Dr Maria Kinali | Consultant Paediatric Neurologist | The Portland Hospital
Headaches are a common problem amongst children of all ages. In meta-analysis studies of paediatric headaches it has been shown that up to 50 per cent of 7-year-olds and up to 80 per cent of 15-year-olds have suffered rom at least one bad headache a year.
Headaches tend to last for much shorter periods in children and are often different from the headaches adults get. They tend to start suddenly, they are often localised on both sides of the head with the child feeling sick but children also generally recover very quickly – the headache can be over in 30 minutes although it can last up to 72 hours, with the child feeling well and playing again like nothing even happened.
Some reports suggest that headaches are more common in boys before they start puberty whilst females suffer from headaches after adolescence.
The main triggers or factors which can cause headaches in children are:
Lack of food, water or sleep - your child may have skipped their packed lunch or not had anything to drink all day. It is also important to put children asleep at a set time on school nights.
Sporty activities - due to lack of dehydration and the effect on blood sugar.
Emotional stress - children sometimes get headaches through emotional problems such as being bullied at school or parents going through divorce.
It’s a good idea to keep a diary of when your child headaches occur as that can be a good identifier of the possible triggers for them.
Often some simple steps will be enough to help your child through a headache or possible migraine attack. For instance:
- Let the child lie down in a quiet and dark room
- Put a moist cold cloth across their forehead to soothe the pain
- Make sure they breathe easily and deeply
- Encourage them to sleep or rest as this speeds recovery process
- Encourage them to eat or drink something (non-caffeine fluids only).
If your child’s headache does not seem to ease off then your child may need painkillers, start the medicine as soon as possible after the headache has begun. Paracetamol and ibuprofen are both safe and work well effectively for children with headaches. The syrups alternatives are easier for children to swallow than tablets. An effective treatment plan with painkillers should end the headache episode and return your child's function back to normal within 1 to 2 hours. Alternatively, if this initial strategy in ineffective or only partially effective an alternative treatment strategy could be tried with triptans (migraine specific medications) such as Zolmitryptan orodispersible tablets, a pharmacy remedy that treats migraine and is suitable only for children over 8 after seeking the advice from your GP.
When the frequency of the headache increases to 3-4 per month with significant disability and school absentism a preventative therapy should be considered. The goal of this daily treatment is to reduce headache frequency and disability and parents should seek advice from the GP. There is a variety of available medications, the appropriate choice and the pros and cons of medication will need to be discussed with the family by a paediatric neurologist. Bio-behavioural treatment with adjusting of lifestyle habits plays also an important and complimentary role.
Most headaches are not a serious concern, however there are two types of headache disorders that warrant further treatment. These are:
1. Primary headache disorders - primary headache disorder in children include migraine, complicated migraine, migraine variants or equivalents and tension type headaches. Migraine without aura is the most common recurrent primary headache disorder in children.
2. Headaches secondary to other causes – the most important diagnoses to consider are intracranial haemorrhage or CNS infection if there is an acute history of headache, or space occupying lesion, idiopathic intracranial hypertension, or other causes of raised intracranial pressure if the headache history is subacute or chronic.
Like with adults, most headaches in children are not a serious health concern. Often children can be treated or recover at home with pharmacy medicines and often prevent them occurring by ensuring children get enough food, drink and sleep.
Where other treatments have not worked Botox is now being used to relieve the pain of chronic daily headaches and migraines (at least 15 days per month) in adolescents. Although Botox treatment is a last resort option, children attending The Portland Hospital may receive this form of treatment if appropriate, which means the months to follow should be headache-free for them.
If you are worried about the frequency of your child’s headaches please contact your GP or Dr Maria Kinali, Consultant Paediatric Neurologist at The Portland Hospital on 020 7390 8020.