Headache is not as common in children as in adults. Any recurring headache or headache associated with vomiting, poor coordination or other symptoms should be evaluated in the office during regular office hours. Keep a diary of how often the headache occurs, how long it lasts and how severe it is. Mild infrequent headaches can be treated with acetaminophen (see Dosing Guide for proper dose). Headaches associated with fever and a stiff neck are potentially serious and should be evaluated by the doctor right away. This can be a sign of meningitis. Headache associated with head trauma should be treated as you would head injury. Please see this section of our handbook by clicking here. Vomiting associated with headache after head trauma is an alarming development worrisome for brain (intra-cranial) bleeding (epidural hematoma, sub-dural hematoma). Go to the nearest ER or call 911, an emergency CT of the head is needed to evaluate this possibility.
Chronic recurring headaches such as migraine headache, tension headache and sinus headache, can be quite painful and difficult to tolerate. Migraine headaches tend to be inherited and run in the family. Migraine symptoms include a pounding headache, nausea, vomiting, and light sensitivity. Most people with a severe migraine headache will go to bed in a quiet, dark room and go to sleep. Most of the time, by the time the child awakens, the headache is much better. Children with chronic, recurring headaches need to be evaluated in the office during regular office hours. Treatment options are available to prevent them.
You need to know that headaches that awaken a child from sleep are worrisome for increased intra-cranial pressure. Brain tumors, brain swelling, brain bleeding and Pseudo-tumor cerebri are possible. Intra-cranial pressure increases when the contents of the skull exceed its capacity. A brain tumor can increase intra-cranial pressure because there is no room for the tumor as it continues to grow. The same thing can happen if you have too much cerebrospinal fluid (pseudo-tumor cerebri), or if your brain swells such as due to a brain bleed or due to a brain injury such as a concussion.
The increased intra-cranial pressure of pseudo-tumor cerebri may be a result of a problem in the re-absorption and subsequent excess of cerebro-spinal fluid, the fluid around and in the brain that cushions it. Since the skull is fixed in size, any increase in the amount of cerebro-spinal fluid will raise the intra-cranial pressure. Increased intra-cranial pressure is painful and this results in headaches which awaken the child at night. Pseudo tumor cerebri has been associated with obesity, growth hormone administration, the antibiotic Tetracycline and excess vitamin A.
An office visit is needed should headaches begin to awaken your child from sleep. The other signs and symptoms of increased intra-cranial pressure may include: moderate to severe headaches that may originate behind the eyes and worsen with eye movement, tinnitus (ringing in the ears), nausea and vomiting, blurred vision, decreased vision, difficulty seeing to the side, double vision, seeing light flashes, and dizziness.
Thankfully, increased intra-cranial pressure with all it’s attendant causes is rare. Most children with headaches have tension and migraine headaches which are not harmful to the child, only painful. An office visit is needed to work up any child with chronic headaches.
Headache associated with head trauma should be treated as you would head injury. Please see this section of our website.