What to Do When Your Child Has Persistent Headaches

Understanding Childhood Headaches

Headaches are a common issue for kids of all ages, but some children experience them more frequently than others. These painful episodes can disrupt their daily lives, leaving parents searching for answers.

“We don’t understand exactly what happens during a headache,” says Prasanna Gangishetti, MBBS, a neurologist at Children’s Nebraska. “Our current hypothesis for headaches is brain irritation due to sensory overload. There is an underlying genetic component, though not all genes have been identified.”

Headache Types in Children

Headaches generally fall into two categories: primary headaches and secondary headaches. A primary headache doesn’t have a specific cause, unlike a secondary headache. For example, if your child has a viral illness, the resulting inflammation can lead to a secondary headache.

Dr. Gangishetti sees all patients with headaches, including children with primary headaches, of which there are three types:

Headache Prevention

There are a few ways to try to prevent headaches in children. However, your child may be more prone to getting headaches if a parent or close relative also gets them.

• Get more rest and sleep. Sleep is very important for preventing and treating headaches. Kids should try to get eight to 10 hours of sleep each day and keep a consistent sleep routine.

• Focus on hydration. If your child is prone to headaches, drinking 40–60 ounces of water per day (based on their age) can help.

• Eat a balanced diet. When glucose levels go up and down, it can trigger headaches. Make sure kids eat regular meals and snacks throughout the day.

• Stay active. For some children, increased physical activity can make headaches worse. However, usually, getting 20–30 minutes of physical activity per day two or three times each week is enough to help with headaches.

• Avoid triggers. Taking medication can treat headaches, but avoiding what triggers a headache is much more helpful for prevention. With time, you can help your child identify what causes their headaches or migraines.

What Should I Do If My Child Constantly Complains of Headache or Migraine?

If your child frequently experiences headaches, start by talking to their pediatrician. They can help determine whether your child needs additional care from a neurologist.

How to Stop Headaches at Home

If your child has a headache, sleeping in a dark, quiet place can help improve symptoms. You can also give your child over-the-counter medications, such as acetaminophen or ibuprofen. However, children shouldn’t take these medications for more than 10–12 days each month, or two to three times each week, because overuse can make them less effective. Proper hydration and adequate meals can also reduce head pain.

Dr. Gangishetti says when it comes to stopping a headache at home, it’s best to listen to your child.

“Most of the time, kids tell us what helps,” he says. “When they’re having a headache, sound may be bothering them or light, and they may want to rest in their room.”

Additionally, he recommends keeping a headache diary if your child has frequent headaches. A headache diary is a place to track headaches and help identify the triggers that cause them. It can be as simple as writing down information about a headache in a notebook or on your phone. There are even specific apps, such as Migraine Buddy. Write down the date, how severe the headache is, how long it lasts and possible triggers. Consider sleep, stress and whether your child skipped meals.

When to See a Doctor for Your Child’s Headaches

Dr. Gangishetti recommends talking to your child’s pediatrician about any headache concerns. It’s especially important to see your child’s provider if headaches:

• Lead to missed school days or extracurriculars

• Happen more than once per week

• Cause weakness on one side of the face or body

• Cause pain around the eyes or vision changes

• Get worse when lying down

• Get worse when coughing or sneezing

Your pediatrician can determine if your child needs to see a neurologist for more advanced care. In the meantime, they’ll guide you through lifestyle modifications and supplements that can help with headaches, such as riboflavin, magnesium, coenzyme Q10 and melatonin.

Most headaches do not cause damage to the brain structure, which is a common concern among parents. A dilated eye exam can help rule out concerning brain conditions that affect vision. Most headaches, even though uncomfortable, do not cause harm to the brain.

There’s not a specific test, like an MRI or lab test, that can confirm a headache or migraine diagnosis, so providers must rely on diagnostic criteria. If your child meets the criteria, they’re diagnosed with a tension headache or migraine.

A diagnosis can be helpful, since migraines are recognized in disability laws, including the Americans with Disabilities Act and Section 504 of the Rehabilitation Act. You can request school accommodations for your child if needed.

What to Expect if My Child is Referred to Neurology

Your child’s pediatrician may refer them to Adolescent Medicine or Neurology at Children’s Nebraska if their headache diagnosis isn’t clear or they’re worried about the brain. A specialist can offer more advanced headache care. Your child can expect:

1. Questions about their headache history

2. A physical exam to check for any issues with the brain, including balance or coordination problems

3. Information about different treatment options

Your pediatrician likely doesn’t offer the same specialized treatments as a neurologist, who may recommend:

• Anti-seizure medications that help with certain types of headaches

• Antidepressants that help with headaches

• Neuromodulation devices, such as Nerivio and Cefaly, that change nerve activity

• A clinical research trial for calcitonin gene-related peptide (CGRP) medications, which offer targeted therapy for migraines

If traditional headache treatment doesn’t work for your child, they may be referred to Children’s Headache Clinic. The multidisciplinary team of providers from Neurology, Adolescent Medicine offers even more comprehensive headache care. They look at mood, stress and anxiety levels. We also have specialists in Plastic Surgery who can help with procedures such as local anesthesia or botulinum toxin (like Botox) — a treatment found to decrease headache frequency.

“Headache diagnosis and treatment is not always a straightforward process,” says Dr. Gangishetti. “Sometimes, you have a headache after a concussion or as part of a pain syndrome. Or it’s a complex case. Fortunately, at Children’s, we have more than 50 pediatric specialists to collaborate with if you need them.”

Other Common Questions About Headaches in Children

Why do children get headaches?

Children get headaches for many reasons. Headaches can be genetic, meaning if one or both of a child’s parents get headaches, the child will likely get them, too. Other factors, such as sleep and eating habits, hydration, weather and environmental changes can trigger headaches.

What’s the difference between a headache and a migraine?

Tension headaches and migraines are both types of primary headaches. Often, the main difference with a migraine is a headache with nausea. It’s also more likely to cause disability, like missing school or extracurricular activities.

Does headache location matter?

Though headaches can affect different parts of the head, in children, the location isn’t as important. Many children can’t determine where the pain is or verbalize it. Parents should pay attention to if kids mention eye or vision changes, or head pain that gets worse when the child lies down.

At what age do migraines start?

Migraine can happen at any age. According to the American Academy of Pediatrics, 50% of people who get migraines have their first one before age 12. Around puberty, headaches and migraines are more common in girls than boys.

What triggers a migraine in children?

Migraine triggers vary by person but often relate to sensory overload. The most common triggers are light and sound. Other triggers may include weather changes or strong smells.

How long is too long for a child to have a headache?

Contact your child's pediatrician if your child’s migraine lasts for more than two days. Tension headaches are more concerning if they are on one side of the head and last a week or more.

What are migraine treatment and relief options?

If treated within the first couple of hours, oral medication can help a migraine. If the migraine has lasted more than 48 hours, a child may need to visit urgent care or the hospital for IV medications.

Does your child have headaches more than once per week? Do headaches interfere with school or other activities? Contact your pediatrician.