The Truth About Headaches in Children

Migraines in children are shockingly common yet tough to spot. Could you be missing the signs?
By Julia Savacool
Mar 17, 2015




Mar 17, 2015

When Cathy Glaser’s daughter Samantha was 2 years old, she developed a troubling illness: Seemingly out of the blue, she suffered episodes of projectile vomiting followed by tears and withdrawal. Glaser couldn’t figure out the cause. “She’d be ill for a few hours, but just when I thought I should take her to the doctor, she’d get better,” Glaser recalls.

The cycle continued for weeks. Assuming she had a stubborn stomach bug, Glaser took Samantha to the pediatrician. But the actual diagnosis was very different: migraines. “The doctor had seen cases like this in kids before and zeroed right in on it,” Glaser says. “I thought, ‘A headache? Are you kidding me?’ How could that cause all her sickness and suffering?”

It may surprise you to learn that head pain, including migraines, ranks as one of the top five health issues for school-age children, according to a recent study in the Journal of the American Osteopathic Association. “Headaches aren’t even on parents’ radar,” says Jennifer Bickel, M.D., a headache specialist at Children’s Mercy Hospital in Kansas City, MO. “They don’t know kids can get them, let alone migraines.”


In fact, the numbers are astounding: 20 percent of kids are considered “frequent sufferers,” meaning they get tension headaches or migraines four or more times in a two-week span, and 30 percent have them at least once a week, according to German researchers. (When migraines start occurring more than once a week, new attacks tend to strike more easily, notes Andrew Hershey, M.D., director of the Headache Center at Cincinnati Children’s Hospital.)

Despite how common migraines are in kids, researchers have yet to fully understand why some suffer from them and others don’t. Genetics likely plays a role; if you have headaches, your child’s risk is higher. Some kids may also be born with lower thresholds for certain migraine triggers; following exposure, they experience a decrease in serotonin production, which creates inflammation in the brain and leads to head pain, says Jack Gladstein, M.D., director of the Pediatric Headache Clinic at the University of Maryland Medical Center in Baltimore.

What experts know for sure is that debilitating headaches are a disaster for kids in the classroom. For one thing, they’re practically assaulted by headache triggers the moment they walk in the door. Classrooms are bright, noisy places that, while often fun, can be stressful, says Kimberly Anderson Khan, Psy.D., a pediatric clinical psychologist specializing in pain management at Children’s Hospital of Wisconsin. No wonder migraine-prone kids miss twice as much school as their classmates. (Those who do manage to make it to class are often severely compromised in their ability to focus.) “Students who miss school because they don’t feel well become stressed. The more stressed they feel, the greater the chance of another headache — and missing more school,” says Dr. Bickel.

Besides causing kids to fall behind on their work, absences disrupt emotional growth, Dr. Khan notes. Just a few days away from peers is a lifetime for kids this age. They return to endless questions about where they’ve been and they lose the “plot” in peer dynamics and relationships. “Kids can feel out of sync and like they’re being singled out,” Dr. Khan says. It can trigger a vicious cycle. Fortunately, this guide can help parents end that cycle.


Decoding Migraine Symptoms
Migraines don’t present in children the same way they do in adults. (Glaser’s daughter, for instance, had never said that her head ached.) “Kids know they don’t feel well but don’t begin to identify it with head pain until age 7 or 8,” says Dr. Bickel. This doesn’t mean children don’t experience actual headaches; rather, they may not know how to put what they’re feeling into words. (If your child struggles to describe how he’s feeling, ask him to draw a picture of where it hurts.)

To determine if your kid could be suffering from migraines, “watch for a cycle of pain so bad that a child has to stop what she is doing and lie down,” says Dr. Gladstein. “The pain can last for an hour to a day. Then it disappears and the child has a period of normalcy — maybe a few days or a week — before it returns.”

Keep in mind, the most obvious symptom may be stomach pain or nausea, says Dr. Gladstein. Indeed, stomachaches are what usually get kids to the doctor, says Dr. Bickel.

While your child’s M.D. may order certain tests like a vision exam or even a CT scan to rule out an underlying disorder, usually migraines can be diagnosed through a conversation.

