of which medications your child takes and how often. This information is valuable for healthcare providers and helps you monitor for overuse. Older children and teenagers can often keep track of this themselves with parental supervision, while younger children need adult assistance.

Non-Medication Treatments

Rest and environment: When a headache strikes, having your child lie down in a quiet, dark room often helps. Apply a cool or warm compress to the forehead or neck (whichever feels better to your child). Ensuring the child is hydrated and has eaten recently addresses potential underlying causes.

Relaxation techniques: Teaching children simple relaxation techniques can be very effective for managing headaches, especially tension-type headaches. Deep breathing exercises, progressive muscle relaxation, and guided imagery are techniques that children can learn and use independently. Many schools and healthcare facilities now offer programs teaching these skills to children.

Biofeedback: This is a technique where children learn to recognize and control physical responses like muscle tension. Studies show biofeedback can be highly effective for childhood headaches, particularly tension-type headaches and migraines. It teaches children to identify early warning signs of a headache and use relaxation techniques to prevent or reduce the headache.

Cognitive behavioral therapy (CBT): For children whose headaches are significantly impacted by stress, anxiety, or depression, CBT can be very helpful. This type of therapy helps children identify thought patterns and behaviors that contribute to their headaches and develop healthier coping strategies.

Prescription Treatments

When headaches are frequent, severe, or significantly impact quality of life, healthcare providers may recommend prescription medications. These fall into two categories: acute treatments (to stop a headache when it occurs) and preventive treatments (to reduce headache frequency).

For migraine, specific medications called triptans are sometimes used in older children and adolescents. Some preventive medications originally developed for other conditions (like certain blood pressure medications or antidepressants) have been found to reduce headache frequency in children. The decision to use prescription medication is made carefully, weighing benefits against potential side effects.

It's crucial that any medication treatment be discussed with and prescribed by a healthcare provider familiar with pediatric headache treatment. Before starting preventive medication, your child should have a proper diagnosis and have tried appropriate lifestyle modifications.

How Can You Prevent Headaches in Children?

Prevent childhood headaches by ensuring regular sleep (8-11 hours), consistent meal times, adequate hydration, limited screen time, regular physical activity, and stress management. Keeping a headache diary helps identify triggers to avoid.

Prevention is often the most effective approach to managing childhood headaches. By identifying and addressing triggers, many children can significantly reduce their headache frequency without medication. A healthy lifestyle with consistent routines forms the foundation of headache prevention.

Prevention strategies should be tailored to each child based on their specific triggers, age, and circumstances. What works for one child may not work for another. The key is to systematically identify your child's individual triggers and develop strategies to avoid or minimize them.

Involving your child in prevention planning is important, especially for older children and teenagers. When children understand why certain changes help and participate in implementing them, they're more likely to stick with the prevention plan. This also teaches them valuable skills for managing their health as they grow older.

Healthy Lifestyle Habits

Sleep hygiene: Establish consistent sleep and wake times, even on weekends. Create a relaxing bedtime routine and ensure the bedroom is dark, quiet, and cool. Limit screen use for at least one hour before bedtime, as the blue light from screens can interfere with sleep. Make sure your child is getting the recommended amount of sleep for their age: 9-12 hours for children ages 6-12, and 8-10 hours for teenagers.

Regular meals: Serve meals and snacks at consistent times each day. Don't let your child skip breakfast – it's particularly important for preventing headaches. Include protein and complex carbohydrates in meals to maintain steady blood sugar levels. Keep healthy snacks available for between meals, especially during busy school days or activities.

Hydration: Encourage your child to drink water throughout the day, not just when thirsty. Send a water bottle to school and remind them to drink at regular intervals. Limit sugary drinks and caffeine, which can contribute to headaches through various mechanisms including dehydration and caffeine withdrawal.

Physical activity: Ensure your child gets regular exercise – at least 60 minutes of moderate to vigorous physical activity daily is recommended. Outdoor play and activities are particularly beneficial. However, make sure children warm up before intense activity and stay hydrated during exercise to prevent exercise-induced headaches.

Using a Headache Diary

A headache diary is one of the most valuable tools for understanding and preventing your child's headaches. By systematically recording information about each headache, patterns often emerge that reveal specific triggers. This information helps both parents and healthcare providers develop targeted prevention strategies.

After keeping the diary for several weeks, review it with your child's healthcare provider. Look for patterns – do headaches occur on certain days of the week? After specific foods or activities? During stressful periods? These insights guide prevention strategies tailored to your child's specific triggers.

How Are Headaches in Children Diagnosed?

Doctors diagnose headaches in children through detailed medical history (including headache diary information), physical and neurological examination, and assessment of symptoms. Imaging studies like CT or MRI are only needed when there are concerning "red flag" symptoms suggesting a secondary cause.

Diagnosing headaches in children primarily relies on a thorough history and physical examination. Unlike many medical conditions, there is no specific test that diagnoses headache types – the diagnosis comes from the pattern of symptoms and their characteristics. This is why detailed information from the child and parents is so important.

During the evaluation, the healthcare provider will ask many questions about the headaches. Bringing a completed headache diary to the appointment is extremely helpful. The provider will want to know about headache frequency, duration, location, character, associated symptoms, triggers, family history of headaches, and the impact on your child's daily life.

A physical examination, including a neurological exam, helps rule out secondary causes of headache. The provider will check things like vision, coordination, reflexes, and strength. In most cases, when the history is typical for a primary headache disorder and the exam is normal, no further testing is needed.

Questions the Doctor May Ask

• How many days per month does your child have headaches?
• When did the headaches start? Have they changed over time?
• Where exactly is the pain located?
• What does the pain feel like – throbbing, pressing, stabbing?
• How severe is the pain?
• How long do the headaches usually last?
• Does physical activity make the headache worse?
• Are there any other symptoms with the headache (nausea, vomiting, light sensitivity)?
• What triggers the headaches?
• Does anything make the headaches better or worse?
• What medications have been tried, and do they help?
• Does anyone else in the family have headaches or migraines?

When Is Imaging Needed?

Brain imaging (CT or MRI scans) is not routinely needed for children with typical headache patterns and normal neurological examinations. However, imaging may be recommended if there are concerning features, called "red flags," that suggest a possible secondary cause for the headaches.

Sometimes children are referred to a pediatric neurologist, a doctor who specializes in brain and nervous system conditions in children. This may occur when headaches are frequent or severe, don't respond to standard treatments, have unusual features, or significantly impact the child's quality of life. The specialist can provide additional expertise in diagnosis and management.

Frequently Asked Questions