Answers to questions families often have about caring for their child with headaches

By the time they reach high school, most young people have experienced some type of headache. In younger children, it may be difficult to tell if they are having headaches, but a pale child who seems to be in pain, has nausea and vomiting, or is holding his or her head, particularly in the setting of a family history of headache, may be experiencing headaches.

Migraines are a type of headache that often start as a dull ache and then become throbbing and are felt on one side or all over the head. The pain can come with nausea, vomiting, sensitivity to light, touch, or noise, impaired thinking, change in mood, or anger. Some people (25-30% of migraine sufferers) experience an aura prior to headache onset—these can include visual changes (such as seeing sparks, bright dots, zig zags, tingling on one side of the body, inability to speak clearly, lasting up to an hour), or feelings of pins and needles. Some people will experience the aura, but never get the headache, which is called acephalgic headache or migraine without headache.

What is an abdominal migraine?

Abdominal migraine occurs in children more than adults and can cause nausea, vomiting, reduced appetite, and paleness. Head pain may also be present, but often is not the chief complaint.

The underlying causes of migraine are not well understood, though inheritance (a family history) plays a key role. Changes in the nervous system, its blood flow, and the balance of brain chemicals that regulate pain may be important factors.

Better understood are the “triggers”—those things that, for individuals, seem to cause them to get a migraine. These triggers can include a variety of exposures; see What is a headache trigger? below for more detail.

About 10% of children experience migraine; older children and adolescents have them (8-23%) and younger children (4-11%). Children with one parent suffering from migraine have a 50% change of having it too.

Migraine headache symptoms are described above under What is a migraine. The term chronic daily headache is used when headaches occur 15 or more days a month. Some people with chronic headache describe headaches present every day with a range of pain from 0-10 throughout the day. Accompanying symptoms such as nausea and vomiting are less common with chronic daily headache than with typical migraines.

There is no test for migraine—the diagnosis is based on the description of symptoms, time course, and physical exam being normal. Headaches in children are rarely caused by underlying tumors or other serious brain disease. Children, like adults, can also have stress headaches, which are also more common in older children.

Migraines and chronic headaches can be triggered by many things, including poor sleep, stress, hormone changes (as with menstrual periods), bright lights, strong smells, foods, weather changes, and many other exposures. Keeping a headache journal can help identify triggers—with each new headache, think through and write down recent exposures or changes in the environment. If most headaches are found to be occur with or after the same exposures, discuss that with your doctor and, if possible, try avoiding those things see if that reduces migraine frequency.

Some children have migraines only for a while, seeming to outgrow them, but others will continue to have them into adulthood. Most children, and adults, with migraine can manage them so that they affect their lives minimally. Healthy lifestyle (sleep, diet, exercise), avoidance of triggers, and appropriate use of medications can make a big difference in the frequency, duration, and severity of migraines. New medications are being developed and becoming available that may help those whose migraines persist despite the usual measures.

There is a genetic component to headaches but it is difficult to predict just who will be affected. A child has a 50% chance of having migraines if one parent suffers and a 75% chance if both parents suffer.

Headache treatment may involve lifestyle changes in addition to medications and other therapies. Identifying headache triggers and then trying to avoid them can be key. Other helpful strategies can be:

• Decreasing stress
• Increasing hydration
• Making sure meals aren’t missed
• Getting enough sleep

Headache medications are primarily those meant to stop headaches before they get bad. Some people are helped by preventive medications, though recent evidence suggests that most are not helped. Medications taken when a patient feels a headache starting should reduce its duration and severity, and sometimes stop it completely. These medications include:

1. Anti-inflammatory medications such as ibuprofen and naproxen sodium
2. Stimulants like caffeine
3. Combinations, such as Exedrin for Migraine and Midrin
4. Triptans – prescription medications that come as pills, dissolving tablets, nasal sprays, and injections
5. Ergot-based medications that come in oral and injectable forms
6. Tranquilizer and anti-nausea medications

A variety of medications have been used as daily treatment meant to prevent migraines. Though recent studies have shown that they don’t help most children, they may be worth trying. These medications include:

1. Calcium channel blockers
2. Blood pressure medications
3. Antidepressants
4. Anticonvulsants (anti-seizure medications)

A new class of medications, called calcitonin gene-related peptide (CGRP) inhibitors are the first preventive therapy specifically designed to prevent migraines and may be considered in patients who don’t respond to other measures.

Other approaches that have been found helpful include:

• Physical therapy
• Yoga
• Biofeedback
• Counseling, particularly cognitive behavioral therapy

The impact of headaches will depend on their severity, frequency, and response to treatment. Families can help a lot by supporting children in avoiding triggers and maintaining a healthy lifestyle, assuring a supportive school environment (including special accommodations if needed), and helping friends and their families understand the condition.

Biofeedback may be helpful for those whose headaches are triggered by stress. It is a technique using equipment that monitors your body's involuntary physical responses such as breathing, pulse, heart rate, temperature, muscle tension, and brain activity. Biofeedback helps you improve your relaxation exercises by learning to control the physical responses that are related to stress. After learning the technique, the equipment is no longer necessary.

A psychologist or counselor can be very helpful for children with migraine, and for their families. They can:

• Help with finding and removing headache triggers
• Help children learn how to deal with the headaches
• Address missed school days and social interactions
• Address peer or family pressures
• Help with lifestyle changes to relieve stress and promote relaxation
• Help with specific techniques to relieve pain, such as imagery or self-hypnosis

When a doctor says that your child is "fine" or “has nothing wrong.” that most likely means your child doesn't have a serious condition causing the headaches. It doesn't mean that the headaches aren't real, or that they don't hurt, or that the pain can't cause significant problems and absences from school or work.

Rebound headaches happen when a person with headaches has taken headache medications too often (more than two days per week) or has taken too much medication (more than the label or a doctor advises). With rebound, headaches tend to occur whenever the medication wears off. Rebound headache is treated by tapering the overused medication, sometimes substituting a different type of treatment or medication. Consult your primary care doctor if you regularly use headache medications more than two days per week or more than the label advises.