Mercy Health-St. Rita’s Health Focus: Headaches in children


By Huiyuan Jiang MD, PhD - Guest columnist

Do children get headaches very often?

In my opinion, headache is one of the most common complaints among children, but it usually is ignored because sometimes the parents do not pay much attention or they think the kids are faking or it is not a big deal. On the other hand, the child will not complain until the headache reaches a very severe point.

What are the common causes of headaches in children?

The most common cause of recurrent headaches in children is a migraine. There are so many different types of headaches, so the correct diagnosis is very important. The most important is to recognize the secondary headaches due to head trauma, brain tumor, infection, inflammation or increased pressure in the head.

When do children need to see a neurologist?

If the headaches are frequent enough the child has started to miss school or the headaches are increasing over time, it is time to seek a physician’s advice. For any new complaint of headaches or worsening/persistent headaches, you should check with your primary care physician first. If he or she thinks it is more complicated, the child will be referred to a neurologist for further diagnosis and management.

Do all headaches require imaging like CT or MRI?

No. For typical episodic migraine, there is no strong indication to have brain imaging. A neurologist will decide when it is needed depending on the clinical information, including history and physical examination.

When should parents be concerned about brain tumors?

Headache can be one symptom of a brain tumor, but sometimes tumors can be silent without any symptoms. For the headache is new, progressive, increasing, change of type and there are other symptoms like vertigo, intractable vomiting or focal neurological deficit, brain tumors will be within the consideration.

Is sleep an issue with children with headaches?

Yes. Sleep and headaches affect each other. Sleep quality and regular sleep cycle are very important in the prevention of headaches. If there is snoring with daytime drowsiness, obstructive sleep apnea needs to be considered. Sleep hygiene including regular bedtime and enough hours of sleep is critical in the management of headaches.

Is there any association between headaches and video games?

It depends on how long the child spends on the game. Prolonged game playing will cause stress on your visual pathway, overexcitement of the brain affecting sleep, affecting regular exercise, all of which will trigger headaches.

What kind of work up do you recommend?

First, we will try to rule out any specific reasons for the headaches. We call that type secondary headaches, which can be due to head trauma, brain tumor, infection, inflammatory disorders, increased pressure in the head or other systemic disorders. We may consider MRI brain, lumbar puncture or blood test accordingly. Occasionally, electroencephalography may be needed for short-duration headache episodes.

Do you recommend any dietary modifications?

Extensive dietary restriction is not recommended. You should keep a headache log sheet to see any association between certain food and the onset of headaches. If the headaches are triggered by certain a food, then the child should avoid that. Otherwise, try to eat a balanced diet with no skipping meals, especially breakfast, keep well hydrated, avoid caffeine and watch the child’s carbohydrate intake to avoid being overweight.

What can a parent do at home for a child with headaches?

At the onset of headaches, over-the-counter nonsteroidal anti-inflammatory drugs — such as Ibuprofen and Tylenol — can be used at right dosage per the body weight and age, provided there is no contraindications for such medication use. I suggest keeping the child well hydrated at all times. Sleep and rest may help. Avoid too frequent use of pain medications. If the headache is severe and last longer than 24 hours, the child should come to the emergency room for further investigation and management. Subsequently, I also suggest bringing these concerns to the primary care physician who can make decisions regarding the need for a neurology consultation.

By Huiyuan Jiang MD, PhD

Guest columnist

Huiyuan Jiang MD, PhD, Pediatric Neurology & Epilepsy Specialist

Huiyuan Jiang MD, PhD, Pediatric Neurology & Epilepsy Specialist

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