The Allergy & Asthma Center

Headaches in Children

Many children suffer from headaches, just like their parents! Most headaches in children are benign, meaning that they are not the result of severe disease. Most adults who suffer from headaches started having headaches as children. In fact, 20% of adults report onset of headaches prior to age ten. Disability from headaches can be significant with many days lost from school or play. It is estimated that only 4-5% of children suffer from the more severe form of headache known as migraine. Many migraine patients experienced their first headache before the age of seven. Before puberty, migraines occur equally in boys and girls. After puberty, female migraine sufferers outnumber males three to one. Migraine headaches are an inherited disorder (autosomal dominant with incomplete penetrance) and thus can be passed down from parents to children.

There are two main types of headache: Primary and Secondary

1. Primary headaches include tension-type, migraine, and cluster headaches and are not caused by other underlying medical conditions. More than 90% of headaches are primary.

2. Secondary headaches result from other medical conditions, such as infection, meningitis or increased pressure in the skull due to a tumor or head injury. These account for fewer than 10% of all headaches. Signs and symptoms need to be evaluated for a possible underlying cause that needs treated.

Tension-type headaches

Tension type headaches are the most common, affecting upwards of 75% of all headache sufferers.

Tension-type headaches are typically a steady ache rather than a throbbing one and affect both sides of the head.
Some people get tension-type (and migraine) headaches in response to stressful events or a hectic day.
Tension-type headaches may also be chronic, occurring frequently or even every day.
Psychological factors have been overemphasized as causes of headaches.

Migraine Headaches

Migraine headaches are less common than tension-type headaches. Nevertheless, migraines afflict 25 to 30 million people in the United States alone.

As many as 6% of all men and up to 18% of all women (about 12% of the population as a whole) experience a migraine headache at some time.
Roughly three out of four migraine sufferers are female.
Among the most distinguishing features is the potential disability accompanying the headache pain of a migraine.
Migraines are felt on one side of the head by about 60% of migraine sufferers, and the pain is typically throbbing in nature.
Nausea, with or without vomiting, as well as sensitivity to light and sound often accompany migraines.
An aura --a group of telltale neurologic symptoms--sometimes occurs before the head pain begins. Typically, an aura involves a disturbance in vision that may consist of brightly colored or blinking lights in a pattern that moves across the field of vision.
About one in five migraine sufferers experiences an aura.
Usually, migraine attacks are occasional, or sometimes as often as once or twice a week, but not daily.

Characteristics Associated with Primary Headaches Help Differentiate Tension-Type Headaches from Migraine

Columns A and B show the symptoms commonly seen in two types of headache. Compare your symptoms with those listed and determine what type of headache you may have by noting whether your symptoms are most like those in column A or B. Some people have both of these types of headache. If your headaches are very severe or if you think they are some other type, do not delay in seeking professional medical attention.

Symptom	A Tension	Lactose Content
Intensity and Quality of Pain
Mild-to-Moderate	*	*
Moderate-to-severe	*	*
Intense, pounding, throbbing and/or debilitating		*
Distracting but not debilitating	*
Steady ache	*
Location of Pain
One side of head		*
Both sides of head	*	*
Associated Symptoms
Nausea/vomiting		*
Sensitivity to light and/or sounds		*
Aura before onset of headache such as visual symptoms		*
Note: Rebound headache may have features of tension and/or migraine headache

Cluster Headaches

Cluster headaches are relatively rare, affecting about 1% of the population. They are distinct from migraine and tension-type headaches.

Most cluster headache sufferers are male-about 85%.
Cluster headaches come in groups or clusters lasting weeks or month.
The pain is extremely severe but the attack is brief, lasting no more than a hour or two
The pain centers around one eye, and this eye may be inflamed and watery. There may also be nasal congestion on the affected side of the face.
These "alarm clock" headaches may strike in the middle of the night, and often occur at about the same time each day during the course of a cluster.

Rebound Headache

Rebound headache may occur among people with tension-type headaches as well as in those with migraines.

It appears to be the result of taking prescription or nonprescription pain relievers daily or almost every day, contrary to directions on the package label.
If prescription or nonprescription pain relievers are overused, headache may "rebound" as the last dose wears off, leading one to take more and more pills. This is a good reason to call your doctor!

What you should know about headache

Most people with headache use nonprescription pain relievers to treat their symptoms.
Store shelves hold a remarkable array of pain relievers, so you need more facts than ever to select one that best meets your needs.
In light of the growing trend towards self-care, you have more responsibility than ever in safeguarding you and your family's health and well-being.

When to call your doctor

Although very few headaches are signs of serious underlying medical conditions, call your doctor at once if any of the items below apply to you.

Call your doctor if:

Your child has three or more headaches per week.
Your child must take a pain reliever every day or almost daily.
Your child needs more than recommended doses of over-the-counter medications to relieve headache symptoms.
You child has a stiff neck and/or fever in addition to a headache.
Your child's headache is accompanied by shortness of breath, fever, and/or unexpected symptoms that affect your eyes, ears, nose, or throat.
Your child is dizzy, unsteady, or has slurred speech, weakness, or changes in sensation (numbness and/or tingling) in addition to a headache.
Your child has experiencee confusion or drowsiness with a headache.
Your headaches begin and persist after head injury.
Your child's headache is triggered by exertion, coughing, bending, or activity.
You child's headache keeps getting worse and won't go away.
Your child's headaches have changed in character.
Persistent or severe vomiting accompanies headache.
Your child has his/her "first and/or worse" headache.

Keep in mind that even if your child has had headaches for many years, it's still possible to develop a new and possibly more serious type of headache.