Headaches & Migraines in Children

Treating Headaches & Migraines in Children, Toddlers, & Teens

Headaches are a common and sometimes debilitating medical condition, affecting toddlers, children, and teens.

How Many Children Get Headaches?

Many of us think of headaches as an adult problem, but children can get headaches and chronic headaches too.

About 20 percent of 5-year-olds get occasional headaches.
About 75 percent of teenagers get headaches.

Can a Child Suffer From Migraines?

Many people assume that migraines only happen during adulthood. But children as young as 6 can have migraines. In fact:

about one in 50 (or two percent) of 7-year-olds get migraines
about one in 20 (or five percent) of 15-year-olds get migraines

Many parents don't realize their young children are suffering from migraines. That's because children younger than 7 years old may not be able to describe the symptoms of a migraine clearly.

Educate Yourself About Headaches in Children

To find effective treatment for your child, it's critical for both patients and families to understand headaches. Here are some educational resources to help understand and cope with headaches in children and teens:

Find a Pediatric Neurologist

Symptoms

Symptoms of Chronic Headaches in Children

Chronic daily headache is a very worrisome and often disabling problem for children and families. As the name suggests, chronic daily headaches happen every day, and often keep happening for months or years.

Chronic headaches are usually constant. Children wake up with chronic headaches and the headache stays throughout the day, although it may get better or worse in severity during the day.

Many children with chronic headaches are also nauseous and sensitive to light. Most children and adolescents with chronic daily headache don't have any serious medical condition that's causing their headaches.

Migraine Symptoms in Children

Migraines in children are occasional headaches that usually last several hours and usually get better when children rest or sleep. Migraines can cause:

nausea,
vomiting or loss of appetite, and
sensitivity to bright lights and loud sounds.

A migraine can have a pounding, throbbing or constant quality and can get worse if your child moves around.

Many children, adolescents, and adults with migraines also have car-sickness.

Children or adults with migraine can also have temporary neurological problems such as problems with:

seeing,
talking,
feeling, or
moving their body.

It's important for parents to remember that children younger than 7 years of age may not be able to describe many of these symptoms clearly.

Migraine Warning Signs

Some children only get migraines once in a while. These types of migraines can be treated with medication or changing your child's lifestyle habits.

But you should take your child to a doctor if your child has any of the following:

headaches that wake your child up from deep sleep
headaches that cause new problems with your child's vision, personality, school performance, or coordination
a sudden headache that is the worst headache your child has ever had
signs or symptoms that suggest your child may have depression or anxiety along with migraines

Causes

What Causes Headaches in Children?

Our brains don't have nerve endings (like the nerves found on our fingers or toes), so our brains can't “feel” pain. However, the blood vessels within or around our brain and the tissues covering our brain (the dura) have pain sensors.

Activating these sensors can produce the pain that we have during a headache.

Stretching of blood vessels and dura causes headaches when children or adults have brain tumors. Other headaches happen because the muscles on our scalp contract repeatedly, causing pain.

Because headaches can be caused by many medical conditions, they produce a lot of worry for both parents and physicians.

For example, brain tumors can certainly cause headaches. But the vast majority of children and adolescents with headaches do not have tumors or other severe medical conditions.

Chronic Headaches

Chronic daily headaches often start with an event that significantly changes a child’s daily routines. This can be:

an illness, like infectious mononucleosis;
an injury, like a tear of knee ligaments that prevents a teenager from playing sports; or
a major family stress, like divorce or death of a close friend or relative.

Understanding that these events can cause headaches helps parents, teachers, and friends to support children and teenagers through a life crisis or difficult period.

The "Vicious Cycle" of Chronic Headaches

For most children, chronic daily headaches happen because of a “vicious cycle” where many factors work together to cause and the keep causing headaches. Emotional or psychological factors often contribute to this vicious cycle.

Many children also have a genetic predisposition for headaches and often have had migraines in the past.

Then, a trigger like a head injury, concussion, an infection such as “mono” (infectious mononucleosis caused by the Epstein Barr virus) or some other illness or stress starts the headache cycle.

The cycle of chronic headaches keeps going, with other factors adding to it:

Headache pain causes stress and tension, which may cause painful muscle contractions in your child's scalp and neck.
These contractions make your child's pain worse, which activates serotonin nerves and releases more serotonin, which makes your child's pain even worse.

