Headaches in Children: When to Worry

Both children and adults can experience occasional headaches with mild to moderate pain that lasts a few hours. For some, however, the headaches become severe, debilitating or chronic.

What headache symptoms in children should parents look for?

A lot depends on your child's age and their ability to communicate with you. Children as young as infants can experience headaches.

The way they express their pain is different depending on their age. Babies who can't speak yet may cry, touch their heads or tightly close their eyes to avoid painful stimuli. Toddlers or elementary-age children may say their head hurts, bright lights are bothering them or use visual imagery (i.e. feels like someone is using a hammer on their head) to express their level of pain. Teens may become moody or withdrawn. Children experiencing headaches may report pain in the front of their head, or all over their head. Headaches in children may occur repeatedly, be provoked by something (i.e. a loud noise, bright lights or too much activity around them) or occur out of the blue.

When should you worry about your child's headache?

As many as one in six teens experience migraines. For some, the headaches become severe, debilitating or chronic. Approximately 2% of teens have headaches daily or every other day.

Headaches can occur on their own, or as a symptom of another condition. While headaches can be a sign of a serious problem like a brain tumor, this is true only about 1% of the time. If your child develops a severe, new headache out of the blue, has a headache that is getting worse, or has a concussion, seek help from your pediatrician immediately. In 99% of cases, the headaches are related to a relatively mild problem like a treatable infection, or related to primary headache disorder, meaning that there is not another underlying problem.

Primary headache disorders include:

• Tension headaches – the most common type of headache that produces mild to moderate pain
• Migraines – severe, debilitating headaches that can last hours or days and are often accompanied with pain, nausea, vomiting, sensitivity to light and sound, and dizziness
• Chronic migraines – frequent painful headaches (15 days a month or more), that occur for at least three months in a row

Most of the time your child's healthcare provider can make these diagnoses based on the pattern of symptoms, and tests are not needed. Primary headache disorders are not life-threatening, but they can cause significant problems, like absence from school. If your child is experiencing frequent headaches or migraines, talk to their pediatrician or a neurologist about treatment options.

How you can help your child with headaches

There are several things parents can do to support their children with headaches, especially as school resumes. For many children, headache patterns differ depending on their routine and environment.

You can encourage the following helpful habits for your child who experiences headaches:

• Maintain consistent schedules for sleep, eating, exercise and school work. Ensure children get adequate uninterrupted sleep at night (8-12 hours per night depending on age).
• Be physically active each day, including at least 20 minutes of vigorous, sweat-producing exercise 3-4 days a week. If your child is experiencing a headache when exercise is scheduled, try to encourage them to be as active as possible for short periods of time or exercise on all non-headache days.
• Drink lots of water and eat well; discourage skipping meals. Keeping properly hydrated and fed can help avoid the onset or continuation of headaches.
• Pursue new hobbies or interests such as crafts, reading or cooking. By relaxing your child's mind after intense schoolwork, they can release stress and stop headaches from starting or worsening.
• Engage with friends and family for companionship and fun.

Coping with headaches in school and at-home

It's normal for headaches to increase with a return to in-person schooling; Increased stress from academic demand can be a headache trigger. School can be overstimulating to your child's nervous system – especially after a prolonged absence due to recent COVID-19 school shutdowns and summer. There are several ways you can smooth the transition to school work and limit debilitating headaches at home.

Some coping tools for children with headaches to improve learning:

• Encourage 5- to 10-minute breaks frequently throughout the day to allow a "screen" break from computers, iPads or other electronic devices.
• If your child is bothered by screens, consider purchasing blue-light blocking glasses or consider installing an anti-glare screen on any electronics (laptop, tablet, etc.) they use regularly. The evidence for these is limited by most are inexpensive and worth a try.
• Ask your child's school for alternatives to computer/tablet use for some projects. For example, some work may be completed using paper copies or listening to audio files.
• Pacing is important. Ensure your child is not overdoing activities or using screens to the point of burnout. Too much eye strain or brain work at once could lead to migraines and missed time from learning or fun.

What to do if a problem arises

If your child is experiencing frequent or debilitating headaches that are preventing them from normal activities, contact a healthcare professional. An evaluation from a skilled professional team, like the Pediatric Headache Program at Children's Hospital of Philadelphia, can determine the extent of your child's symptoms and, if needed, suggest treatment that may include lifestyle modifications, acute or preventive medications, cognitive behavior therapy, and procedural and intravenous treatments.

Your child's primary care physician, neurologist or headache professional can connect you with a specialist as needed. Headaches can be a progressive disorder; don't allow COVID-19 to prevent you from seeking treatment for your child.

Christina Szperka, MD, MSCE, is a pediatric neurologist and director of the Pediatric Headache Program; Dina Karvounides, PsyD, is a psychologist with the Pediatric Headache Program, both at Children's Hospital of Philadelphia.