Headaches

What is a headache?

A headache is pain felt somewhere in the head or neck. Headaches are common and can affect people of all ages, including children and adolescents.

Headaches can occur on their own or as a symptom of another condition. Most are harmless and go away within a few hours, but having headaches can impact your child's life, both at home and at school. Severe or recurring headaches, especially those accompanied by other symptoms, may indicate a more serious disorder and should be evaluated by a doctor.

Our approach to headaches in children

UCSF's Pediatric Headache Program was the first on the West Coast to focus on diagnosing and treating severe or frequent headaches in children. The team includes pediatric neurologists who specialize in headaches. They work closely with kids and their primary care doctors to deliver lasting headache relief.

Types of headaches

A headache that occurs on its own is called a primary headache. A headache caused by another condition is a secondary headache.

Primary headaches

Kids may experience the following types of primary headaches:

• Migraine. This is the primary headache type that most commonly leads to doctor visits. Migraine often runs in families. In kids, migraine pain – a throbbing or pounding sensation – is often felt on both sides of the head. Migraine can also cause nausea and sensitivity to light, sound or head movement.
• Tension-type headache. Typically less severe than migraine, tension headaches feel like pressure or tightness across the forehead or on the sides and back of the head.
• Cluster headache. This type is severe and quite rare in children. A cluster headache causes sudden, intense pain on one side of the head, often behind an eye. The pain may extend to other areas on the same side of the head. The attacks often happen multiple times a day for several weeks or months, then subside for a while. A headache specialist is generally needed to confirm the diagnosis and provide treatment.

Secondary headaches

Upper respiratory infections, such as a cold, flu or sinus infection, are a common cause of secondary headaches in children. The headache occurs alongside other infection symptoms, such as sinus pressure and a stuffy nose. As the infection clears up, the headache symptoms should improve. Secondary headaches can also develop after a head injury.

Rarely, secondary headaches in kids are caused by:

• Bleeding in the brain
• Brain tumors
• Serious infections, such as meningitis

When to see a doctor

Take your child to a doctor right away if they have a headache that:

• Is severe, comes on suddenly, and is unlike any headache they've had before, especially if there are additional symptoms, such as vomiting, double vision, confusion, sleepiness or difficulty waking
• Is accompanied by neck pain or stiffness, with or without a fever

Take your child to their pediatrician if their headaches:

• Are happening regularly
• Are triggered by straining, such as while running, sneezing or having a bowel movement
• Began after a head injury and aren't going away
• Are waking your child from sleep
• Are accompanied by confusion, eye or ear pain, sensitivity to light or sound, nausea, vomiting, numbness or other concerning symptoms

If the doctor thinks your child needs specialized care for headaches, you'll be referred to a pediatric neurologist.

Diagnosis of headaches

The doctor will review your child's medical history and ask questions about the headaches. They may also perform a physical or neurological exam.

If the doctor suspects that an underlying condition is causing the headaches, they may order medical tests, including blood analyses or imaging tests such as an MRI or CT scan.

Keeping a headache diary

A headache diary can help the doctor determine what type of headaches your child is having as well as the best treatment approach. Every time your child has a headache, note down:

• When the headache started and ended
• What the pain felt like (for example, like tightness, pressure or throbbing and if it was a dull ache or sharp pain) and its severity
• Where the pain was located (for instance, behind the eyes or on both sides of the head)
• Any other symptoms your child experienced
• Anything that eased the pain or made it worse

If your child is very young, their behavior may be the best indicator of a headache. Your child may be fussy or unable to sleep. Young children with a migraine may look pale, be less active than normal, cry or throw up.

Treatment of headaches

If your child has a mild headache and doesn't need medical attention, you can try home care measures, such as:

• Having them rest in a dark, quiet room (allow your child to sleep if they want to)
• Placing a cool, damp cloth on their forehead
• Giving them a gentle head or neck massage
• Having them take a warm shower or bath

If you give your child acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) for headache pain, be sure to check the label to determine the right dose for your child's weight. Also, be aware that taking more than two to three doses per week can lead to medication overuse headaches, meaning the headaches will get more painful and more frequent and the medication won't ease the pain. If your child has developed medication overuse headaches, you should stop giving them the medication and work with their doctor to find a more effective treatment.

If your child has secondary headaches, they should be treated for the underlying illness or injury as well as their headache pain.

Children with primary headaches – such as tension-type headaches and migraines – may be prescribed medications to relieve their pain and prevent the headaches from recurring. The treatment plan may include identifying any factors that trigger your child's headaches, so your child can avoid them as much as possible. Healthy lifestyle changes may help, too. These include:

• Eating regular, healthy meals
• Drinking plenty of water
• Getting enough sleep
• Practicing healthy stress management
• Getting enough physical exercise