Every child gets a headache from time to time, but as a parent one wonders when to worry. Although it is true that most pediatric headaches are harmless and will go away in a few hours, it is important to know what you can do for a headache and when you should seek medical care.
There are many different types of headaches which may affect children including tension, migraine, concussion, rebound, and congestion (sinus) headaches. Tension headaches are usually mild to moderate, occur during the middle of the day, are accompanied by fatigue, and may feel dull or achy. Migraine headaches tend to run in families, may throb, and may be accompanied by light and/or sound sensitivity, nausea, and vomiting.
Some patients with migraines have an aura before the headache begins and see flashing lights or a zigzag line in their vision. Congestion or sinus headaches occur with a stuffy or runny nose and present with pain and tenderness around the eyes or sinuses. Bending over may increase the pain. Rebound headaches occur after pain medication has worn off or may be associated with caffeine withdrawal. They present behind the eyes, with grogginess. Concussion headaches occur after a head injury and are accompanied by dizziness, mental fogginess, blurred vision, trouble concentrating, and fatigue.
What can you do if your child gets a headache? Offer fluids, especially water. Proper rest is essential for children. Be sure that your child gets the necessary 9-10 hours of sleep. Consistent bedtimes and wake times are helpful. A cool cloth on the forehead may be soothing. The occasional use of OTC medication such as Children’s Tylenol or Motrin is acceptable but resist the urge to medicate headaches routinely. Be sure to dose these medications based on weight, rather than age, and never exceed the maximum dose and frequency recommended for children.
Do not mix or alternate types of pain medications to avoid accidental overdose. Do not use aspirin in children, due to the risk of Reye’s syndrome. Keep track of how often your child requires pain medication. Be sure to see your child’s pediatric healthcare provider if headaches are frequent, recurring or concerning.
It is helpful to keep track of your child’s headaches in a diary. You should list the date and time of the headaches, when they start, how long they last, how bad they are (0-10 pain scale), symptoms the child is having, what makes them better, what makes them worse, and suspected causes (injury, food, fatigue, dehydration). A headache diary is helpful for your pediatric healthcare provider or neurologist to make an accurate headache diagnosis.
Call your pediatric health-care provider if your child’s headaches are concerning, frequent, are increasing in frequency or severity, are caused by a head injury, occur with pain in the eyes or ears, occur with nausea, vomiting, confusion, fever, or illness, light or sound sensitivity. Any headache that wakes a child from sleep, presents with pain in the back of the head, or occurs with behavioral changes should be evaluated urgently. Your provider will evaluate your child and may recommend a referral to a specialist such as a neurologist if necessary.
Go to your local emergency department if your child has a headache that presents with a stiff neck or neck pain and fever, any sudden severe headache pain, changes in vision, confusion, projectile vomiting, seizure, numbness, or if your child is difficult to wake.
Most headaches are harmless and can be cared for at home, but if you have concerns about your child’s headache, reach out to your local pediatric healthcare provider.
For more information, visit kidshealth.org/en/parents/headache.html
Dr. Melanie J Wilhelm, DNP, CPNP, is a Doctor of Nursing Practice, and a Certified Pediatric Nurse Practitioner in Norfolk, as well as an Assistant Professor at ODU. Her book, Raising Today’s Baby: Second Edition, is available on Amazon. Visit www.raisingtodayschild.com.
