Little Heads, Big Pain: Understanding Paediatric Headache Disorders

As parents, caregivers, and educators, we often associate headaches with the stresses of adult life – deadlines, bills, and endless to-do lists. But the reality is that children and adolescents experience headaches frequently, and for some, these can be just as debilitating and disruptive as they are for adults. At Nervous Doc, we believe that understanding and addressing paediatric headache disorders is crucial for the well-being and development of our young generation.

It can be heartbreaking to see a child sidelined by head pain, missing school, sports, or simply the joy of playing. Often, their pain is dismissed as "just a headache," but for many children, these headaches are a sign of a genuine underlying disorder that needs recognition and management. Today, we’re diving into paediatric headache disorders, exploring the standard types, potential causes, red flags, and the importance of seeking appropriate care.

More Than Just Growing Pains: The Prevalence of Headaches in Children

Headaches are surprisingly common in children and adolescents. Studies have shown that by age 15, around 75% of children will have experienced a significant headache (Headaches.org, 2023). While occasional tension headaches are often benign, recurrent or severe headaches can significantly impact a child's quality of life, affecting their school performance, social interactions, and overall well-being.

Understanding the different types of headaches that affect children is the first step towards providing adequate support. Just like adults, children can experience both primary and secondary headaches.

Primary Headache Disorders in Children:

These are headaches where the headache is the primary issue, not a symptom of another underlying illness. The most common primary headache disorders in children and adolescents include:

1. Tension-type headaches (TTH): Similar to adult TTH, tension-type headaches are often described as a dull, aching pain or a feeling of tightness or pressure across the forehead, sides, or back of the head. The pain is usually mild to moderate and doesn't typically worsen with physical activity. Stress, lack of sleep, dehydration, and poor posture can be triggers. While often less disabling than migraines, frequent TTH can still impact a child's concentration and daily life.
2. Migraine: Yes, children get migraines, too! Migraine is a significant cause of recurrent headaches in children and adolescents. Paediatric migraines can sometimes present differently from adult migraines.

• Symptoms: While the classic throbbing pain on one side of the head can occur, children may also experience bilateral (both sides) pain or a shorter headache duration. Abdominal pain, nausea, and vomiting are often more prominent in paediatric migraines than in adults. Sensitivity to light (photophobia) and sound (phonophobia) is also common. Some children may experience aura (visual disturbances, sensory changes) before or during the headache, similar to adults.
• Impact: Migraines can be very debilitating for children, causing them to miss school and social events and impacting their emotional well-being. Understanding the impact of using tools adapted from adult measures, like a simplified headache diary (inspired by our post on Migraine Diaries/Tracking), can help communicate the burden.

3. Cluster Headaches are rare in young children but can occur in adolescents. They are characterised by intense, sharp, stabbing pain, usually around one eye or temple, often accompanied by a watery eye, nasal congestion, or a drooping eyelid on the affected side. Attacks are typically short-lived but occur in clusters over weeks or months.

Secondary Headache Disorders in Children:

An underlying medical condition causes these headaches. While less common than primary headaches, it's crucial to be aware of potential secondary causes, especially when "red flags" are present (which we’ll discuss shortly, building on our post about Red Flags in Headaches, such as meningitis or encephalitis). Some potential secondary causes in children include:

• Infections: Viral illnesses, sinusitis, ear infections, and more serious infections, such as meningitis or encephalitis, can cause headaches. (Remember our discussion on HIV and other infectious causes of headache in South Africa, while focused on HIV, highlights the importance of considering infections in headache presentations, especially in regions with high contagious disease burdens.)
• Head Trauma: Even minor head injuries can lead to post-concussion headaches.
• Eye Problems: Uncorrected vision problems or eye strain can sometimes trigger headaches.
• Dental Issues: Problems with teeth or jaw alignment (such as TMJ disorders) can cause facial pain that may be misperceived as a headache.
• Increased Intracranial Pressure: This can be caused by conditions such as hydrocephalus or brain tumours (although these are rare).
• Certain Medications: Some medications can have headaches as a side effect.
• Systemic Illnesses: Conditions like high blood pressure or autoimmune disorders can sometimes present with headaches.

