Headaches in Children - Specialists and Information

About 20 percent of preschool-aged children and 50 percent of children at the end of elementary school have already experienced headaches.

The frequency increases further during puberty: By age 12, 9 out of 10 children experience headaches of varying frequency and intensity.

Recurrent headaches lead to concentration problems and impair academic performance, quality of life, and social behavior.

Just as in adulthood, tension headaches are one of the most common causes of headaches in childhood and adolescence. 

Possible causes include:

• Academic pressure
• Lack of exercise
• Poor posture (prolonged sitting, use of computers/tablets)
• Lack of rest periods
• Lack of sleep

In addition to academic pressure, adolescents also face social pressure from their peer group and school.

Migraine-like headaches can also occur as early as childhood, especially if other family members are also affected.

In childhood, the typical migraine symptoms are not yet fully developed. Most often, a mixed presentation of tension headaches and migraines is observed.

Less common types of headaches include cluster headaches and medication-overuse headaches. Frequent use of pain relievers alters the brain’s sensitivity to pain. Eventually, even non-painful stimuli are perceived as pain.

The symptoms described so far are classified as primary headaches. However, there are also secondary headaches. Medical professionals refer to headaches as secondary when they are the result of another underlying condition. To distinguish between primary and secondary headaches, a thorough diagnostic evaluation is necessary even in childhood and adolescence.

Tension headaches

When children have tension headaches, they usually feel the pain on both sides of the head, often in the forehead area. Children describe a pressing pain, accompanied by nausea but without vomiting. 

Younger children, in particular, may not be able to clearly describe their symptoms and instead report stomachaches. Other possible signs of tension headaches include mood changes. Some children are irritable and whiny. Others withdraw and seem apathetic. The child may also simply touch their head.

Headaches in children are usually harmless and can be relieved with simple measures @ Tatiana Foxy /AdobeStock

Migraine

Migraine pain is often throbbing and stabbing in nature and is usually localized on one side in adolescents. In younger children, it is usually on both sides. 

The pain intensity ranges from moderate to very severe. 

The following additional symptoms usually occur:

• Nausea
• Vomiting
• Sensitivity to light (photophobia)
• Sensitivity to sound (phonophobia)

In adults, a migraine attack lasts at least 4 hours if left untreated or if treatment is unsuccessful. In children, it may last for a shorter period. The pain intensifies with physical activity.

Cluster headaches

Cluster headaches, which are rare in childhood, usually occur suddenly and are very severe on one side of the head, typically in the temple area and behind the eye. Patients describe the pain as a tearing, drilling sensation.

Migraines are relatively common in children and adolescents @ Africa Studio /AdobeStock

For mild and occasional headaches, rest, attention, and increased fluid intake are often sufficient.

If your child experiences the following symptoms, you should see a doctor immediately:

• A first-time, sudden, and severe headache, and
• High fever and/or 
• If the child cannot bend their neck

A medical examination is also required immediately if the following unusual accompanying symptoms are present:

• Weakness in an arm or leg
• Vision and speech problems
• Drowsiness

In these cases, headaches may also be symptoms of another condition.

For children and adolescents who experience frequent headaches, a pediatric neurological evaluation is important to establish an accurate headache diagnosis. Only then can the doctor initiate a treatment plan tailored to the individual.

The cornerstones of headache diagnosis are:

• A detailed review of the child’s medical history, including developmental history and previous medical conditions
• A specific pain history using questionnaires 
• Headache diary
• A detailed neurological examination and, if necessary, an electroencephalogram (EEG). 

Additional tests, such as cerebral imaging (MRI), an examination by an ophthalmologist, an ENT specialist, or an orthopedist, may be appropriate depending on the patient.

Common risk factors for tension headaches include:

• A child’s busy daily schedule
• School-related stress
• High pressure to perform
• Insufficient fluid intake
• Physical inactivity

Children with migraines usually also have a family history of migraines. General psychological stressors can also arise within the family environment and at school.

The following are beneficial for all types of headaches:

• A regular daily routine 
• Free time without a schedule

The focus of treatment is on analyzing the headache diary. This allows you to identify potential triggers and discuss them with the family.

Therapeutically, even minor adjustments to the child’s weekly schedule can often help. Depending on the severity, general measures may already be effective.

General measures include:

• Rest
• Lying down in a darkened room
• Applying a cold compress to the forehead
• Massaging peppermint oil into the temples, forehead, and neck

Children often fall asleep while doing this and wake up pain-free.

Acute medication treatment depends on the child’s age and the type of headache. In cases of very frequent headaches (usually migraines), prophylactic medication may also be an option on a case-by-case basis.

A key part of treatment is usually consistently adjusting the child’s daily routine to include:

• A regular sleep schedule
• Stress reduction
• Avoiding risk factors

In many cases, the following measures can help reduce the frequency of headaches:

• Prophylactic use of natural substances such as magnesium 
• Learning relaxation techniques 
• Specialized physical therapy

Families, teachers, and friends often greatly underestimate headaches in children and their impact on quality of life.

Chronic headaches are associated with a statistically higher risk of:

• Other pain-related diagnoses
• Mood Disorders
• Attention disorders

Since pain in childhood and adolescence usually leads to chronic pain in adulthood, early treatment is very important.