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Microsoft word - headaches in children
Kevin C Gaffney, MD
The Woodlands Neurology & Sleep
Helping Children with Headaches
Over 8 million children and adolescents have migraines, resulting in over 1 million lost school days each
year. Fortunately, children's headaches rarely indicate a serious problem. They are more frequent in
children whose parents often discuss their own headaches. Children tend to imitate their parents, so
mention headaches as little as possible.
Before puberty, boys and girls have similar headache frequencies, but after puberty, migraine is more
common in girls. Migraines often stop as children grow to adulthood, but may return in middle age.
Physicians look for slightly different symptoms to diagnose migraine in children. In some cases, certain
recurrent, or cyclical, medical conditions — such as vomiting, abdominal pain, or dizzy spells — are thought
Younger children usually feel migraine pain on both sides of the head, while older children tend to feel it on
one side only. Fortunately, attacks are usually shorter in children than adults. The most commonly related
symptoms in children are nausea and vomiting, diarrhea, increased urination, sweating, thirst, swelling, and
tearing. Visual auras may not be as common in children as in adults.
What Causes Migraine?
The exact cause of migraine is uncertain, although various theories are being studied. One theory favored
by many researchers is that migraine is due to a vulnerability of the nervous system to sudden changes in
either your body or the environment around you. Many researchers believe that migraine sufferers have
inherited a more sensitive nervous system response than those without migraine. During a migraine attack,
changes in brain activity produce inflamed blood vessels and nerves around the brain. Migraine medication
may produce relief by quieting sensitive nerve pathways and reducing the inflammation response.
Emotional tension is the most common cause of headaches in children. A parent can often discover the
cause of stress and help relieve it. Many times, just talking about a problem may help a child relax. Some
children try to do too much or are pushed to do too much at home or at school. Even fun activities can be
overdone and cause fatigue and headaches. Encourage your children to talk openly about problems and
stress at school.
Triggers or Provokers of Migraine
Certain factors can provoke or trigger migraine in some people. If the
pattern of your attacks of migraine suggests that you are sensitive to
stimuli or triggers that you can easily avoid, your physician may help you
modify your lifestyle. Keeping a migraine headache diary will help you and
your physician identify specific triggers. Not all migraines have the same
provoking factors nor do all these factors necessarily provoke an attack:
Tension headaches are common in teenagers and are generally caused by emotional stress related to
school, sports, or relationships. Migraine headaches sometimes begin during the teen years.
Hunger can also cause headaches in children. A daily breakfast and a nutritious after-school snack may
prevent them. Eyestrain may also cause headaches. Headaches are also common with viral illnesses that
Migraine treatment in children
Often migraine headaches improve within a year even without treatment. As in adults, identifying and
avoiding provoking factors or triggers may help. Your physicians may recommend maintaining a regular
bedtime and meal schedule for your child, and avoiding an overload of activities. Non-drug treatments, such
as biofeedback and relaxation techniques, are especially recommended for children and adolescents, who
often are more enthusiastic about such approaches than adults.
Drugs to treat tension-type headaches
If drug treatment is needed, your physician will start with simple analgesics. Combination analgesics used in
adults are given at lower doses. Depending on the frequency, duration, and intensity of the headaches, and
your child's response to simple analgesics, preventive drugs may also be included in the treatment plan.
Many drugs used for adults may also be prescribed for children. The antihistamine drug, cyproheptadine, is
often used. This drug is sold under the brand name Periactin and is taken in tablet or syrup form, usually
every 8 to 12 hours, as needed. Possible side effects include drowsiness and weight gain. Nonprescription
analgesics. These are usually adequate to relieve mild to moderate pain. They include aspirin,
Combination analgesics. The use of these drugs is limited, because overuse can worsen the headache
pattern or become habit forming. These agents often contain butalbital or narcotics.
Drugs that prevent tension-type headaches
• Tricyclic antidepressants
. Physicians may prescribe drugs such as amitriptyline or doxepin to reduce
the frequency and severity of attacks in people who get headaches so often they require daily
. A drug such as propranolol may be combined with an antidepressant, such as
amitriptyline to treat people with chronic daily headaches.
• Divalproex sodium
. This drug is effective for adults with chronic daily headache, including chronic
Talk to your child. If the headache seems to be due to emotional tension, try to discover the source of the
headache and deal with it. Let the child know you care. Tension headaches are sometimes attention
headaches. In these cases, quiet time and extra attention can manage the headaches without pain
Play quietly with the child, or read stories together.
If the headache is still present, have the child lie down in a darkened room with a cool cloth on the
If non-drug treatments do not relieve the pain, try acetaminophen. Avoid creating the pattern of using a pill
for every pain. Do not give aspirin to children.
Call a Doctor.
If a headache is severe and is not relieved by relaxation or acetaminophen.
• If a severe headache occurs with signs of encephalitis or meningitis, especially following a viral illness.
• If a child's headaches occur two to three times a week or more, or if you are using pain relievers to
control a child's headaches more than once a week.
• If you cannot discover a reasonable cause. A child may share problems with someone other than a
• If headaches awaken the child at night or are worse early in the morning.
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