From the July 2019 issue

Headache or Sign of Something More?

Headaches are common, but not all headaches are worry-free. Here, the chief of neurology at Children's Hospital of Michigan in Detroit offers insight and advice for families.

As the chief of neurology at the Children’s Hospital of Michigan in Detroit, Dr. Lalitha Sivaswamy knows how common headaches are among children and teens.

“If you look at the prevalence of migraines, I would say about 2 to 5 percent of children below the age of 10 years – and about 6 to 8 percent of children who are pre-adolescent between 10 and 14 – have headaches, and the prevalence increases quite a bit after that,” Dr. Sivaswamy says, adding that most medical studies focus on migraines, which are just one form of headache.

In many cases, headaches are not serious and shouldn’t cause too much concern. However, there are some instances when headaches could be a sign of a bigger health issue for your child.

To help families decipher the difference, Dr. Sivaswamy offers insight and advice when it comes to children’s headache pain.

Causes of headaches

Headaches commonly occur in conjunction with another illness such as the flu, a sinus infection, earache or throat infection. But, for children who experience a headache alone – without any other systemic symptom – this could be the sign of a tension or migraine headache.

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Tension headaches include a pressing tightness in the head muscles and mild to moderating non-pulsating pain, according to the Mayo Clinic. Migraines, on the other hand, can cause pulsating, throbbing or pounding pain and may result in vomiting and extreme sensitivity to light. Dr. Sivaswamy has treated patients as young as 2 for migraines.

Hormones play a role in headaches, as well. “Especially girls who are about to start their menstrual cycle tend to have frequent headaches,” she adds.

Family history of migraines can also be a factor.

Sleep deprivation and the often-underdiagnosed sleep apnea are also culprits. When a child has sleep apnea, he or she may have an early morning headache and even be sleepier.

“Oftentimes, I see sleep deprivation as a cause of headache, especially in teenagers,” she says. “They may only get four or five hours of sleep.”

Caffeine is another common cause of headaches in children. Many of them can experience headaches due to caffeine withdrawal.

When to worry

Does your child wake up in the middle of the night to complain that his or her head hurts? If so, this could be a red flag for raised intracranial pressure, Dr. Sivaswamy says. Raised intracranial pressure can be caused by swelling or bleeding of the brain, a brain tumor, brain or head injury, or too much fluid around the brain or spinal cord, to name a few.

If your child is having headaches at a different frequency – from once per week to every day, for example – that could be sign of something more serious, as well. Certain symptoms such as frequent vomiting, double vision, blurry vision and coordination and balance issues are concerning symptoms in the presence of a headache, she adds.

“If a child has difficulties with coordination and gait, or the child has double vision or things along those lines, it could potentially be space-occupying lesions or conditions, which cause raised pressure in the brain,” she adds.

Treatment

If your child is showing any of the above signs, contact his or her pediatrician immediately. “Oftentimes, the pediatrician is the best place to start,” Dr. Sivaswamy says.

The child’s pediatrician can determine whether he or she needs to go to the emergency room or schedule an appointment with a neurologist.

A neurologist will look for any other signs of increased pressure in the brain, perform certain examinations such as looking at the back of the child’s eye – and he or she might even order further testing, including imaging or brain scans.

Treatment for headaches depends on the age and condition of the child, she says. Daily medication, lifestyle changes, physical therapy and acupuncture are just some of the interventions.

“Botox is FDA-approved for the treatment of migraine,” she says. At Children’s Hospital of Michigan, the doctors have performed Botox in children as young as 10 years old.

Awareness is key when it comes to a child’s headaches.

“Some children who have migraines can look and sound very sick, because many people think that migraine headaches are just a bad headache,” Dr. Sivaswamy says. “But actually, a migraine can cause a child to withdraw from normal activities and not be able to play and just kind of retreat into their room and want the curtains closed.

“Children can have quite a bit of disability related to migraines, so I think that being aware of migraine headaches is important so they can make sure the child is receiving appropriate intervention.”

Content brought to you by Children’s Hospital of Michigan. For more information, visit the Children’s Hospital of Michigan neurology and neurosurgery website.

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