By – Dr Rekha Mittal, Pediatric Neurology, Madhukar Rainbow children hospital
Headaches aren’t just for adults – children can have them too, often as frequently and as severely as older people; and as many as 1 in 5 school-age children and teenagers can suffer from recurrent headaches. In young children, the condition may remain undiagnosed because they are unable to express the problem.
The cause of headache in children is usually not serious; however, the headaches can be so distressing and disturbing, that they may result in school absences and even affect school performance. Each child with headache, therefore, must be evaluated and treated appropriately.
Headaches can occur because of problems in structures of head eg ear, throat, sinuses, eyes or teeth. Also, any fever especially many viral fevers, can also cause headache. It was a common symptom of Covid 19 in many children. In these cases, the headache gets relieved when the cause is treated.
Severe headaches can also occur because of brain infections or brain tumors. In these cases, the headaches are accompanied by what are called red flags. ( BOX 1). These types of headaches may be life threatening and require urgent investigations to find and treat the cause.
However, many children have recurrent headaches; the frequency could be once in a few months to many times a month. The 2 most common causes are migraine and tension type headache.
In migraine, the headache is severe and throbbing, and causes disruption of usual activities, with the child usually wanting to lie down. The child may feel irritated by bright lights or usual sounds. Nausea and vomiting are commonly associated, and sometimes abdominal pain too, making the parents go to a gastroenterologist. Often the child ends up having an endoscopy! Young children who are unable to express these symptoms, may just cry and hold the head to indicate severe pain. Treatment consists of medication to relieve the pain, and if the attacks are very frequent, more than 2-3 times in a month, preventive medicines can be given. Besides this, avoidance of certain food items like caffeine, dry fruits, monosodium glutamate, etc may be advised by the doctor.
Tension type headache is the other common type of headache. It occurs as a result of a stressful situation at home or school. The child can have a pressing tightness in the muscles of the head or neck. It is milder than migraine, and the child can continue normal activities. There is no nausea or vomiting. Younger children may withdraw from regular play and want to sleep more. The headaches can last from 30 minutes to several days. These are also treated with pain killers. Sometimes, medicines to relieve stress or tension may be prescribed.
Both migraine and tension type headache can become chronic, and may occur very frequently – as many as 15 times a month. Both may occur together, and may aggravate each other. Both may also be aggravated by poor lifestyles like prolonged screen times, poor and irregular sleeping and eating habits ( late nights, inadequate sleep, skipping meals, stress for any reason, whether for studies, or home social situations). It is imperative to address to these issues, along with medications, for good results. Yoga and meditation also helps.
All in all, headaches in children can become headaches for the parents. But simple changes in lifestyle can help in ameliorating the symptoms to a certain extent. The bottom line is that they should not be ignored, just in case there is a serious underlying cause, and importantly, also to avoid a vicious cycle of headache – stress – headache.