Headaches in Children

Posted on June 21, 2017

Headaches in children, from the perspective of our neuro-ophthalmology partner...

By: Dr. Krista Kinard, MD

Here is another guest post from our awesome Neuro-Ophthalmology partner, Dr. Krista Kinard. She has been kind enough to share with us her thoughts on the topic of kids & headaches...

"Children get the same headaches as adults but symptoms can differ somewhat. Headaches can be divided into benign primary headache disorders or secondary causes of headache. Benign primary headache disorders include migraine, tension, trigeminal autonomic headaches, and other headache disorders. Secondary headaches are due to a cause such as head injury, infection, intracranial mass, and other abnormalities.

Migraines in children are often shorter in duration than in adults (typically 2 hours or more instead of 4 or more hours). Children are also more prone to visual aura’s or visual illusions with their migraines than adults. Recurrent abdominal pain in children is often a form of migraine as well. Migraine is characterized by moderate to severe headache pain that is unilateral (more commonly bilateral in children) or pulsating and may be worsened by physical activity. Light or sound sensitivity or nausea or vomiting are often associated with migraine. Tension type headaches typically are bilateral pressing/tightening type of pain that is mild to moderate and not worsened by routine activity such as walking, playing, or climbing stairs. Nausea/vomiting does not occur with these headaches but either light or sound sensitivity can. Cluster headaches are less common in children under 10. These headaches are characterized by sharp stabbing pain with either tearing, congestion/runny nose, red eye, or restlessness/agitation. Rebound headache can occur if taking over the counter pain medications more than 2-3 times in a week. Chronic migraine, new onset daily persistent headache, and chronic tension headache can all also occur in children.

Headaches that are concerning are positional headaches, meaning pain is affected by body position. Positional headaches are typically due to changes in intracranial pressure. Headaches due to high intracranial pressure are typically worse lying down and get better with sitting up. Children or adults with high intracranial pressure often prefer to sleep elevated or wake up with headaches in the morning that get better when they get up and start moving around. Low intracranial pressure is the opposite. Headache pain is better lying down and headache pain tends to start later in the day. High and low intracranial pressure headaches can be accompanied by nausea/vomiting and double vision.

Children can be difficult to diagnose headache in because they often have difficulty describing what they are experiencing. The younger the child, the more behavior has to be relied on to help with diagnosis. Worrisome signs are headaches waking a child from sleep, changes in personality, persisting headache after trauma to the head, persistent nausea/vomiting, or headache accompanied by fever and neck pain. Also, many people assume that a headache is caused from eye problems. Eyestrain can trigger a headache, but contrary to popular belief, eye problems do not typically cause headache. High intraocular pressure can trigger a headache but the eyes are typically red and painful with a mid-dilated unreactive pupil, blurry vision, and nausea/vomiting. If your child is suffering from headaches, seeking medical care to determine the etiology (benign primary headache disorder vs secondary) is always a good idea."