​Headaches in children and adolescents may be due to a primary headache syndrome or are secondary to underlying medical conditions.

Primary Headaches

The common primary causes include tension type headache, migraine, cluster headache and chronic daily headache.

Secondary Headaches

Secondary headaches may provide a clue to a serious underlying condition that requires prompt intervention. The secondary causes are usually related to a virus infection with 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)
  

​Primary Headaches

• Tension Type Headache
  
• Tension type headache is 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
  
• Migraine is the most frequent recurrent headache syndrome in childhood. It is characterised by headaches associated with nausea, vomiting, abdominal pain and desire to sleep. The headaches are usually one-sided, throbbing in nature and lasts for hours to days. In younger children, the headache may be bilateral, over the forehead or sides of the head and lasts 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 headache is 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 headache is 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.
  

Secondary Headaches

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

• Night-time awakening due to headache
  
• Headache which is progressive
  
• Headache 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 Computerised Tomography (CT) scan or Magnetic Resonance Imaging (MRI) if clinically indicated.

Primary Headaches

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 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 cycle), mood or anxiety problems. Counselling or psychotherapy sessions may be required.
  
• Maintaining a regular sleep/wake 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.
  
  

Secondary Headaches

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 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.