Headaches are seen in 10% of younger children and up to 30% of teens. Most headaches are mild and do not limit activity. Recurrent headaches are often migraines and are frequently under recognized and under treated. Migraine headaches can be stressful to children and their families and cause school absences.
Migraines are inherited and are associated with focal dysfunction of the brain. They are a complex condition involving dysfunction of the brain, the autonomic nervous system, cranial nerves and cranial vessels. Distant organ systems including the gastrointestinal system are often involved.
Recurrent headaches are worrisome if the child is under age 5 years or if there is no family history of migraine headaches. If there is no extended history of headaches or if there are mental status changes associated with the headaches concern should be raised. Other warning signs include pain during exercise or a history of trauma to the head or neck. If there is fever or signs of neck stiffness there is also concern.
Substance abuse, toxins, pregnancy and various medications can also cause recurrent headaches.
Migraines in children last from 1hour to 2 days. The pain is often on one or both sides of the front and side of the head. It often is pulsating, moderate to severe in intensity and aggravated by physical activity. During the headache at least one of the following is present: nausea and/or vomiting or noise and/or light sensitivity.
Children can also have migraines with an aura. An aura warns of a coming headache. It may be visual or consist of numerous sensory changes. It usually lasts minutes to less than one hour and pain follows the aura. Common non head pain migraine symptoms include nausea, vomiting, diarrhea, dizziness, light or noise sensitivity, vertigo, chills, sweats and hives.
Many chronic and recurrent headaches are not migraines and are due to medication overuse. Caffeine withdrawal is another common cause.
Neuroimaging is recommended if the headache is of new onset and there is a history of trauma or no family history of migraine. If your child’s neurological exam is not normal or if seizures occur an MRI needs to be obtained. An MRI is preferable unless there is an immediate concern of trauma as the cause.
The goal of treatment is to reduce headache frequency, intensity and duration through the use of education and lifestyle changes while using the minimum amount of medication intervention.