Chronic Headaches & Sleep and School Problems

Children who have chronic headaches usually don't sleep well. Lack of proper sleep and rest can make chronic headaches even worse. As a result, most children with chronic daily headaches don't feel well, aren't active, and can't concentrate. All of these things can make going to school very stressful and challenging.

All of this feeds into the vicious headache cycle.

In addition, frequently using anti-pain (“analgesic”) medications like ibuprofen and acetaminophen can actually make your child's headaches worse by causing a “rebound” or “medication overuse” headache.

All of these things can lead to discouragement, loss of hope, and depression which makes the headache symptoms even more difficult and treatment of your child’s pain even more challenging.

Genetics—Chronic Headaches Are Passed Down in Families

Most people who experience chronic headaches seem to be predisposed to migraines or other headaches.

In addition, 50 percent or more of teens with chronic daily headaches have family members with headaches, usually migraine. This suggests that hereditary factors (genes in families) make headaches more likely to begin with.

What Causes Migraines in Children?

Scientists believe that migraines, one of the most common types of headaches, begin with the release of chemical serotonin into the blood stream. This release leads to chemical and electrical changes within a child's brain and blood vessels. These changes can cause migraines.

Treatment For Chronic Headaches

Treatment relies on all options that can hopefully “break” the vicious cycle of chronic daily headache. Treatment may include:

setting healthy habits including eating well, exercising, and getting enough sleep;
taking pain medications less often, or quitting them altogether;
trying new medications to prevent headaches from returning; and,
trying non-medication approaches to help cope with and slowly recover from headaches.

Medication & Other Treatments

Many of the same medications that prevent migraines can be used to treat chronic headaches. These include:

divalproex sodium (Depakote),
gabapentin (Neurontin),
topiramate (Topamax), and
amitriptyline.

However, many children and teens may not respond to these medications, and headaches continue.

Non-medication treatments may be very helpful in reducing the severity of headaches or in coping with the headache problem. These include:

relaxation training,
massage therapy,
physical therapy that tries to reduce muscle tension,
biofeedback,
self-hypnosis, and
imagery therapy.

These are all safe therapies that may be very helpful and do not have side effects (although some of these therapies are very expensive).

Psychological & Emotional Treatment

Don't underestimate the potential benefit of having your child or teen see a psychologist or psychiatrist.

Sometimes, a psychologist will find an undiagnosed learning disability or life stress that may be underlying reasons for your child’s headaches or school absences.

A psychologist can also help your child when school absences become an additional burden.

Encourage your child to go to school whenever possible. Attending school is an important part of successfully treating chronic daily headaches in teens and children.

Parents' Attitudes Can Affect When a Child Gets Better

Parents should be aware of how their own behavior affects their child's headaches:

excessive worrying (“There must be something the doctors are missing”),
providing excuses (“You have a headache, you shouldn’t go to school today”), and
undermining self confidence (“You won’t do well on the test today because you have a headache”)

can make chronic headaches continue or get worse.

Seeking many other medical opinions from one specialist after another can also prolong rather than shorten chronic headaches.

If you trust your pediatrician, primary care physician, or pediatric neurologist, rely on her or him to guide the evaluation and treatment.

Watch For Signs of Depression

Parents should be alert for signs of depression in their child with chronic headaches, such as:

poor sleep habits,
excessive weight loss or gain,
anger,
declining school performance, or
withdrawing from friends and family.

Depression can be the cause and/or the result of chronic headache. Current information suggests that one in four women and one in six men experience at least one bout of major depression during their lifetimes. Depression often appears first in adolescence.

Your child's headaches won't get better unless depression is recognized and treated.

Treatment for Migraines

The main steps in treating your/your child’s migraines are:

Setting and keeping healthy lifestyle habits
Recognizing and avoiding triggers
Using medications to stop or interrupt headaches once they have started (if needed)
Using medications to prevent the headaches from happening as often (if needed)
If all else fails, using medicines to deal with a headache that will not go away (“rescue” options)
Trying non-medication (complementary) treatment options
Proper general health measures

This includes proper diet, sleep, and exercise. If these basic health measures are ignored, other treatments are less likely to help.

Diet

A well balanced diet with healthy meals three times a day is recommended.

Missing or delaying meals is a common trigger for headaches.

Drinking high caloric beverages (sodas, energy drinks, etc.) can trigger migraines. Doctors also recommend that children don't drink caffeinated beverages often.

