Headache

HEADACHE

Symptom Definition

  • Pain or discomfort of the scalp or forehead areas.
  • The face and ears are excluded.

Causes

  • Viral illnesses: Most headaches are part of a viral illness, especially with colds. These usually last a few days
  • Muscle tension headaches: Most common type of recurrent headaches
  • Migraine headaches: Recurrent severe, incapacitating headaches
  • Other common causes: Hunger, exertion, sunlight
  • Serious causes: Meningitis or encephalitis

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WHEN TO CALL YOUR DOCTOR

Call 911 now (your child may need an ambulance)if:

  • Difficult to awaken or passed out.
  • Confused thinking/talking or slurred speech.
  • Blurred or double vision.
  • Weakness of arm or leg or unsteady walking.

Call your doctor now (night or day) if:

  • Your child looks or acts very sick
  • Stiff neck (can't touch chin to chest)
  • Severe headache
  • Vomiting

Call your doctor within 24 hours (between 9am and 4pm) if:

  • You think your child needs to be seen
  • Fever
  • Sinus pain (not just congestion)

Call your doctor during weekday office hours if:

  • You have other questions or concerns
  • Headache without other symptoms present over 24 hours
  • Sore throat present over 48 hours
  • Any headache present for more than 3 days
  • Headaches are a recurrent chronic problem

Parent care at home if:

  • Mild headache and you don't think your child needs to be seen.
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HOME CARE ADVICE

  1. Pain Medicine:  Give acetaminophen (e.g. Tylenol) or ibuprofen for pain relief (see Dosage table). Headaches due to fever are also helped by fever reduction.
  2. Food:  Give fruit juice or food if your child is hungry or hasn't eaten in more than 4 hours (reason: skipping a meal can cause a headache in many children).
  3. Rest:  Lie down in a quiet place and relax until feeling better.
  4. Local Cold:  Apply a cold washcloth or ice pack to the forehead for 20 minutes.
  5. Stretching:  Stretch and massage any tight neck muscles.
  6. Migraine Headaches Diagnosed in the Past: If your child's doctor has prescribed a specific medication for migraine, give it as directed as soon as the migraine starts. If not, ibuprofen is the best OTC drug for migraine. Give ibuprofen now and repeat in 6 hours if needed (See Dosage Table). Also, have your child lie down in a dark, quiet place and try to fall asleep. People with migraine often awaken from sleep with their migraine gone
  7. Call Your Doctor If:
    • Headache becomes severe
    • Isolated headache lasts over 24 hours
    • Headache lasts for more than 3 days despite using a pain medicine
    • Your child becomes worse

Treatment for Migraine Headache

  1. Reassurance: This headache is similar to previous migraine headaches that your child has experienced.
  2. Migraine Medication:
    • If your child's doctor has prescribed a specific medication for migraine, give it as directed as soon as the migraine starts.
    • If not, ibuprofen is the best over-the-counter drug for migraine. Give ibuprofen now and repeat in 6 hours if needed (See Dosage Table).
  3. Sleep: Have your child lie down in a dark, quiet place and try to fall asleep. People with migraine often awaken from sleep with their migraine gone.
  4. Call Your Doctor If:
    • Headache become much worse than usual
    • Vomiting occurs
    • Isolated headache lasts over 24 hours
    • Headache lasts over 3 days
    • Your child becomes worse

And remember, contact your doctor if your child becomes worse or develops any of the "Call Your Doctor" symptoms.

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REFERENCES

  1. Elser JM. Easing the pain of childhood headaches. Contemp Pediatr. 1991 Nov; 8:108-123.
  2. Feign RD, et al. Diagnosis and management of meningitis. Pediatr Infect Dis J. 1992;1:785-814.
  3. Fisher PG. Help for headaches. Contemp Pediatr. 2005;22(11):34-40.
  4. Forsyth R, Farrell K. Headache in childhood. Pediatr Rev. 1999;20:39-45.
  5. Gabis LV, Yangala R, Lenn NJ. Time lag to diagnosis of stroke in children. Pediatrics. 2002;110:924-928.
  6. Lewis D. Pediatric migraine. Pediatr Rev. 2007;28(2):43-52.
  7. Lewis DW, Qureshi FA. Acute headache in the pediatric emergency department. Headache. 2000;40:200-203.
  8. Molofsky WJ. Managing stroke in children. Pediatr Ann. 2006;35(5):379-384.
  9. Molofsky WJ. Headaches in children. Pediatr Ann. 1998;27:614-621.
  10. Rubin D, Suecoff S, Knupp K. Headaches in children. Pediatr Ann. 2006;35(5):345-353.
  11. Singer HS and Rowe S. Chronic, recurrent headaches in children. Pediatr Ann. 1992;21(6):369-73.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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