Headache in Children: Causes, Symptoms & When to See a Doctor

What Causes Headaches in Children?

Headaches in children are most commonly caused by tension, stress, fatigue, dehydration, hunger, or minor infections like colds and flu. Migraine is the most common headache type requiring medical attention in children and has a strong genetic component. Less common causes include vision problems, sinusitis, and rarely, more serious conditions like brain tumors or meningitis.

Headaches in children and teenagers are extremely common, yet they often cause significant worry for parents. Understanding the underlying causes helps put these headaches in perspective and guides appropriate management. The vast majority of childhood headaches fall into two main categories: primary headaches (where the headache itself is the condition) and secondary headaches (where the headache is a symptom of another problem).

Primary headaches include tension-type headaches and migraines, which together account for approximately 90% of all headaches in children. These headaches are not caused by an underlying disease but rather by complex interactions between the brain, blood vessels, and surrounding nerves. They can be triggered by various factors but are not signs of a serious underlying condition.

Secondary headaches occur as a result of another condition, such as infections, head injuries, dental problems, or eye strain. While most secondary causes are benign, some require prompt medical attention. Understanding the difference between harmless and concerning headaches is crucial for parents.

Common Triggers for Childhood Headaches

Multiple factors can trigger headaches in children, and identifying these triggers is often the first step toward reducing headache frequency. Children are particularly sensitive to changes in their routine and physical state, making trigger identification especially important.

• Dehydration: Many children don't drink enough fluids, especially during school hours or physical activity. Even mild dehydration can trigger headaches.
• Irregular meals: Skipping breakfast or lunch, or going too long between meals, causes blood sugar fluctuations that commonly trigger headaches.
• Sleep disturbances: Both too little and too much sleep can trigger headaches. Irregular sleep schedules, especially on weekends, are common culprits.
• Stress and anxiety: School pressure, social difficulties, family problems, and other emotional stressors are major headache triggers in children.
• Screen time: Excessive use of computers, tablets, and smartphones can cause eye strain and tension headaches.
• Physical triggers: Bright lights, loud noises, strong smells, and weather changes can all trigger headaches in sensitive children.

What Are the Different Types of Headaches in Children?

The two most common headache types in children are tension-type headache (causing mild to moderate pressing pain on both sides) and migraine (causing moderate to severe throbbing pain, often with nausea and sensitivity to light and sound). Tension headaches allow children to continue activities, while migraine often requires rest in a dark, quiet room.

Correctly identifying the type of headache your child experiences is essential for appropriate treatment. While many children with headaches are given a general diagnosis of "headache," understanding the specific type helps predict the course of the condition and guides both immediate treatment and long-term management strategies.

The International Headache Society has established clear diagnostic criteria for different headache types in children. These criteria help healthcare providers distinguish between various headache disorders and ensure that children receive appropriate treatment for their specific condition.

Tension-Type Headache

Tension-type headaches are the most common type of headache in children, although they often go undiagnosed because they're typically mild and don't significantly disrupt activities. These headaches are characterized by a pressing or tightening quality, as if a band were wrapped around the head. The pain is usually mild to moderate and affects both sides of the head.

Children with tension headaches typically describe the pain as dull and constant rather than throbbing. Unlike migraine, tension headaches are not usually accompanied by nausea, vomiting, or significant sensitivity to light and sound. Most importantly, children with tension headaches can usually continue their normal activities, including school and play, though they may not feel their best.

Tension headaches in children often relate to stress, poor posture (especially during screen use), or muscle tension in the neck and shoulders. They may occur episodically or, in some cases, become chronic, occurring 15 or more days per month. Chronic tension headache requires medical evaluation and often benefits from both medication and non-medication approaches.

Migraine in Children

Migraine affects 3-10% of children and is one of the most common reasons for children to seek medical care for headaches. Migraine in children can look quite different from adult migraine, which sometimes leads to delayed diagnosis. Pediatric migraines tend to be shorter (sometimes lasting only 1-2 hours), more often affect both sides of the head, and commonly include prominent abdominal symptoms.

The hallmark features of pediatric migraine include moderate to severe intensity, a throbbing or pulsating quality, and worsening with physical activity. Children with migraine often appear pale, want to lie down, and may vomit. They typically seek out dark, quiet environments and may fall asleep during an attack. Many children experience relief after sleeping, even briefly.

Some children experience migraine with aura, which involves visual disturbances (such as seeing spots, lines, or blind spots), sensory changes (tingling or numbness), or speech difficulties that occur before the headache begins. Aura symptoms typically last 20-60 minutes and resolve completely as the headache develops.

Other Headache Types

While tension headaches and migraines are most common, children can experience other headache types. Cluster headaches, though rare in children, cause severe one-sided pain around the eye with tearing and nasal congestion. New daily persistent headache begins suddenly and continues daily from onset. Various secondary headache types occur due to underlying conditions.

