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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

A Parent's Life A Parent's Life

Children's Headaches -- What Parents Need to Know

April 03, 2014

By Claire McCarthy M.D.

Boston Children's Hospital

Headaches scare parents. It's that simple. The moment a child says he has a headache, parents start thinking, "It's a brain tumor." Or something equally terrible. But kids' headaches are rarely a sign of anything terrible.

Headaches are very common in children. By the time they are 18 years old, 60% to 90% of children will have had at least one headache. And 20% of children have severe or frequent headaches. That's a lot of kids.

Headaches can be divided into two groups: primary and secondary.

Secondary headaches are headaches that are being caused by something else — like a brain tumor. But it's not usually a brain tumor that causes a secondary headache. It's usually a bad cold, or sinusitis, or a bump to the head, or a side effect of a medication. Secondary headaches are the most common headaches in children.

Primary headaches are headaches that are not caused by some other medical condition or abnormality. They're a headache and nothing more.

The most common type of primary headache is a migraine headache. These headaches come and go. Migraines can include nausea, vomiting and sensitivity to light or noise. Sometimes people know they are going to get a migraine because they have changes in their vision, called an aura. Migraines often run in families. Medications like ibuprofen or acetaminophen can help, but the most helpful treatment for migraines is usually prevention. By getting enough sleep, reducing stress, and eating and drinking regularly, migraines often can be avoided.

Tension headaches are the second most common headache type in children. Their symptoms are very similar to migraines, and it can be hard to tell the two apart. They can be brought on by both physical and emotional stress.

Cluster headaches are uncommon before age 10. Headaches come in a cluster for several days or weeks. The pain (which can be severe) is usually behind one eye, and there can be redness and tearing of that eye.

If your child is having frequent headaches, keep a diary of them. This is really helpful to the doctor. Write down:

  • When they happen
  • Other symptoms your child complains of, such as nausea or changes in his vision
  • How long they last
  • How painful they are

We always think we are going to remember these things, but when we get to the doctor we usually have forgotten! Having this information will help the doctor figure out what could be causing the headaches — and how best to help your child.

There are a few warning signs with headaches that make doctors more worried. If your child experiences any of these, you should call your doctor:

  • High fever
  • Stiff neck
  • Dark red rash that doesn't get paler if you press on it
  • Severe pain, especially if it comes on suddenly
  • Seizures
  • Trouble walking, talking or doing any other normal activities
  • Pain that wakes your child from sleep, or that is present first thing in the morning
  • Pain at the back of the head
  • Pain that gets worse, changes, or doesn't respond to treatments

Luckily, all of these rarely happen.

If your child has a headache, have her rest quietly in a darkened room. Shut off the TV and the video games. Give her some ibuprofen or acetaminophen. (Check with your doctor for the right dose for their weight. If your child hasn't eaten in a while, a light snack or meal is a good idea. It's fine for her to have something to drink. (Low blood sugar and dehydration can bring on a headache.) Snuggling can be comforting, too (for both of you).

And chances are that in no time at all, your child will be pain-free and back to normal.

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Claire McCarthy, M.D., a senior medical editor for Harvard Health Publications, is an assistant professor in pediatrics at Harvard Medical School. She is an attending physician and Medical Communications Editor at Children's Hospital Boston.

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