Headaches in children

Headaches in children are pain or discomfort in the head that can have many different causes. The two most common types are tension headaches and migraines. In the vast majority of children, headaches are not a sign of serious illness, but a thorough assessment can help clarify the cause and find the right management.

What are headaches in children?

Headaches in children are pain or discomfort in the head that can occur for many different reasons and look different from child to child. Headaches are generally divided into primary headaches, where the headache itself is the actual condition, and secondary headaches, where the headache is a symptom of something else, such as infection, fever or head trauma. The two most common primary headache types in children are tension headaches and migraines. According to the National Knowledge Center for Headaches, headaches are one of the most common reasons for school absences in children and adolescents.

How common are headaches in children?

Headaches are very common in children and adolescents, and the incidence increases with age. Tension headaches are seen in about 10-15 percent of 10-year-olds as a frequent or chronic condition, and some studies indicate that up to one in five schoolchildren suffer from tension headaches. Migraines are seen in about 7 percent of schoolchildren aged 6-17. More girls than boys report having had headaches, and the difference becomes more pronounced throughout the teenage years.

What is the difference between tension headaches and migraines in children?

Tension headaches cause a steady, pressing or tightening pain on both sides of the head or throughout the head, of mild to moderate intensity. It is not worsened by physical activity, and there is usually no nausea, although mild sensitivity to light or sound may occur. An attack can last from about half an hour to several days. Tension headaches are the most common type of headache in children and typically begin around the age of 7.

Migraines are more severe and often throbbing, worsen with physical activity and are frequently accompanied by nausea, vomiting and sensitivity to light and sound. In children, migraines often occur on both sides of the head and typically last from about 1 hour to a few days. Migraines usually begin a little later than tension headaches, around the age of 12-13, but can also be seen in younger children. In some children, migraines occur together with visual or sensory disturbances, called aura.

You can read more in depth about migraines in children, including symptoms, aura and treatment, on our page about migraines in children.

What can cause headaches in children?

Headaches in children can have many different causes, and are often a combination of several factors. The most common factors that can trigger or worsen headaches in children are:

• Physical or mental stress, e.g. in connection with school or social situations
• Lack of sleep or irregular bedtimes
• Hunger and irregular meals
• Too little to drink
• Too much screen time and sedentary positions
• Infections and fever

In most children, headaches are not a sign of anything serious, but a recurring or persistent headache should always be evaluated by a doctor so that the correct cause and treatment can be found.

Can stress and school cause headaches in children?

Yes, physical and mental stress – including stress related to school, exams or social situations – is one of the most common factors that can trigger or worsen headaches in children, especially tension headaches. In some children, there is a clear correlation between stressful periods at school and more frequent headaches, while other factors such as sleep and screen time play a role at the same time. It can therefore be helpful to look at the child’s daily life as a whole when trying to understand the pattern behind the headache.

Headache and fever in children

Headaches accompanied by fever are often seen in connection with common infections such as colds or flu, and typically disappear again once the infection is over. However, in rare cases, headaches and fever can also be a sign of a more serious infection. Seek medical attention if your child has a fever and headache along with a stiff neck, rash, severe lethargy, or a general condition that is clearly affected.

How can you tell if a small child has a headache?

Young children may have difficulty expressing their headache. In these children, headaches may instead manifest as changes in behavior – for example, the child becomes quieter, seeks rest, wants to lie down, sleeps a lot, touches his head, or becomes more irritable and uncomfortable than usual. If a young child often seems uncomfortable in this way, it may be a good idea to have the child evaluated by a doctor.

Are headaches in children the same as headaches in adults?

Children are generally affected by the same types of headaches as adults, but the headaches may have a different expression in children. Attacks are often shorter, headaches are more often located on both sides of the head regardless of type, and children may have a harder time describing their symptoms accurately. A migraine attack in a child typically lasts 1-72 hours, while in adults it can last 4-72 hours. These differences are part of the reason why headaches in children can sometimes be more difficult to diagnose than in adults.

When should you be concerned about headaches in your child?

The vast majority of children with headaches have an innocent and familiar type of headache that does not require urgent action. However, there are a number of warning signs that should prompt medical attention more urgently, as they may be signs of an underlying, secondary cause of the headache:

• Headaches that wake the child at night or that are worst just after waking up
• Sudden, very severe headache of a completely different nature than the child's usual headache
• Headache with vomiting in the morning, decreasing throughout the day, repeated over days to weeks
• Headache with fever, stiff neck, or a clearly affected general condition
• Headache in a child under five years of age
• New neurological symptoms such as visual disturbances, speech difficulties, paralysis or altered level of consciousness
• Headache along with behavioral changes, increased head size, or changes in weight and growth
• Headaches that are worsened or triggered by certain neck positions or movements

These signs do not necessarily mean that something serious is at stake, but they should always lead to the child being examined by a doctor.

Should I go to the doctor about my child's headache?

Recurrent or persistent headaches should always be evaluated by a doctor so that the cause can be clarified and the child can be properly managed. This applies even if the headache is not accompanied by the more acute warning signs - a thorough clarification can give both child and parents reassurance and open up for targeted treatment, if appropriate. In the case of the more acute warning signs, as described above, a doctor should be sought sooner.

What can be done to relieve headaches in children?

For mild to moderate headaches, it can often help the child to calm down, drink a glass of water, eat something and possibly lie down in a quiet room. Over-the-counter medications such as paracetamol or ibuprofen can also be used if necessary. However, it is important not to give painkillers for headaches too often or over long periods of time, as this in itself can cause the headache to become more frequent and more persistent. For recurring headaches, it is therefore relevant to clarify the cause so that the child can receive the right treatment and guidance – instead of just treating individual attacks.

Examination and diagnosis of headaches in children

The evaluation of headaches in children starts with a thorough discussion about the nature of the headache, where it is located, how often and how long it lasts, as well as any accompanying symptoms such as nausea, sensitivity to light or visual disturbances. It is often a great help if parents have noted in advance when the headache occurs and what precedes it – for example in a headache diary.

The clinical examination includes a general examination of the child, including measuring pulse and blood pressure, as well as a neurological examination to assess vision, movement and reflexes. In the vast majority of children, there are no abnormal findings, and the diagnosis is made primarily based on the medical history. Only in special cases, where there are atypical symptoms or warning signs, may further examinations such as an MRI scan be considered - this is always an individual medical assessment.

Headaches in children at Charlottenlund Private Hospital

At Charlottenlund Private Hospital, your child can be examined by a specialist with experience in headaches in children and adolescents. The examination is based on a thorough conversation about the child's headache pattern and everyday life, and we emphasize that both the child and parents are safe and informed throughout the entire process.

Based on the overall assessment, we clarify whether it is a tension headache, migraine or another cause, and make a plan for the further course of action. If relevant, we can draw on our other specialists within ear, nose and throat and psychology in the same course, as headaches in children are sometimes related to other conditions such as sleep problems or stress.

Experience and skills at Charlottenlund Private Hospital

At Charlottenlund Private Hospital, children with recurring headaches are assessed by pediatric specialists. The assessment is based on a thorough medical history and a clinical and neurological examination, and it clarifies whether it is a tension headache, migraine or another cause. You will find an overview of all departments on our department page.

Sources:

- National Knowledge Center for Headache: Headaches in children and adolescents – prevalence of tension headaches and migraines.