What Are the Warning Signs That Require Medical Attention?

Seek immediate medical care if your child has sudden severe headache ("worst headache ever"), headache with fever and neck stiffness, headache with confusion or altered consciousness, headache after head injury, or headache with weakness or vision changes. Also consult a doctor for headaches that wake your child from sleep, worsen over time, or occur more than once per week.

While most childhood headaches are benign, certain features require prompt medical evaluation. Parents often worry about serious causes like brain tumors or meningitis, and while these are rare, recognizing the warning signs that distinguish concerning headaches from common ones is essential for timely intervention.

The key is to identify headaches that represent a significant change from your child's baseline or those accompanied by concerning neurological symptoms. A headache that is different from usual, more severe than typical, or associated with other symptoms warrants evaluation. Trust your parental instincts—if something seems wrong, seeking medical advice is always appropriate.

Red Flags That Require Medical Evaluation

Several headache features, while not requiring emergency care, should prompt you to schedule a medical appointment. These "yellow flag" symptoms suggest that further evaluation would be helpful to rule out secondary causes and develop an appropriate management plan.

• Headaches that wake your child from sleep: While migraine can do this, headaches that consistently occur during sleep or wake children from sleep need evaluation.
• Morning headaches with vomiting: Headaches that are worse upon waking, especially with vomiting, should be assessed.
• Progressive worsening: Headaches that steadily become more frequent or severe over weeks to months require investigation.
• New headache type: A child who suddenly develops a new pattern of headaches different from any previous headaches should be evaluated.
• Frequent headaches: Headaches occurring more than 1-2 times per week warrant medical review.
• Headaches in young children: Headaches in children under 5 years should generally be evaluated by a healthcare provider.
• Associated symptoms: Personality changes, declining school performance, or changes in gait or coordination alongside headaches need assessment.

How Can I Help My Child's Headache at Home?

For occasional headaches, have your child rest in a quiet, dark room. Offer water and a light snack, apply a cool compress to the forehead, and give age-appropriate doses of ibuprofen or acetaminophen if needed. Most headaches improve within 30-60 minutes with these measures. Avoid giving aspirin to children under 16.

Many childhood headaches respond well to simple home measures without the need for medication. Creating an environment that promotes comfort and relaxation while addressing potential triggers like dehydration or hunger is often sufficient to relieve mild to moderate headaches.

When your child complains of a headache, the first step is to assess the situation calmly. Ask about the location, intensity, and quality of the pain. Check for any associated symptoms like fever, nausea, or vision changes. Then proceed with supportive measures based on what your child needs.

Step-by-Step Home Care

The following approach works well for most common childhood headaches. Implement these steps in order, and most headaches will resolve within 30-60 minutes. If symptoms persist or worsen despite these measures, consider medication or seek medical advice.

1. Create a comfortable environment: Take your child to a quiet, dimly lit room away from screens, noise, and activity. This is especially important for migraine, where light and sound sensitivity are common.
2. Encourage rest: Have your child lie down in a comfortable position. Sleep often helps headaches resolve faster, so if your child wants to nap, encourage it.
3. Offer fluids: Dehydration is a common headache trigger. Offer water, diluted juice, or clear broth. Avoid caffeinated or sugary drinks.
4. Provide a light snack: If your child hasn't eaten recently, a small healthy snack like crackers, fruit, or cheese can help stabilize blood sugar.
5. Apply a cool compress: Place a cool (not ice cold) damp cloth on your child's forehead or the back of their neck. This can provide soothing relief for many types of headaches.
6. Try gentle massage: For tension headaches, gently massaging the temples, neck, and shoulders can help relax tight muscles.

How Can Headaches Be Prevented in Children?

Prevent headaches by ensuring regular sleep schedules (same bedtime and wake time daily), staying well-hydrated, eating regular meals, limiting screen time, managing stress, and getting regular physical activity. Keeping a headache diary helps identify and avoid specific triggers like certain foods or activities.

Prevention is the cornerstone of managing recurrent headaches in children. While it's not possible to prevent all headaches, lifestyle modifications can significantly reduce their frequency and severity. For children with frequent headaches, these preventive measures are often more effective than relying solely on pain medication.

The goal of prevention is to maintain stability in the factors that influence headache occurrence. Children's brains are particularly sensitive to changes in sleep, meals, hydration, and stress levels. By keeping these factors as consistent as possible, many headache episodes can be avoided.

Lifestyle Modifications

Implementing healthy habits throughout the day creates a foundation for headache prevention. These changes may seem simple, but their combined effect can be powerful. Work with your child to make these modifications gradually and sustainably.