Sleep

Getting enough sleep is critical to good health and improving your child's headaches. Unfortunately, many children with frequent or uncontrolled migraines don't sleep well, especially teenagers.

Your child’s doctor may need to treat your child's sleep problem as well as their headaches.

Activity/Exercise

To prevent migraines, it's important that your child has a healthy lifestyle that includes getting physical activity and exercise every day.

Doctors recommend that children get at least 30 minutes per day or some enjoyable activity such as walking, hiking, playing sports or swimming. Physical activity can help children with migraines.

Staying active also improves mental health as well as sleep and improves a child’s ability to cope with headaches.

Recognizing & Avoiding Triggers

An important step in preventing migraines involves identifying what triggers can "spark" your child's migraines.

Your doctor will give you a list of potential headache triggers. Remember that everyone is different and each child's triggers may be different.

Sometimes triggers are not obvious or cannot be identified. It may be helpful to track your child’s headaches on a calendar to try to recognize which triggers might apply to your child.

Many foods can trigger migraines, including:

prepared meats,
cheeses, and
chocolate.

These things can also trigger migraines:

dehydration (not drinking enough fluids throughout the day),
stress (both good and bad),
high altitude,
lack of adequate sleep, and
irregular routines.

Peaceful sleep and healthy, regular meals are the best ways to manage migraines.

Medications To Stop or Interrupt Headaches

Infrequent migraines (less than 4 per month) that last less than 24 hours and don't interfere with school attendance or other activities can be treated with interruptive medications.

These medicines, sometimes called rescue medications, all work best when given as early as possible after the headache starts. In general, the longer a headache lasts, the harder it can be to stop.

We usually recommend ibuprofen (Motrin, Advil), or naproxen sodium (Aleve). These work best if combined with rest.

If ibuprofen alone does not help, a combination of ibuprofen plus caffeine (60 to 90mg) may be better. You can purchase caffeine tablets over the counter in your local pharmacy.

Triptan Medications

Neurologists believe that the triptan family of medications, such as sumatriptan (Imitrex), zolmitriptan (Zomig), frovatriptan (Frova), rizatriptan (Maxalt) and almotriptan (Axert), are the best medications for treating migraines in adults.

Although triptans aren't approved by the FDA to treat children and younger teens, pediatric neurologists often recommend them when headaches don't get better with appropriate doses of ibuprofen or naproxen.

Neurologists believe that triptans are very safe in children, but they should be used cautiously and not more than three times per week.

Medications to Prevent Migraines from Happening

When migraines happen as often as once per week, if they last several days at a time, or if migraines interfere with your child's school attendance or performance, or cause neurological problems, taking a daily medication to prevent the headaches may be a good idea.

A variety of medicines can prevent headaches in children and adolescents. The “best choice” depends on your child’s:

age and weight,
the side-effects of the medication, and
the presence of other factors, such as depression, insomnia, or asthma.

These preventive (or “prophylactic”) medications include:

cyproheptadine (Periactin),
topiramate (Topamax),
propranolol (Inderal),
divalproex sodium (Depakote),
amitriptyline,
imipramine,
gabapentin (Neurontin),
verapamil, and
others.

We often recommend cyproheptadine for children of normal weight under 10 years of age and topiramate for children over 10.

Medications to Help With a Migraine That Won't Go Away

Your pediatric neurologist will help you and your child’s primary care doctor develop a plan that can be used at home to treat a headache that doesn't seem to be responding to the usual treatments listed above. This should help you avoid having to call your child's doctors urgently and should keep you from having to bring your child to the emergency room for a severe headache.

For a severe headache that isn't getting better, getting to sleep is the goal. We recommend that your child lie down in a darkened, quiet room. We may prescribe promethazine (an anti nausea medication) combined with either diphenhydramine (Benadryl) or hydroxyzine (Atarax, Vistaril) in order to induce a deep sleep that may break the headache cycle.

If your child is vomiting, you may need to give your child promethazine as a suppository. You may need to give your child these medications as often as every six hours for a day or two to make sure your child sleeps for a longer period of time to stop the headache.

Sometimes your doctor may choose to prescribe a medication that is sprayed into the nose (intranasal Imitrex or dihydroergotamine [DHE; Migranal]) as a way of treating headaches that don’t stop.

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