The Ponytail Headache: A Very Real Pain for Kids

Could your child really suffer from a ponytail headache? A metro Detroit pediatric neurologist says yes and explains what parents can do to help.

Ponytails are the ultimate no-fuss hairstyle for kids. But they can also be a big pain, literally, if they result in a ponytail headache.

It’s true: The same style that keeps hair out of your daughter’s (or son’s) face and even helps your child avoid head lice could, unfortunately, be causing kid or teen headaches.

This type of headache is an issue Fox 2 Detroit has reported on locally – and one that doctors say is a very real and painful condition

“It’s a real phenomenon,” says Beaumont Health pediatric neurologist Dr. Elizabeth Leleszi, M.D. So if your child wears ponytails and gets headaches, it’s important to consider the possible connection.

“You have to ask the question,” says Leleszi, who has had many patients who experience pain during or after wearing a ponytail and notes that she has even had them herself. “It happens even to a headache specialist.”

Anatomy of a ponytail headache

So what’s happening internally to cause the pain?

“Essentially this is a tension-type headache,” Leleszi explains, due to the traction of the hair on the scalp irritating the scalp’s nerves. “When worn for a long period of time, that can provide irritation – and that irritation lends itself to some headaches.”

While painful, this type of headache is not the same as a migraine. A ponytail can’t cause a migraine, Leleszi says, since migraines are intracranial (inside the cranium) and tension headaches are extracranial (outside of it).

But children and adults who get migraines may be more susceptible to a ponytail headache. “Their scalps and are more sensitive,” Leleszi says.

While she isn’t aware of any studies that have specifically researched tension headaches due to ponytails, Leleszi notes that this phenomenon is described in a 2004 issue of the journal Headache.

Track the headaches

If you suspect your child is prone to the ponytail headache, it’s best to talk with your doctor. New headaches or something that’s getting worse should always be evaluated.

“It’s important to define what types of headaches these children and adolescents are having,” she says. “If your child is complaining of frequent headaches, we have to remember they could be due to something else.”

Your first stop should be your child’s primary care doctor, Leleszi says – or find one in Metro Parent’s Mom-Approved Docs directory – and specialists are also available when needed. Before your appointment, try to track your child’s headaches in a diary with details such as time, duration, what your child ate that day and their amount of sleep.

Be sure to talk to your child’s doctor about any headaches that are affecting school performance, early morning headaches with vomiting, balance or coordination problems or behavior issues. But parents should know that headaches are usually not a sign of a bigger problem.

“Nine times out of 10, it’s not something more severe,” Leleszi says.

Pediatric neurologists like Leleszi who specialize in headaches are also available to address parents’ concerns.

“We at Beaumont Children’s have a dedicated headache center with a multidisciplinary approach,” she says. “We’re available to evaluate the child, listen to the family and provide the best care.”

How to treat a ponytail headache

If your child has a headache due to wearing a ponytail, the obvious step is to take down the hair or even try just tying it back more loosely. Beyond that, over-the-counter medications such as Tylenol or Motrin can be used.

“We do try and avoid excessive use of pain medicine – no more than three doses per week,” Leleszi notes, pointing out that overuse of pain medication can even cause head pain. If your child needs more than that, talk to her doctor.

Hydration can also help with headaches, she says.

With tension headaches, the pain typically lasts 30 to 45 minutes. “Then it should dissipate,” Leleszi says.

This post was originally published in 2017 and is updated regularly.

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