Headaches in children

HEADACHES ARE common in children and most are not due to serious illness.

Headaches are classified as primary and secondary. In primary headaches, the headache itself is the disease. These include migraine and tensiontype headaches, both seen in children. Secondary headaches are due to an underlying illness.

Migraine headaches are usually hereditary. Adults and older adolescents typically have headaches which are throbbing or pounding, unilateral (occur on one side of the head) and last more than

four hours. Children ‘s migraine are often not throbbing or unilateral but occur across the forehead, are shorter in duration, lasting one to two hours and occur less frequently. They are often associated with stomachaches, nausea, vomiting and sensitivity to light and sound. Lack of sleep, excess fatigue, hunger, certain foods, dehydration, and stress are some triggers for migraine.

HEADACHE DIARY

Keeping a headache diary helps to document features of the headache which helps in diagnosis and also in identifying triggers. Headaches are usually managed by avoiding triggers and reducing stress. They are relieved by over-the-counter (OTC) analgesics (painkillers) such as acetaminophen or ibuprofen, and sleep or rest. If headaches are frequent, preventative medication, taken daily, can be considered and prescribed.

Tension-type headaches are due to stress. The pain is diffuse and described as a tightening around the head. They are not associated with nausea, vomiting or light, or sound sensitivity. And unlike migraine, are not made worse by physical activity.

Stress may be due to problems at school, such as challenges with academic performance, difficulties with relationship with peers, and bullying. Home-related stressors include sibling rivalry, parental discord and absent parent. Treatment consists of addressing the stressor and OTC analgesics. Care must be exercised, as excessive use of painkillers may worsen headaches.

Secondary headaches may be due to:

1. Illness – Viral illness or upper respiratory infections such as the common cold, ear, throat and sinus infections are all associated with fever and maybe associated with headache. Once the illness resolves, the headache also resolves. These are among the most frequent causes of headaches in children.

More serious brain infections such as meningitis and encephalitis are less common causes of headache and are associated with fever and drowsiness and in older children, neck stiffness.

2. Head trauma – Bumps and bruises to the head due to a fall or hit on the head may result in a headache which last a few hours and get better within days of the injury. Most head trauma in young children are of a trivial nature.

3 . Headache may be secondary to serious brain pathology such as brain tumours, bleeds and abscess, but these are uncommon causes of headache. Headaches are usually persistent, worsen over time and are associated with emesis and other neurological complaints such as visual disturbance, weakness, gait and balance problems and drowsiness.

WHEN TO SEEK MEDICAL ATTENTION

1 . Pain that is persistent, worsening and does not respond to over-thecounter treatment.

2 . Headaches associated with vomiting.

3 . Pain that interferes with the child’s normal activities, prevent him or her from going to school and/or playing.

4 . Headache associated with sleepiness, visual disturbance such as double or blurred vision, trouble talking or walking, and balance problems.

5 . Headaches associated with fever and neck stiffness.

6 . Pain that awakens the patient from sleep or occurs in the mornings on awakening.

7 . Headaches that persist following a blow to the head.

Headaches associated with an acute illness get better when the illness does and usually responds to OTC analgesics. Keeping a diary of the child’s headaches and symptoms, and seeking and following medical advice, are important in relieving recurrent headaches. CONTRIBUTED BY

DR JUDY TAPPER, Consultant Paediatric Neurologist