Headache in children

Diagnosis

The diagnosis of headaches in children requires thorough assessment of the symptoms, conduct of physical and neurological exam, and requests of several tests, if necessary. No more testing is typically required if the child is otherwise healthy, and headaches are the only symptom. 

• Headache history: A headache journal may be recommended to record necessary information regarding the child’s headaches, including frequency, pain intensity, and potential triggers. Detailed description of the headaches must be provided so they can be evaluated for a pattern or a common cause. 
• Physical and neurological exam: The healthcare provider will assess if the movement is normal and if there are any issues with coordination or sensation. They will also do a physical exam, which involves measuring the child’s height, weight, head size, and checking their blood pressure and pulse. They will also look at the child’s eyes, neck, head, and back. 

Tests can occasionally assist in determining a diagnosis or in ruling out further medical conditions that might be the source of the headaches.

• Magnetic resonance imaging (MRI): Comprehensive images of the brain are obtained using a large magnet, radio waves and a computer. The blood vessels that supply the brain can be examined using an MRI. MRI scans are typically used to identify tumors, strokes, aneurysms, neurological conditions, and other abnormalities of the brain. 
• Computerized tomography (CT) scan: This aids in the diagnosis of tumors, infections, and other conditions that might result in headaches. A sequence of computer–directed X–rays are used in this imaging process to produce a cross–sectional image of the child’s brain.
• Spinal tap (lumbar puncture): This involves using a thin needle to take a small sample of cerebrospinal fluid from the lower back, which will be examined in a lab for further evaluation. This may be advised if the healthcare provider has reason to believe that an underlying disease, such as bacterial or viral meningitis, is the source of the child’s headaches.

Treatment

When dealing with headaches in children, healthcare providers take various factors into account, such as the child’s age, the type and frequency of the headaches, and the underlying cause. The goal is to customize treatment approaches to meet the child’s specific requirements, ensuring effective management and relief from their headaches. 

There are four primary approaches to treating these headaches: medication, providing headache education, implementing lifestyle adjustments, and teaching stress management techniques. Most of the time, the child’s headache may be cured at home with relaxation, reduced noise, lots of liquids, healthy foods, and over the counter painkillers. 

• Medications
  • Over the counter pain relievers: These medications are ideally taken as soon as a headache starts. Common OTC medications to help relieve headache symptoms, including pain, nausea and vomiting are acetaminophen or ibuprofen. 

Refrain from giving aspirin to children or teens recovering from chickenpox or flu–like symptoms, as it can lead to a rare but serious condition called Reye’s syndrome. 

• • Prescription medications: Abortive drugs help avoid migraine symptoms like pain, nausea, and light sensitivity by interrupting the headache process. These prescription medications include long–acting triptans like frovatriptan and short–acting triptans like sumatriptan. Triptans are efficient and safe for usage in kids over the age of six. Anti–nausea medications may be prescribed for migraines with accompanying nausea and vomiting symptoms. 

Caution: Taking medications should have prior discussion with a healthcare provider. It is important to take note that all medicines have negative side effects. Painkillers and other drugs may become less effective with time. Taking too much medicine can make headaches worse, a condition known as “medication overuse headache.” 

• Therapies: Although stress and depression do not seem to be a direct cause of headaches, they can function as a trigger or exacerbate an existing headache. Several strategies aim to equip children with effective tools to manage and alleviate their headaches while promoting overall well–being.