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Headache

Introduction

Here you’ll find answers to some of the questions that parents often have about this condition. Additional resources are listed at the bottom of the page. Diagnosis and management information can be found in the Headache (Migraine & Chronic) module, which is written for primary care clinicians but also may be of help to parents and family members.

What is a migraine and what causes them?

Migraines are a type of headache that often begin as a dull ache and then become throbbing in nature, felt on one part or all over the head. The pain can be accompanied by nausea, vomiting, and sensitivity to light and noise. Some people (about 15% of migraine sufferers) experience an aura, which is a group of neurologic symptoms such as visual changes or feelings of pins and needles before an attack. Some people will experience the aura, but never get the headache pain. This is called acephalgic headache, or migraine without headache.
We don't completely understand how headaches are caused. They are thought to result from the interplay of genetic factors and environmental triggers. The headache seems to be due to increased blood flow in the blood vessels in and around the brain. This increased blood flow may lead to a release of chemicals that cause inflammation, leading to pain and activation of the sympathetic nervous system, which leads to nausea, vomiting, diarrhea, cold hands and feet, and sensitivity to light and sound. There is most likely a family predisposition as well as 4 out of 5 individuals with migraine report a family history of migraine. See FAQs (National Headache Foundation).

What are the symptoms of chronic daily headaches?

Migraine headache symptoms are described above. The term chronic daily headache is used when headaches occur 15 or more days a month. Some individuals with chronic headache describe headaches present every day with a range of pain from 0-10 throughout the day. Accompanying symptoms such as nausea and vomiting are less common with chronic daily headache than with typical migraines.

How are migraine or chronic headaches diagnosed?

They are diagnosed by excluding other causes of headache which are very rare and include infections and tumors. These are very unlikely if the child's neurologic exam is normal. Then, your child's primary care clinician will ask questions about the headaches to determine appropriate management.

What is the prognosis?

Headaches can be a chronic problem through life that can be managed, but sometimes not cured. In addition to medications, both acute and preventive, lifestyle changes are also necessary. These include exercise, watching for triggers, avoiding stress, and others.

What is the risk for family members and future babies?

There is a familial predisposition to headaches but it is difficult to predict just who will be affected. A child has a 50% chance of having migraines if one parent suffers and a 75% chance if both parents suffer.

What treatments/therapies/medications are recommended or available?

Headache treatment involves lifestyle changes in addition to medications and other therapies that will be covered below. Lifestyle changes include keeping a headache journal and identifying triggers for the headaches if possible, then trying to avoid those triggers. Lifestyle changes also include decreasing stress, increasing hydration, ensuring that no meals are missed, getting enough sleep, and others.
Headache treatment involves both acute medications, to stop headaches, and preventive therapies. Acute medications involve over-the-counter medications such as ibuprofen and naproxen, medications to allow sleep, and others. Preventive medications are those that are given on a daily basis to help prevent headaches. These include amitriptyline, topiramate, valproic acid, and others. In children with very difficult-to-control headaches other therapies may also be recommended including physical therapy, biofeedback, botox injections, psychological counseling, and others. More comprehensive information can be found in the Headache (Migraine & Chronic)

How will my child and our family be impacted?

The impact of headaches will depend on severity of the headache syndrome, frequency of headaches, and response to treatment. Good health care, quality educational programs, a supportive school environment, and positive support from family, friends, and the community are critical to optimizing health and functional outcomes.

Can children get headaches?

By the time they reach high school, most young people have experienced some type of headache. FAQs (National Headache Foundation) In younger children, it may be difficult to tell if they are having headaches but a pale child who seems to be in pain, or has nausea and vomiting, or is holding his or her head, particularly in the setting of a family history of headache, may be experiencing headaches.

What is biofeedback?

Biofeedback is a technique using equipment that monitors your body's involuntary physical responses such as breathing, pulse, heart rate, temperature, muscle tension, and brain activity. Biofeedback helps you refine and perfect your relaxation exercises by learning to control the physical responses that are related to stress. After learning the technique the equipment is no longer necessary.

Why does my child’s doctor want us to see a psychologist for migraine headaches?

There are many reasons why children with recurring headaches should see a psychologist or other health specialist. Common reasons include: for help in identifying and eliminating headache triggers, for counseling to help deal with the headaches, to address missed school days and social interactions, to address peer or family pressures, to help with lifestyle changes to relieve stress and promote relaxation, and to help with specific techniques to relieve pain, such as imagery or self-hypnosis.

Why should my child go to school when he is having a headache?

The Portal has a link to a discussion regarding this question. See Why should my child go to school with a headache? (ShareCare).

If nothing is wrong with my child, then why is she having headaches?

When a physician tells you that your child is "fine," that most likely means that your child doesn't have a serious underlying condition causing the headaches. It doesn't mean that the headaches aren't real, or that they don't hurt, or that the pain can't cause significant disability and absences from school or work.

