Headache

Is this your child's symptom?

• Pain or discomfort of the head
• This includes the forehead to the back of the head
• Not caused by a head injury

Causes of Acute Headaches

• Viral Illnesses. Most acute headaches are part of a viral illness. Flu is a common example. These headaches may relate to the level of fever. Most often, they last a few days.
• Hunger Headaches. About 30% of people get a headache when they are hungry. It goes away within 30 minutes of eating something.
• MSG Headache. MSG is a flavor enhancer sometimes added to soups or other foods. In larger amounts, it can cause the sudden onset of a throbbing headache. Flushing of the face also occurs.
• Common Harmless Causes. Hard exercise, bright sunlight, blowing a wind instrument or gum chewing have been reported. So has severe coughing. "Ice cream headaches" are triggered by any icy food or drink. The worse pain is between the eyes (bridge of nose).
• Head Injury. Most just cause a scalp injury. This leads to a painful spot on the scalp for a few days. Severe, deeper or entire-head pain needs to be seen.
• Frontal Sinus Infection. Can cause a headache on the forehead just above the eyebrow. Other symptoms are nasal congestion and postnasal drip. Rare before 10 years old. Reason: the frontal sinus is not yet formed. Other sinus infections cause face pain, not headaches.
• Meningitis (Very Serious). A bacterial infection of the membrane that covers the spinal cord and brain. The main symptoms are a stiff neck, headache, confusion and fever. Younger children are lethargic or so irritable that they can't be consoled. If not treated early, child can suffer brain damage.

Causes of Recurrent Headaches

• Muscle Tension Headaches. Most common type of frequent headaches. Muscle tension headaches give a feeling of tightness around the head. The neck muscles also become sore and tight. Tension headaches can be caused by staying in one position for a long time. This can happen when reading or using a computer. Other children get tension headaches as a reaction to stress or worry. Examples of this are pressure for better grades or family arguments.
• Migraine Headaches. Severe, very painful headaches that keep your child from doing normal activities. They are throbbing and often occur just on one side. Symptoms have a sudden onset and offset. Vomiting or nausea is present in 80%. Lights and sound make them worse. Most children want to lie down in a dark, quiet room. Migraines most often run in the family (genetic).
• School Avoidance. Headaches that mainly occur in the morning on school days. They keep the child from going to school. The headaches are real and due to a low pain threshold.
• Rebound Headaches. Caused by overuse of pain medicines in high doses. Most often happens with OTC meds. Caffeine is present in some pain meds and may play a role. Treatment is taking pain meds at the correct dosage.
• Not Due to Needing Glasses (Vision Headaches). Poor vision and straining to see the blackboard causes eye pain. Sometimes, it also causes a muscle tension headache. But, getting glasses rarely solves a headache problem that doesn't also have eye pain.

Pain Scale

• Mild: your child feels pain and tells you about it. But, the pain does not keep your child from any normal activities. School, play and sleep are not changed.
• Moderate: the pain keeps your child from doing some normal activities. It may wake him or her up from sleep.
• Severe: the pain is very bad. It keeps your child from doing all normal activities.

When to Call for Headache

Call 911 Now

• Hard to wake up or passed out
• Acts or talks confused
• Weakness of arm or leg on one side of the body
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Vomiting
• Blurred vision or seeing double
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Fever
• Sinus pain (not just congestion) of forehead
• Swelling around the eye with pain
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Headache without other symptoms lasts more than 24 hours
• Migraine headache suspected, but never diagnosed
• Sore throat lasts more than 48 hours
• Any headache lasts more than 3 days
• Headaches are a frequent problem
• You have other questions or concerns

Self Care at Home

• Mild headache
• Migraine headache, just like past ones

Care Advice

Treatment for Mild Headache

1. What You Should Know About Mild Headaches:
   • Headaches are very common with some viral illnesses. Most often, these will go away in 2 or 3 days.
   • Unexplained headaches can occur in children, just as they do in adults. They usually pass in a few hours or last up to a day.
   • Most recurrent headaches that can occur in anyone are muscle tension headaches.
   • Most headaches (including muscle tension headaches) are helped by the following measures.
2. Pain Medicine:
   • To help with the pain, give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Use as needed.
   • Headaches due to fever are also helped by bringing the fever down.
3. Food May Help:
   • Give fruit juice or food if your child is hungry.
   • If your child hasn't eaten in more than 4 hours, offer some food.
   • Reason: Skipping a meal can cause a headache in many children.
4. Rest - Lie Down:
   • Lie down in a quiet place and relax until feeling better.
5. Cold Pack for Pain:
   • Put a cold pack or a cold wet washcloth on the forehead.
   • Do this for 20 minutes. Repeat as needed.
6. Stretch Neck Muscles:
   • Stretch and rub any tight neck muscles.
7. Muscle Tension Headache Prevention:
   • If something bothers your child, help him talk about it. Help him get it off his mind.
   • Teach your child to take breaks when he is doing school work. Help your child to relax during these breaks.
   • Teach your child the importance of getting enough sleep.
   • Some children may feel pressure to achieve more. This may cause headaches. If this is the case with your child, help him find a better balance.
   • Caution: Frequent headaches are often caused by too much stress or worry. To be sure, get your child a medical checkup first.
8. Call Your Doctor If:
   • Headache becomes severe
   • Vomiting occurs
   • Headache without other symptoms lasts more than 24 hours
   • Headache lasts more than 3 days
   • You think your child needs to be seen
   • Your child becomes worse

Treatment for Migraine Headache

1. What You Should Know About Migraine Headaches:
   • This headache is like the migraine headaches that your child has had before.
   • The sooner a migraine headache is treated, the more likely the treatment will work.
   • Often the most helpful treatment is going to sleep.
   • Here is some care advice that should help.
2. Migraine Medicine:
   • If your child's doctor has prescribed a medicine for migraines, use it as directed. Give it as soon as the migraine starts.
   • If not, you can use ibuprofen (such as Advil). It is the best over-the-counter drug for migraines. Give it now. Repeat in 6 hours if needed.
3. Try to Sleep:
   • Have your child lie down in a dark, quiet place.
   • Try to fall asleep.
   • People with a migraine often wake up from sleep with their migraine gone.
4. Prevention of Migraine Attacks:
   • Drink lots of fluids.
   • Don't skip meals.
   • Get enough sleep each night.
5. What to Expect:
   • With treatment, migraine headaches usually go away in 2 to 6 hours.
   • Most people with migraines get 3 or 4 attacks per year.
6. Return to School:
   • Children with a true migraine headache are not able to stay in school.
   • Children with migraine headaches also commonly get muscle tension headaches. For those, they should take a pain medicine and go to school.
7. Call Your Doctor If:
   • Headache becomes much worse than past migraines
   • Headache lasts longer than past migraines
   • You think your child needs to be seen

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 10/11/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.