Headaches are among the most common
childhood complaints. In fact it is the most frequently reported pain in this population.
Dr. Anna Alshansky says that parents of her patients often say, “But my child is too young to have headaches!” It turns out, however, that the headaches can occur at any age.
Up to 75% of children can experience headaches
Studies show the 3-8% of children will complain of headaches by the age of 3, by the age of 7, 40% of children will experience headaches, and by the age of 15, this number arises to 75%.
Most of the headaches in children are benign, not life-threatening. There are multiple causes of headaches in children.
Often they are related to primary headache disorders, like migraines, tension headaches, chronic daily headaches, cluster headaches.
Some of them however can be a symptom of other medical and neurological conditions and they are called secondary headaches. They can be related to systemic infection with fever, trauma, headaches related to diseases of other head and neck structures, like eyes, sinuses, TMJ. Headache can be a physical symptom of psychiatric conditions, like depression or anxiety .Sometimes headaches can be related to sleep disorders, for example sleep apneas.
When a child complaints of headaches, parents usually seek medical attention to get reassurance that the cause is not a brain tumor or other serious problems.
Exams and history key to diagnosis
A thorough history, physical, and neurological examinations and, when appropriate, diagnostic testing, usually allow physicians to distinguish primary headache disorders from the headaches related to secondary problems. However, evaluation of children, especially those younger than age 10, is not always easy and can require special knowledge and techniques.
During a visit to a pediatric neurologist, thorough neurological and physical examinations are performed looking for signs of increased intracranial pressure, like swelling of the discs of the optic nerves on funduscopic examination, double vision, focal neurological signs, like weakness of the limbs, sensory deficits, coordination and balance dysfunction, which could suggest presence of intracranial cerebral abnormalities.
The medical examination pays attention to vital signs, including blood pressure, weight, height, temperature, skin, and skeletal abnormalities, looking for evidence of conditions like trauma, infectious or inflammatory processes.
Important to identify headache triggers
Most of the time diagnosis can be made based on data from the history and neurological and physical examination. Laboratory studies are rarely indicated in children with normal neurological, physical examinations and a history, not suggestive of the presence of other medical condition. The studies report that of all children referred for the evaluation of the headache, laboratory tests were helpful in less than 5%. In these 5%, the underlying abnormality was usually suspected on the basis of a careful history and findings of physical examination.
Most of the children with primary headaches can be managed with reassurance, appropriate modifications of the regime of the day, including sleep and diet, as well as simple analgesics.
In more severe cases migraine specific pharmacological agents can be used.
Dr. Anna Alshansky is a board certified Pediatric Neurologist who specializes in the diagnosis, management, and treatment of pediatric neurologic disorders. She practices out of the CareMount Medical Fishkill location.
Other articles by Optum Medical Care