Doctors’ Notes



As a parent, when you see your child with headaches, you want to know what’s causing them, and how to make them better.

As a headache sufferer, a parent, and a pediatrician, I can relate. So in this Note, I’ll offer some information that can help.

Headache Facts

HeadacheHeadaches are common in childhood. 58% of children reported some form of headache over the past year. Based on research, a practical headache classification includes primary and secondary headaches.

Primary headaches are headaches that are NOT the result of another medical condition. They include: acute recurrent headaches (or, migraines) and chronic non-progressive headaches (or, tension-type headaches). Secondary headaches result from another medical condition. Acute headaches most commonly result in a visit to the pediatrician’s office. If there are no neurological signs or symptoms, the most common cause for acute headaches in children and teens is a cold or sinus infection. There are also secondary headaches called chronic progressive headaches — headaches that get worse and happen more often over time, but thankfully these are rare.

Children can also get migraine or tension headaches. Tension headaches are the most common type of headache in children, but are generally less severe than migraine headaches. Stress and mental or emotional conflict often trigger pain related to tension headaches. Pain with tension headaches is typically dull and mild to moderate, may last for 1 hour or several days, and is often described as “band-like” pressure around the head. (Brain tumors can cause headaches, but they are VERY rare and usually have other symptoms associated with them.)

Migraine Headaches

A migraine headache is usually an intense pounding or pulsing headache. As many as 5% of elementary school children, and up to 20% of teenagers, suffer from them. They are more common in girls than boys. There is also a genetic component, so your provider may ask you if anyone in your family has them.

The cause of migraines is no longer believed to be from constriction of the brains blood vessels, but from a complex cascade of events. The exact cause is not completely understood, but we sing know that a migraine has strong environmental triggers. Common triggers include stress, “let-up” from stress, illness, fasting, fatigue, poor sleep, dehydration, and certain foods.

Migraines in children are usually shorter than in adults, lasting about 30-60 minutes, though they can last up to 1-3 days. Other symptoms include photophobia (abnormal sensitivity to light), nausea, and vomiting during an attack. Bright lights and loud noises make migraines worse.

There is a type of migraine called migraine with aura, but this is much less common with children. If children do get one, they may not always get the aura. An aura usually occurs 30 minutes before the headache and lasts 5-20 minutes. A typical visual aura may be flashing lights or vision changes, but other auras occur too. The symptoms of aura are completely reversible and should last less than 30 minutes.  If not, call us in the office.

How to Diagnose a Tension or Migraine Headache

Your doctor can diagnose migraines or tension headaches on the basis of the symptoms your child describes combined with a thorough physical exam. It’s rare that a head CT or MRI of the brain is necessary for inchildren with recurrent headaches who have a normal physical exam and a consistent history.

Treatment of Acute Childhood Migraines

When a migraine headache occurs, your child should go to a cool, dark place and lie down with a wet cloth across his or her forehead. If your provider has given your child a medicine for migraines, your child should take it as soon as he or she knows a headache is starting. Usually, over the counter medicines like ibuprofen (Motrin), or Naproxen (Aleve) are effective.

See our Note on Fever and Pain Relief for proper doses, or consult with one of us. These medicines, however, should not be used more than 2-3 times per week. For more severe headaches, combine the ibuprofen with caffeine such as a soda, as long as the child doesn’t regularly consume caffeine. If this is not effective, give us a call in the office

Lifestyle Changes Key to Prevention & Management 

  • Regular and sufficient sleep, with a consistent bedtime (and don’t forget to remove electronics from the bedroom)
  • Regular and nutritious meals (including breakfast!) and good hydration (6-8 glasses of water a day for teens)
  • Regular exercise (1 hour per day is recommended)
  • Relaxation and stress reduction/management
  • Avoid triggers such as stress, sleep deprivation, or other identified triggers/stressors
  • For those with anxiety, depression, or significant stress, seeking support from a mental health provider is very helpful
  • Look for foods that might trigger an attack, like cheese, processed meats, chocolate, caffeine, MSG (a preservative in many foods, including Asian foods), nuts, or pickles. Your child only needs to avoid eating these foods if one of them triggers headaches.

Signs of a More Serious Type of Headache

  • If the headaches become more severe and/or frequent
  • Worsening headache with straining, coughing, or sneezing
  • Explosive or sudden onset of severe headache
  • Additional symptoms like fever, weight loss, rash, or joint pain
  • If you have another disease such as cancer, sickle cell disease, or other immunosuppression
  • Altered mental status, abnormal eye movements, enlarged pupils or other neurologic changes
  • A new or different kind of severe headache, with change in attack frequency or severity
  • Sleep-related headache — like headaches when the child wakes from sleep, or headaches always present first thing in the morning

When to Seek Help 

For identification of the type of headache your child might be having, if your child has any of the red flags, or if the treatment prescribed by your pediatrician isn’t working, come see us in the office to discuss the headaches.

If your child ends up having migraines, remember a regular routine with good exercise and sleep can go a long way to leading a headache-free life!

Dr. Ditte Karlovits joined Kids Plus in 2012.