Headaches (Children)

Headaches in children and adolescents may stem from a primary headache syndrome or be secondary to underlying medical conditions. 

Primary Headaches 

Common primary causes include tension-type headaches, migraines, cluster headaches and chronic daily headaches. 

Secondary Headaches 

Secondary headaches may indicate a serious underlying condition requiring immediate attention. These often relate to a viral infection with fever, but can stem from 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 fluid in the brain)
• Intracranial haemorrhage (bleeding in the brain)
• Idiopathic intracranial hypertension (high brain pressure)

Primary Headaches

• Tension-type Headache: 
  Often described as a sensation of a tight band around the head, this headache is diffuse, bilateral, and squeezing in nature, mild to moderate in intensity and lasts from 30 minutes to several days. Tension headaches may worsen with lack of sleep, but do not typically involve nausea or vomiting. 
  
  
• Migraine: 
  Commonly recurring in childhood, migraines are characterised by headaches accompanied by nausea, vomiting, abdominal pain and a desire to sleep. The headaches are usually one-sided, throbbing and can last for hours to days. In younger children, migraines may be bilateral and occur over the forehead or sides of the head, lasting for a shorter duration. Some children might experience light sensitivity or visual disturbances, including flashes of light or blurred vision before the onset of headaches. 
  
  
• Cluster Headache: 
  Exclusively one-sided, often around the forehead or eye, cluster headaches are severe and typically last less than three hours. It is rare in children under 10 years old. Symptoms include eye tearing, red eyes and increased nasal secretions. 
  
  
• Chronic Daily Headache: 
  Diagnosed in patients experiencing headaches for more than 15 days per month, these can result from primary headaches or medication overuse. Psychosocial evaluation and support are often beneficial. 

 Secondary Headaches 

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

• Night-time awakening due to headache 
  
• Progressive headaches 
  
• Headache which worsens with the Valsalva manoeuvre of exertion (forcefully attempting 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 typically follows a detailed history assessment and physical examination. If deemed clinically necessary, the doctor may order neuroimaging tests, such as computerised tomography (CT) scans or magnetic resonance imaging (MRI) of the brain. 

Primary Headaches 

Treatment principles for primary headaches involve using analgesics as needed and minimising triggers such as psychological stress, sleep deprivation and prolonged screen time. 

Analgesics, or painkillers, such as paracetamol and non-steroidal anti-inflammatory drugs, can be administered for acute severe headaches (tension-type headaches and migraines). However, to avoid the risk of medication-overuse headaches, restrict their use to no more than twice per week. 

Prophylactic therapy, a preventive treatment, is advised when migraines are frequent or have a severe impact on your child's life. A doctor will discuss the potential benefits and side effects of these medications before commencing treatment. 

Treating chronic headaches requires a holistic, multi-model approach aiming at restoring normal activities of the child, including:

• Administering headache medication strictly as prescribed. 
• Identifying and avoiding headache triggers and addressing stressors, such as exams and menstrual cycles, mood or anxiety issues. Counselling or psychotherapy sessions may be beneficial. 
• Ensuring regular sleep patterns, with 8 to 10 hours of uninterrupted sleep nightly. 
• Providing regular and nutritious meals, avoiding MSG and ensuring hydration to prevent dehydration-related headaches. 
• Avoiding caffeine and alcohol, as they can trigger headaches. 
• Encouraging exercise to increase blood flow and endorphin levels, which helps to reduce stress and maintain physical fitness. 
• Maintaining a headache diary to monitor progress. 
• Allowing time for relaxation and hobbies. 
• Setting realistic expectations, as the frequency and severity of headaches may decrease over weeks to months, but they may not disappear completely. 

Secondary Headaches 

Treatment for secondary headaches depends on the underlying cause. 

Seek immediate medical attention at the Children's Emergency immediately if your child exhibits any of the following symptoms: 

• Intense, unprecedented headache  
• Headaches disrupting sleep 
• Headaches exacerbated by coughing or sneezing 
• Morning vomiting 
• Weakness, numbness or difficulty walking 
• Drowsiness or reduced consciousness 
• Visual impairments such as blurred or double vision 
  
• Headaches can be improved by avoiding triggers, exercising, ensuring adequate sleep and seeking appropriate medical treatment.