Headache

Introduction

The Questions and Answers that follow aim to provide an introduction to headaches/migraines for parents and other family members. Following those, we offer links to selected resources for more information and support and a list of valuable services.
More information about many topics relevant to children with headache and many other chronic conditions and their families can be found in the left menu. Detailed information aimed at primary care doctors can be found in our Headache (Migraine & Chronic) module.

Can children get headaches?

By the time they reach high school, most young people have experienced some type of headache. In younger children, it may be difficult to tell if they are having headaches, but a pale child who seems to be in pain, has nausea and vomiting, or is holding his or her head, particularly in the setting of a family history of headache, may be experiencing headaches.

What is a migraine?

Migraines are a type of headache that often start as a dull ache and then become throbbing and are felt on one side or all over the head. The pain can come with nausea, vomiting, sensitivity to light, touch, or noise, impaired thinking, change in mood, or anger. Some people (25-30% of migraine sufferers) experience an aura prior to headache onset—these can include visual changes (such as seeing sparks, bright dots, zig zags, tingling on one side of the body, inability to speak clearly, lasting up to an hour), or feelings of pins and needles. Some people will experience the aura, but never get the headache, which is called acephalgic headache or migraine without headache.
What is an abdominal migraine?
Abdominal migraine occurs in children more than adults and can cause nausea, vomiting, reduced appetite, and paleness. Head pain may also be present, but often is not the chief complaint.

How do you get migraines/headaches?

The underlying causes of migraine are not well understood, though inheritance (a family history) plays a key role. Changes in the nervous system, its blood flow, and the balance of brain chemicals that regulate pain may be important factors.
Better understood are the “triggers”—those things that, for individuals, seem to cause them to get a migraine. These triggers can include a variety of exposures; see What is a headache trigger? below for more detail.
About 10% of children experience migraine; older children and adolescents have them (8-23%) and younger children (4-11%). Children with one parent suffering from migraine have a 50% change of having it too.

What are the symptoms?

Migraine headache symptoms are described above under What is a migraine. The term chronic daily headache is used when headaches occur 15 or more days a month. Some people with chronic headache describe headaches present every day with a range of pain from 0-10 throughout the day. Accompanying symptoms such as nausea and vomiting are less common with chronic daily headache than with typical migraines.

How are they diagnosed?

There is no test for migraine—the diagnosis is based on the description of symptoms, time course, and physical exam being normal. Headaches in children are rarely caused by underlying tumors or other serious brain disease. Children, like adults, can also have stress headaches, which are also more common in older children.

What is a headache trigger?

Migraines and chronic headaches can be triggered by many things, including poor sleep, stress, hormone changes (as with menstrual periods), bright lights, strong smells, foods, weather changes, and many other exposures. Keeping a headache journal can help identify triggers—with each new headache, think through and write down recent exposures or changes in the environment. If most headaches are found to be occur with or after the same exposures, discuss that with your doctor and, if possible, try avoiding those things see if that reduces migraine frequency.

What is the expected outcome?

Some children have migraines only for a while, seeming to outgrow them, but others will continue to have them into adulthood. Most children, and adults, with migraine can manage them so that they affect their lives minimally. Healthy lifestyle (sleep, diet, exercise), avoidance of triggers, and appropriate use of medications can make a big difference in the frequency, duration, and severity of migraines. New medications are being developed and becoming available that may help those whose migraines persist despite the usual measures.

Will anyone else in the family get migraines/headaches?

There is a genetic component to headaches but it is difficult to predict just who will be affected. A child has a 50% chance of having migraines if one parent suffers and a 75% chance if both parents suffer.

What is the treatment?

Headache treatment may involve lifestyle changes in addition to medications and other therapies. Identifying headache triggers and then trying to avoid them can be key. Other helpful strategies can be:
  • Decreasing stress
  • Increasing hydration
  • Making sure meals aren’t missed
  • Getting enough sleep
Headache medications are primarily those meant to stop headaches before they get bad. Some people are helped by preventive medications, though recent evidence suggests that most are not helped. Medications taken when a patient feels a headache starting should reduce its duration and severity, and sometimes stop it completely. These medications include:
  1. Anti-inflammatory medications such as ibuprofen and naproxen sodium
  2. Stimulants like caffeine
  3. Combinations, such as Exedrin for Migraine and Midrin
  4. Triptans – prescription medications that come as pills, dissolving tablets, nasal sprays, and injections
  5. Ergot-based medications that come in oral and injectable forms
  6. Tranquilizer and anti-nausea medications
A variety of medications have been used as daily treatment meant to prevent migraines. Though recent studies have shown that they don’t help most children, they may be worth trying. These medications include:
  1. Calcium channel blockers
  2. Blood pressure medications
  3. Antidepressants
  4. Anticonvulsants (anti-seizure medications)
A new class of medications, called calcitonin gene-related peptide (CGRP) inhibitors are the first preventive therapy specifically designed to prevent migraines and may be considered in patients who don’t respond to other measures.
Other approaches that have been found helpful include:
  • Physical therapy
  • Yoga
  • Biofeedback
  • Counseling, particularly cognitive behavioral therapy