Paediatric Headache Red Flags:

When to Seek Immediate Medical Attention

Like in adults, certain headache features in children should raise concern and warrant prompt medical evaluation. These "red flags" are crucial for identifying potentially serious underlying conditions:

• Sudden onset of a severe headache ("thunderclap headache").
• Worsening pattern or increasing frequency and severity of headaches.
• Headache associated with fever, stiff neck, and/or rash.
• Headache accompanied by neurological symptoms:
  • Weakness or numbness on one side of the body.
  • Difficulty with balance or coordination.
  • Vision changes (double vision, blurred vision).
  • Difficulty speaking or understanding speech.
  • Seizures.
• A headache that awakens the child from sleep.
• Headache associated with persistent vomiting (especially projectile vomiting).
• Changes in personality or behaviour.
• New onset of headaches in a very young child (under 3 years old).
• A headache that is significantly worse in the morning.
• A headache associated with a bulging fontanelle (in infants).
• Headache following head trauma, especially if worsening.

If your child experiences any of these red flags, seeking immediate medical attention from a doctor or taking them to the nearest emergency room is crucial.

Diagnosis and Management of Paediatric Headaches:

A Team Approach

Diagnosing the cause of a child's headache involves a thorough medical history, including details about the headache (frequency, duration, intensity, associated symptoms, triggers, relieving factors), a physical examination, and a neurological examination. Keeping a detailed headache diary (adapted for children) can be incredibly helpful in providing valuable information to the doctor.

In most cases of primary headaches, imaging studies such as CT scans or MRIs are generally unnecessary, especially if there are no red flags and the neurological examination is normal. However, these tests may be ordered if there are concerns about a secondary cause.

Management strategies for paediatric headaches are tailored to the specific type of headache and the individual child. They often involve a combination of:

• Lifestyle Modifications: Ensure adequate sleep, regular meals, proper hydration, stress management techniques (appropriate for the child’s age), and identify and avoid potential triggers (foods, activities, environmental factors).
• Acute Medications: Over-the-counter pain relievers, such as paracetamol or ibuprofen, can be effective for mild to moderate headaches. For more severe migraines, doctors may prescribe triptans (although not all are approved for use in younger children, and dosages need careful consideration). Anti-nausea medications may also be prescribed for migraine-associated nausea and vomiting.
• Preventive Medications: Preventive medications may be considered for children with frequent and disabling migraines. These can include certain beta-blockers, tricyclic antidepressants (often used for their pain-modulating effects), or anti-seizure medications (like topiramate). The decision to start preventive medication is made carefully, considering the frequency and severity of headaches, the impact on the child's life, and the potential side effects of the drug. Newer CGRP inhibitors are being studied in adolescents and may become an option in the future (American Migraine Foundation, 2024).
• Non-pharmacological therapies, such as biofeedback, cognitive behavioural therapy (CBT), and relaxation techniques, can help manage chronic headaches and teach children effective coping strategies.
• Education and Support: It is crucial to provide the child and their family with information about headaches, triggers, and management strategies. A supportive and understanding environment can significantly improve a child's ability to cope with headaches.

The Impact on Productivity (Even for Kids!):

While we often associate "productivity" with adults in the workplace, children's "work" is school, learning, and engaging in activities that contribute to their development. Frequent or severe headaches can lead to missed school days, difficulty concentrating in class, reduced participation in extracurricular activities, and social isolation. Addressing paediatric headache disorders is essential for maximising a child's potential and ensuring healthy development.

A Collaborative Approach:

Parents, Children, and Healthcare Professionals

Managing paediatric headaches effectively requires a collaborative effort between parents, the child, and healthcare professionals. Open communication, accurate tracking of symptoms (using a child-friendly diary), and a willingness to explore different treatment options are key to finding the best approach for each child.

At NervousDoc.com, we are committed to providing resources and information to support families navigating the challenges of neurological conditions, including paediatric headaches. Children with headache disorders can lead full and active lives with the proper knowledge and support.

Ready to learn more about neurological health and gain practical tips for supporting your family's well-being and productivity? Subscribe to NervousDoc.com today! Join our community and access expert insights, helpful resources, and a supportive network. Let's work together to ensure that even our youngest members can thrive, free from debilitating headaches.

Till next time,

Nervous Doc