What is a rebound headache?

Rebound headaches occur when an individual with headaches has taken acute headache medications too often (more than two days per week) or in excessive amounts (more than the label or a doctor advises). With rebound headache, your medications not only stop relieving pain, they actually begin to cause headaches. Doctors treat rebound headache by tapering the medication that is being overused, sometimes by gradually substituting a different type of treatment or medication. Stopping may be a challenge, but regularly overusing a medication increases the potential for serious side effects. Consult your primary care clinician if you regularly use headache medications more than two days per week or more than the label advises. FAQs (National Headache Foundation)

What is a headache trigger?

Migraines and chronic headaches can be triggered by many things including changes in the weather, certain foods, hormonal changes, and stress to name a few. It is important for you or your child to keep a headache journal to try to identify these triggers. The National Headache Foundation has additional information and a list of possible triggers. See FAQs (National Headache Foundation).

Resources

Information & Support

Where can I go for further information?

For Parents and Patients

Support

Headache Information (NHF)
Information, online support groups, and regional conferences; includes a physician finder; from the National Headache Foundation.

General

Kids Help (ACHE)
Educational sheets and resources for families who are affected by disabling headaches; American Council for Headache Education, sponsored by the American Headache Society.

Headaches in Children (Headaches.org)
An excellent resource, with information written for parents and for the child experiencing the headaches, by David Rothner, MD, a headache expert and former head of child neurology at the Cleveland Clinic.

Headaches (Cincinnati Children's)
Information about chronic, daily, and tension headaches in children.

Pediatric headache (Medscape)
Basic information for families about pediatric headache.

Causes of Headaches (KidsHealth)
Includes tips for how to help your child when he or she has a headache and when to call a doctor; sponsored by Nemours.

Headache Patient information (UptoDate)
From the publishers of the premier online medical textbook and authored by the same physicians who write the content of the textbook.

Headaches in Children (Boston Children's Hospital)
Patient/parent-oriented material including information about diagnosis and treatment.

Headache Information (NINDS)
Detailed information about headache and related research; from the National Institute of Neurological Disorders and Stroke.

Why should my child go to school with a headache? (ShareCare)

Patient Education

Chronic Daily Headache Guide (Div Ped Neurol, Univ Utah Health Sciences Center, Primary Children's Medical Center) (Word Document 30 KB)

Headaches in Children (ACHE)
A printable sheet discussing common parent questions about headaches in children; from the American Headache Society's Committee for Headache Education.

Headaches in Children (Cleveland Clinic)
Basic information about headaches for families, including when it is important for a child with headaches to be seen by a physician.

Headaches in Kids: What Parents Can Do to Help (ACHE)
Describes what they call four simple but critical steps; from the American Headache Society's Committee on Headache Education.

Migraine Family Guide (Div Ped Neurol, Univ Utah Health Sci Center, Primary Children's Medical Center) (Word Document 30 KB)

Patient Education Sheets (AHS)
From the American Headache Society and the Journal of Head and Face Pain, a web page full of links to useful patient education materials on many aspects of headache.

Services

Behavioral Programs

See all Behavioral Programs services providers (31) in our database.

Developmental - Behavioral Pediatrics

See all Developmental - Behavioral Pediatrics services providers (5) in our database.

Pain Clinics

See all Pain Clinics services providers (3) in our database.

Pediatric Integrative Medicine

See all Pediatric Integrative Medicine services providers (1) in our database.

Pediatric Neurology

See all Pediatric Neurology services providers (10) in our database.

Pediatric Ophthalmology

See all Pediatric Ophthalmology services providers (8) in our database.

Physical Therapy

See all Physical Therapy services providers (62) in our database.

For other services related to this condition, browse our Services categories or search our database.

Studies

Clinical Trials on Headache in Children (clinicaltrial.gov)

The Childhood and Adolescent Migraine Prevention Study (CHAMP)
Ages 8-17, 34-week study, paid, comparing two medicines--amitriptyline and topiramate--with a placebo. Only one participant so far; need 16 total. May end study for lack of participants. Study being conducted at the University of Utah Clinical Neurosciences Center.

Thin Film Spectacle Coatings to Reduce Light Sensitivity and Headaches in Child and Adolescent Patients with Migraine
ages 7-18, a 12-week study wearing lenses with a coating to minimize light. No medications involved. Study conducted through the University of Utah's Clinical Neurosciences Center.

Authors

Author: Lynne M Kerr, MD, PhD - 3/2012
Compiled and edited by: URLEND Trainees, 2011-2012 - 3/2012
Content Last Updated: 12/2015

Funding/Support

The Medical Home Portal thanks the 2011-2012 URLEND Medical Home Portal trainees group for their contribution to this page.