How will my family's life be changed?

The impact of headaches will depend on their severity, frequency, and response to treatment. Families can help a lot by supporting children in avoiding triggers and maintaining a healthy lifestyle, assuring a supportive school environment (including special accommodations if needed), and helping friends and their families understand the condition.

What is biofeedback?

Biofeedback may be helpful for those whose headaches are triggered by stress. It is a technique using equipment that monitors your body's involuntary physical responses such as breathing, pulse, heart rate, temperature, muscle tension, and brain activity. Biofeedback helps you improve your relaxation exercises by learning to control the physical responses that are related to stress. After learning the technique, the equipment is no longer necessary.

Why does my child’s doctor want us to see a psychologist for migraine headaches?

A psychologist or counselor can be very helpful for children with migraine, and for their families. They can:
  • Help with finding and removing headache triggers
  • Help children learn how to deal with the headaches
  • Address missed school days and social interactions
  • Address peer or family pressures
  • Help with lifestyle changes to relieve stress and promote relaxation
  • Help with specific techniques to relieve pain, such as imagery or self-hypnosis

If nothing is wrong with my child, then why is she having headaches?

When a doctor says that your child is "fine" or “has nothing wrong.” that most likely means your child doesn't have a serious condition causing the headaches. It doesn't mean that the headaches aren't real, or that they don't hurt, or that the pain can't cause significant problems and absences from school or work.

What is a rebound headache?

Rebound headaches happen when a person with headaches has taken headache medications too often (more than two days per week) or has taken too much medication (more than the label or a doctor advises). With rebound, headaches tend to occur whenever the medication wears off. Rebound headache is treated by tapering the overused medication, sometimes substituting a different type of treatment or medication. Consult your primary care doctor if you regularly use headache medications more than two days per week or more than the label advises.

Resources

Information & Support

Where can I go for further information?

For Parents and Patients

Support

Headache Information (NHF)
Information, online support groups, and regional conferences; includes a physician finder; from the National Headache Foundation.

American Migraine Foundation
Provides education, support and resources for adults and children living with migraine. “Its mission is to advance migraine research, promote patient advocacy, and expand access to care for patients worldwide.”

General

Headaches in Children (Headaches.org)
An excellent resource, with information written for parents and for the child experiencing the headaches, by David Rothner, MD, a headache expert and former head of child neurology at the Cleveland Clinic.

Causes of Headaches (KidsHealth)
Includes tips for how to help your child when he or she has a headache and when to call a doctor; sponsored by Nemours.

Migraine World Summit
Annual virtual event for patients with migraine presenting information from researchers and physician specialists. Past sessions are archived.

Services for Patients & Families in New Mexico (NM)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Studies

Childhood and Adolescent Migraine Prevention Study (CHAMP) (clinicaltrials.gov)
Ages 8-17, 34-week study, paid, comparing two medicines--amitriptyline and topiramate--with a placebo. Only one participant so far; need 16 total. May end study for lack of participants. Study being conducted at the University of Utah Clinical Neurosciences Center.

Clinical Trials Related to Migraine in Children (clinicaltrials.gov)

Thin Film Spectacle Coatings to Reduce Light Sensitivity and Headaches in Child and Adolescent Patients with Migraine (clinicaltrials.gov)
Ages 7-18, a 12-week study wearing lenses with a coating to minimize light. No medications involved. Study conducted through the University of Utah's Clinical Neurosciences Center.

Authors & Reviewers

Last update/revision: November 2019
Current Authors and Reviewers:
Author: Lynne M. Kerr, MD, PhD
Reviewer: Lisa Thornton
Funding: The Medical Home Portal thanks the 2011-2012 URLEND Medical Home Portal trainees group for their contribution to this page.