Headaches (Children)

A Headache occurs when one experiences a sharp pain, a throbbing sensation, or a dull ache in any part of the head. The pain may be at one or both sides of the head, only at a certain point, or throughout the whole head.

A Headache can happen any time, or develop gradually. It may last from less than an hour to several days.

Headaches are common in children and adolescents. It is one of the frequently cited reasons for clinic and emergency department visits. The prevalence ranges from 17% to 90% of children. Headaches are more common in boys than girls before puberty, but the ratio changes after they go through puberty.

Headaches in children and adolescents may be due to a Primary Headache Syndrome or are secondary to underlying medical conditions.

The common primary causes include Tension-type Headaches, migraine, Cluster Headaches and Chronic Daily Headaches.

Secondary Headaches may provide a clue to a serious underlying condition that requires prompt intervention. Secondary causes are usually related to a viral infection with a fever but may be due to rare causes such as:

• Meningitis
• Acute febrile illness (upper respiratory tract infection, sinusitis)
• Head trauma
• Acute and severe hypertension (high blood pressure)
• Acute or chronic meningitis (brain infection)
• Brain tumour
• Hydrocephalus (increased water in the brain)
• Intracranial haemorrhage (bleeding in the brain)
• Idiopathic intracranial hypertension (high brain pressure)

• Tension-type Headache
  • Tension-type Headaches are classically described as pain that feels like a tight band around your head. The Headache is diffuse, bilateral, squeezing in nature, of mild to moderate intensity, and lasts from 30 minutes to several days. Tension Headaches may be worsened by lack of sleep but are not associated with nausea or vomiting.
• Migraine
  • Migraines are the most frequent recurrent headache syndrome in childhood. They are characterised by Headaches associated with nausea, vomiting, abdominal pain, and the desire to sleep. The Headaches are usually one-sided, throbbing in nature, and last for hours to days. In younger children, the Headache may be bilateral, occurring over the forehead or on the sides of the head, and may last for a shorter period of time. In some cases, there may be light sensitivity or visual symptoms including flashes of light, or blurring of vision prior to the Headaches.
• Cluster Headache
  • Cluster Headaches are always one-sided and usually over the forehead or around the eye. The pain is severe and lasts less than 3 hours. It is associated with increased eye tearing, red eyes, and increased nasal secretions. They are rare in children below 10 years of age.
• Chronic Daily Headache
  • Chronic Daily Headaches are diagnosed in patients who have Headaches for more than 15 days in a month. These may be due to Primary Headaches or medication overuse. Psychosocial evaluation and support are useful.

Parents should look out for signs and symptoms suggestive of secondary causes of Headaches. These include:

• Night-time awakening due to Headaches
• Headaches which are progressive
• Headaches which worsens with Valsalva manoeuvre of exertion (forcefully attempt an exhalation while keeping the nose and mouth shut)
• Persistent vomiting
• Any neurological deficits such as limb weakness or slurring of speech

Any Headache which is getting more frequent or severe will warrant medical attention.

Diagnosis is made usually after a detailed history taking, and physical examination. The doctor may order neuroimaging such as a Computerised Tomography (CT) scan, or Magnetic Resonance Imaging (MRI) if clinically indicated.

Treatment principles for Primary Headaches include using painkillers when needed and minimising triggers such as psychological stress, sleep deprivation and prolonged screen time.

Analgesics, also known as painkillers, such as paracetamol and Non-Steroidal Anti-Inflammatory Drugs can be used when your child is experiencing an acute severe Headache (Tension-type Headache and Migraine). However, painkillers should not be given more than 2 days per week to avoid the risk of Medication-Overuse Headache.

Prophylactic therapy is a type of preventive treatment used when migraines occur frequently, or have a significant adverse impact on your child's life. A doctor will discuss the effectiveness and possible complications of the medications with you before starting the prophylactic treatment.

Treatment for chronic Headaches requires a holistic approach over several months with the aim of your child returning to normal activities. The specific measures include:

• Giving Headache medication only as directed by your doctor. Excessive use of painkillers can lead to rebound Headaches (Medication-Overuse Headaches).
• Identifying and avoiding Headache triggers, and addressing sources of stress (including exams and menstrual cycles), mood or anxiety problems. Counselling or psychotherapy sessions may be required.
• Maintaining a regular sleep cycle. Ensure that your child gets at least 8 to 10 hours of undisturbed sleep at night.
• Eating regular and nutritious meals. Do eat regular healthy meals that include carbohydrates, protein, fruits and vegetables. Avoid MSG in your child's meals as it can trigger Headaches.
• Drinking plenty of water. Dehydration can lead to Headaches as well.
• Avoiding caffeine and alcohol. Caffeine is a stimulant. When levels of caffeine in the blood decrease, Headaches increase. Alcohol can be a trigger of Headaches.
• Exercising. Exercise can increase blood flow and endorphins to your child's brains, helping to reduce stress and keep your child physically fit.
• Keeping a Headache diary. This will help you and your doctor to track your child's progress.
• Relaxing. Take some time off your child's busy schedule to pursue a hobby or to do a relaxing activity.
• Having realistic expectations. The frequency and severity of the Headaches may decrease over weeks to months of treatment but they may not completely disappear.

The treatment for secondary causes of Headaches will depend on the underlying cause.

Go to the Children's Emergency immediately if your child is experiencing any of these symptoms:

• Worst Headache they ever experienced
• Headaches that wake your child up from sleep
• Occipital (over the back of the head) Headaches
• Headaches that are worsened by coughing or sneezing
• Early morning vomiting
• Fever with neck stiffness
• Weakness, numbness, or unsteady gait (walking)
• Drowsiness, or decreased consciousness
• Visual disturbances, such as blurring of vision or double vision

Headaches can be improved by avoiding the triggers, exercising, sleeping well, and seeking proper treatment from a doctor.