3 Frequent Triggers
If your kid suffers from headaches, try to ID the most common causes so you can avoid them as much as possible. Chances are, one of these three will top the list:

An irregular diet
Skipping or delaying meals, dehydration, and caffeine can all spark pain. “Migraine sufferers’ brains may be more sensitive to changes in normal daily rhythms,” Dr. Hershey explains.
Avoid it
Provide three meals a day, plus a morning and afternoon snack. Pack easy-to-eat options (e.g., turkey on whole wheat) and stick with healthy snacks like apples, bananas, veggie sticks, and low-fat cheese cubes. Kids also need 6 to 8 glasses of fluid daily, most of which should be caffeine free and without added sugar.

Sleep trouble
Too little, too much, and irregular sleep are all connected with an increased risk of head pain, possibly because each issue can cause an imbalance in the brain’s neurotransmitters, including serotonin, says Dr. Bickel.
Avoid it
Set a regular bedtime and skip sleeping in on weekends. For kids getting under 8 hours of sleep nightly, inch bedtime forward by 15 minutes a night until kids are getting 10 to 11 hours total.


Performance anxiety
Stress relating to an event your child has invested a lot of energy in preparing for, like a guitar recital, can lead to tension in neck and shoulder muscles, which can trigger a headache.
Avoid it
Relaxation techniques may help. Read books like Be the Boss of Your Pain by Timothy Culbert, M.D., who teaches kids de-stressing skills. Also check out kid-focused relaxation apps, such as Breathe2Relax, which talks users through breathing techniques, and iCan: Anxiety Free, an easy meditation primer.

Simple Steps for Easing the Ouch
There’s no foolproof method for squashing headaches once they start, but these tricks may help tame the pain:

Step one
Help kids spot symptoms early
“Kids are good at ignoring head pain initially and playing through it,” says Dr. Hershey. “By the time they tell their parents that their head hurts, it’s often too late.” So teach your child to recognize signs of an oncoming migraine (feeling tired, dizzy, or bothered by light or noise) and to tell an adult right away.

Drink up
Once a headache begins, your first line of defense is to make sure your child is hydrated. “Try a sports drink,” says Dr. Hershey. “The electrolytes they contain have been found particularly effective in reducing symptoms.”

Find a quiet spot
Headaches are exacerbated by loud noises, heat, and bright lights, so try this strategy from the National Headache Foundation: Have your child lie down in a dark, quiet, cool room with a cool washcloth on her forehead.

Step two
For kids age 6 and up, give ibuprofen according to package instructions. (Ibuprofen is preferable to acetaminophen because it is an anti-infammatory.) Just don’t use it more than two or three times a week, says Dr. Hershey — overuse can lead to rebound headaches once the meds wear off.

Consider Rx relief
If OTC meds aren’t doing the trick, your next step is to talk with a pediatrician about triptans, prescription meds that work by stimulating the production of serotonin, a neurotransmitter that helps constrict brain blood vessels and lessen pain.

“There are seven triptans on the market, two of which have been approved for use by children and adolescents with minimal side effects,” says Dr. Hershey. Rizatriptan (Maxalt) can be given to those as young as 6, while Almotriptan (Axert) can be prescribed to kids 12 to 17.

Ask about preventive pills
Some kids who suffer frequent migraine attacks may benefit from a daily prescription that can stop headaches before they start. Because there are currently no preventive medications approved for use in children, doctors generally go “off-label” with prescriptions; ask the pediatrician about options that can help, including amitriptyline (an antidepressant), topiramate (an anti-epileptic), and propranolol (a beta blocker), as well as supplements like ribofavin and CoQ10.

Keep in mind that a daily Rx now does not guarantee that your child will be on meds for the rest of her life — to the contrary, actually. As children also learn to maintain a healthier lifestyle and avoid triggers, preventive medication can often be stopped.


Step three
Formulate a plan
Migraine meds work best if taken at the earliest sign of head pain — which means having access to them at school. Work with your child’s teacher or school administrators to devise a system where she can leave the classroom quietly and go straight to the nurse’s office for medication if she feels a headache coming on.

Just knowing she has an action plan in place — not to mention a designated spot to rest — can relieve your child’s anxiety about what will happen if pain strikes.

When to Worry
If your child shows any of these symptoms, his headache requires immediate medical attention:

  • numbness or tingling
  • severe dizziness
  • confusion
  • speech difficulties


Photo Credit: Joey Moom
Doll created by Margaret McCartney


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