Taking the "Ouch" Out of Children’s Headaches

When children complain of headache pain, parents armed with information can determine whether the problem is serious, if it warrants action, and if so, what action to take.

"Headaches in children can be acute and/or recurrent," said Dr. Marvin Fishman, chief of neurology at Texas Children’s Hospital. "Often, headaches are related to the release of serotonin, which can cause an inflammation around the blood vessels going to the brain."

Headache triggers can include light, heat, physical activity, stress, adjustment problems, sinus problems and eye diseases. Children also can experience migraine or muscle-contraction headaches. Some children experience a combination of the two.

Most headaches are not serious, but parents should contact their child’s primary care physician if the headache is severe, the child has never experienced a severe episode, and the headache persists for more than a day or two, said Dr. Fishman, who also is a professor of pediatrics and neurology and director of child neurology at Baylor College of Medicine.

Parents should consult a doctor if their child’s headache is accompanied by any of the following symptoms: weakness, double vision, stiff neck, fever, vomiting, coordination problems, unusual sleepiness or lethargy.

Headaches sometimes indicate a significant neurological problem, but more often, a headache simply requires pain management, Dr. Fishman said. The best treatment is to administer medication early and encourage rest or sleep.

"Occasional headaches respond well to over-the-counter drugs," he said. "However, parents should be aware that when headaches become frequent and over-the-counter medications are given to children too often, you actually can cause more headaches. These are called analgesic abuse headaches."

When headaches occur frequently or don’t respond to these drugs, Dr. Fishman advises parents to seek help from their child’s doctor, who can prescribe analgesics or other medications such as triptans to manage pain. Some medications can be prescribed to abort severe attacks at the onset of a headache, and others can prevent headaches altogether.

Sinus headaches and allergy-related headaches; however, require different treatment.

"Sinus headaches may be caused by bacterial or viral-induced sinus infections. Bacterial infections, unlike viral infections, may respond to antibiotics. Brief use of nasal decongestant sprays can relieve nasal symptoms," said Dr. Stuart Abramson of Texas Children’s Allergy and Immunology Clinic. "People with severe allergies can get headaches due to swelling of nasal passages and sinus pressure. These are different from sinus infection headaches. They often are accompanied by itching, sneezing, watery eyes and rubbing of the nose and eyes."

Headaches caused by allergies can be treated with antihistamines, decongestants and anti-inflammatory inhaled nasal steroids, Dr. Abramson said. Saline solution also can be used to wet nasal passages and bring relief.

Dr. Abramson does not advise long-term use of over-the-counter drugs to treat allergies, as many nonprescription allergy medications can induce drowsiness and lethargy. Allergy testing might be required if a child exhibits symptoms and headaches and has not been treated for allergies. Parents should contact their child’s primary care physician for guidance in determining the best course of action.

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