• Sleep hygiene: Maintain consistent sleep and wake times, even on weekends. Most school-age children need 9-11 hours of sleep, while teenagers need 8-10 hours. Avoid screens for at least an hour before bedtime.
• Regular meals: Never skip breakfast, and ensure your child eats regular, balanced meals throughout the day. Pack healthy snacks for school to prevent long gaps between eating.
• Hydration: Encourage your child to drink water throughout the day. A good goal is 6-8 glasses of water daily, more during physical activity or hot weather.
• Screen time limits: Set reasonable limits on computer, tablet, phone, and video game use. Encourage regular breaks (every 20-30 minutes) when using screens.
• Physical activity: Regular exercise can reduce headache frequency. Aim for at least 60 minutes of moderate physical activity daily.
• Stress management: Help your child develop healthy coping strategies for stress. Consider relaxation techniques, mindfulness, or cognitive behavioral therapy for children with stress-related headaches.

Keeping a Headache Diary

A headache diary is an invaluable tool for identifying triggers and patterns. Recording details about each headache helps you and your healthcare provider understand what factors contribute to your child's headaches and how well treatments are working.

For each headache, record the date and time it started and ended, the pain intensity (using a 1-10 scale or faces scale for younger children), the location and quality of pain, any associated symptoms, potential triggers from the past 24 hours, any medications taken and their effectiveness, and what your child was doing when the headache started.

What Medications Can Be Used for Childhood Headaches?

For acute headache treatment, ibuprofen and acetaminophen are first-line options for children. Give medication early in a headache attack for best results. Avoid using pain relievers more than 2-3 times per week to prevent medication overuse headache. For children with frequent migraines, preventive medications prescribed by a doctor may be appropriate.

While lifestyle modifications and non-pharmacological approaches are the foundation of headache management, medications play an important role when headaches occur despite preventive measures. Understanding how to use medications appropriately helps ensure safety and effectiveness while avoiding common pitfalls like medication overuse.

The key principle in acute headache treatment is to treat early and adequately. Medications work best when taken at the first sign of a headache, before pain becomes severe. Waiting too long to treat can result in the medication being less effective and the headache lasting longer.

Acute Treatment Options

Over-the-counter pain relievers are appropriate for occasional headaches in children. The two main options are ibuprofen (Advil, Motrin) and acetaminophen (Tylenol, Panadol). Both are safe and effective when used correctly, though ibuprofen is often slightly more effective for headaches.

Always follow dosing instructions based on your child's weight rather than age alone. Give the medication with a small amount of food to reduce stomach irritation with ibuprofen. Ensure adequate hydration, as both medications are processed by the liver and kidneys. Track how often you give pain relievers—using them more than 2-3 days per week can lead to medication overuse headache.

Do not give aspirin to children or teenagers under 16 years of age due to the risk of Reye's syndrome, a rare but serious condition affecting the brain and liver. If your child has specific health conditions, consult your healthcare provider before using over-the-counter pain relievers.

Preventive Medications

For children with frequent or severe migraines that significantly impact their quality of life, preventive medications may be recommended by a healthcare provider. These medications are taken daily to reduce headache frequency, severity, and duration. They are typically considered when headaches occur 4 or more times per month or cause significant disability.

Common preventive medications for children include certain antihistamines, antidepressants, beta-blockers, and anticonvulsants. The choice depends on the child's specific situation, other medical conditions, and potential side effects. Preventive medications are usually tried for 2-3 months to assess effectiveness and are adjusted based on response.

When Should I Take My Child to See a Doctor?

Consult a healthcare provider if your child's headaches occur more than once a week, interfere with school or activities, require frequent pain medication, are different from their usual headaches, or don't respond to home treatment. Also seek evaluation for new onset headaches, especially in children under 5, or if you have concerns about your child's symptoms.

Knowing when to seek medical evaluation helps ensure your child receives appropriate care while avoiding unnecessary worry. Many children with headaches never need to see a specialist, but certain situations warrant professional assessment. A healthcare provider can help confirm the headache type, rule out secondary causes, and develop a comprehensive management plan.

Primary care providers can manage most childhood headaches effectively. However, referral to a pediatric neurologist or headache specialist may be helpful for children with difficult-to-control headaches, those requiring preventive medication, or when the diagnosis is uncertain.

Situations Requiring Medical Evaluation

• Frequency: Headaches occurring more than once per week
• Impact: Headaches causing your child to miss school, activities, or social events
• Medication need: Requiring pain relievers more than 2-3 times per week
• Treatment failure: Headaches not responding to appropriate home treatment
• Pattern change: A significant change in headache pattern, frequency, or character
• Young age: Headaches in children under 5 years old
• Parental concern: Any time you feel worried or uncertain about your child's headaches

What to Expect at a Medical Appointment

When you take your child to see a healthcare provider for headaches, the evaluation typically includes a detailed history and physical examination. Bring your headache diary if you've been keeping one. The provider will ask about headache characteristics, triggers, family history, and impact on daily life.

A neurological examination checks for any signs suggesting secondary causes. For most children with typical headache patterns and normal examinations, imaging studies like CT or MRI scans are not necessary. However, these may be recommended if there are concerning features or if the diagnosis is uncertain.