Headache help for youngsters

What to do when your child is the one in pain

Karen Mason’s* five-year-old daughter was normally quite talkative. So when Mason’s daughter, Anne, suddenly became very quiet, Mason knew something was going on. “I asked her what was wrong, and she told me it was her head,” recalls Mason. “And when you see a mood change like that, you’re concerned.”

Like Mason, parents who seek help for a child’s headache will soon realize that maux de tête are not just adult ailments. “Headaches should be taken seriously, but they are common in children and aren’t normally caused by anything worrisome,” says Kathryn Selby, a paediatric neurologist at BC Children’s Hospital in Vancouver. The trouble is that headaches can be caused by a host of factors — illness, injury, noise, stress, fatigue, to name a few — and they can also have a psychological component.

It can be difficult to know what’s “normal” and whether you should treat a child at home, see a doctor or let it be. However, understanding the types of headaches common in children can help you figure out how to help your child.

*Names changed by request.
Illness related

A viral infection is one of the most frequent causes of a headache, says Dominic Chalut, an emergency medicine doctor at the Montreal Children’s Hospital. Ear, nose and throat infections, as well as any sickness that comes with a fever (such as the flu, for example) can also be accompanied by a headache.

Illness-related headaches tend to go away on their own, says Chalut.

Relief plan In most cases, bringing down your child’s temperature with ibuprofen or acetaminophen should quell the headache as well. If your child has, in addition to fever, a stiff neck and seems confused, seek medical help immediately, as these symptoms can indicate meningitis. Keep in mind, however, that meningitis is extremely rare and the signs that something is wrong will be noticeable.

Tension

Aside from headaches that are illness related, the most common form that kids experience are caused by tension. If this surprises you, it shouldn’t, according to Chalut. “We know how much kids are exposed to stress: They’re pushed to perform everywhere,” he says.

Tension headaches don’t follow any set pattern; they can occur sporadically or almost daily. In some cases, they’ll last half an hour; in others, a couple of days. Tension headaches are often felt on both sides of the head, and the discomfort tends to be a dull ache, says Selby. Such headaches shouldn’t interfere with a child participating in an activity she enjoys.

Relief plan Tension headaches aren’t always responsive to acetaminophen or ibuprofen, Selby says, but vitamin B2 has been shown to reduce their intensity — speak to your doctor before trying this approach. (Vitamin B2, or riboflavin, also helps prevent migraine and is found in dairy products, leafy greens, fish, red meats and nuts.) And muscular strain can exacerbate tension headaches. “Sometimes children screw up their foreheads or scrunch up their shoulders,” says Selby, so now might be the time to work on poor posture habits.

Injury related

Minor bumps to the head can be followed by a headache, but very few post-injury headaches (less than one percent) denote something more serious, like a concussion, says Chalut.

Relief plan Pain relievers and time will help most headaches that occur after a bump or fall. But if the pain worsens within a period of four to six hours after injury, seek medical attention.

See a doctor if the headache intensifies, the pupils are unequal, or if your child vomits or seems confused or especially groggy.

Migraine

Just like adults, kids can suffer from migraine headaches that are excruciatingly painful and long-lasting, and interfere with their ability to socialize or concentrate. The experience is especially overwhelming for young ones, who often don’t know how to describe their symptoms. Questions like “Where does it hurt?” can be futile, since migraine can be associated with both head and abdominal pain, as well as distorted vision. According to Selby, a child’s behaviour may offer the most clues. “Often, with a migraine, the child will want to just lie in a dark room and be quiet or sleep,” she explains. Children might not want to eat or drink and aren’t easy to console; in fact, kids with migraines are often impatient, Chalut says, though it’s not known why. “It could just be because they feel frustrated,” he says.

Migraine can start as early as age three or four, says Selby, but this is rare; they’re much more likely to occur in late childhood and adolescence. Studies show about 10 percent of school-aged children will suffer the odd migraine. Girls are often more affected than boys and heredity, weight gain and obesity are also contributing factors, Chalut says.

Relief plan Simple analgesics can greatly diminish the severity of a migraine, and a range of prescription drugs is available both to help prevent and treat the condition in kids and teens. Also, since migraine is made worse by bright light and noise, it’s helpful to have your child rest in a dark, quiet room.

But lifestyle changes and alternative therapies can work wonders. Start with ensuring that your child is getting enough sleep and is well hydrated throughout the day. And since migraine often attacks after a particularly stressful period, determine if something is bothering your child, be it schedule overload or fights with siblings. Keeping a headache diary with your child can help you both pinpoint stress, food or environmental triggers.

Finally, remember that there’s a huge mind-body component with migraine headaches. “It’s important to teach children relaxation techniques, such as yoga-style breathing,” says Selby, explaining that a predisposition to migraine in childhood often continues into adulthood. “Those skills will be a huge help throughout their lives.”

After her daughter’s second headache, Karen Mason made an appointment with her doctor, who recommended she give Anne an over-the-counter analgesic. For subsequent headaches, which occur every other month or so, Anne took children’s ibuprofen and was back to her bubbly self within 20 minutes. Since Karen has realized her daughter’s headaches are triggered by bright light, such as blinding snow, sunglasses have helped. “Now she can tell me right away if she has a headache,” Karen says. “I find treatment is most successful if you nip it in the bud, treating the headache the moment it occurs.”

When to seek medical attention

If your child has any of the following symptoms, a headache could be the sign of a more serious condition:

• one-sided headaches
• confusion or difficulty concentrating
• pain that wakes your child up at night or causes him to miss school
• vomiting
• trouble with walking or fine motor skills