When Your Child's Head Hurts

Everyone gets a headache once in a while, and kids are no exception. Usually we just hand over an appropriate dosage of acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) and forget it about it. However, if there is no sign of illness and headaches begin to interfere with a child's everyday life, it's time to seek intervention.

"Mommy my head hurts"
"Mommy my head hurts"

Before the Doctor

If a child has been complaining of frequent headaches, you should make an appointment with their pediatrician. But don't just plan to waltz in, mention the headaches and walk out with a diagnosis. There are a myriad of causes for headaches, and your pediatrician will need more information in order to get to the bottom of yours.

Start by keeping a calendar. You may have one on your wall, or in your purse, or attached to your phone. Rather than scheduling appointments, begin recording headaches. A grid calendar will work find for this. Just note "HA" and then rate the intensity on a scale from 1-5. 1 being something they felt worth mentioning but didn't ask for meds or really alter their play and 5 being something needing ER treatment. Most headaches will fall somewhere in between 2-4.

If you think there is a trigger that you just aren't identifying, keep a notebook handy and at the start of a headache (or as soon as convenient) record the time, date and a list of potential triggers. Include the weather, any arguments or concerns that your child was dealing with and what they ate at their last meal as well as the most recent snacks. It's a modified food diary. Don't read too much into it, just record your observations and instincts.

While you're recording things, write down what works best for your child's headaches. When you go to the doctor, the first thing they will ask is how frequent the headaches are. A visual calendar showing the days that were affected is much more effective than "Oh, I guess like 3 or 4 times a month."

What to Expect from the Doctor

A pediatrician seeing headaches for the first time will first need to rule out illness. No fever, no stiff neck...probably not meningitis. They'll look for congestion which might indicate a sinus infection. They should do an in office vision test, and may suggest going to an ophthalmologist for a more thorough eye test. If the headaches are persistent, they may also order a CT scan and/or an MRI. These will look for more potential causes and rule out anything scary.

When people hear MRI or CT scan they start to panic that the headache is caused by a tumor. The odds are astronomically low. The doctors are more likely to see things like plugged sinuses, or a structural anomaly than a tumor. What they are really most likely to see is nothing at all. Which tells them...that the problem isn't serious, although it needs to be pursued.

Treating a Headache

I'm not going into the variety of potential causes here (tension, sinus, cluster, migraine), although each needs a little bit of specific care, there are some things that all headaches need, regardless of the original cause.

Medication. Treat the headache appropriately, and according to the doctor's instructions. But unless the doctor says otherwise, treat it early. The sooner you start a pain medication, the quicker it sets in to block pain messages before they get too bad.

Calm down. Teach your child to take a few deep calming breaths. Close their eyes, and make a fist. Get their whole body tight and tense...and then suddenly, drop like a rag doll (safely, of course, this exercise should be done while sitting or lying on a bed or sofa.) Making their whole body tense makes them aware of any tension that is already there, and going 'rag doll' encourages them to consciously relax.

Cool cloths. Many headaches respond well to a nice, cool, slightly damp cloth laid over the eyes for a few moments. For actual migraines, sometimes it helps to place a cold cloth or ice pack on the back of the neck or the insides of the arms and wrists as well.

Sleep. When all else fails, the best thing you can possibly do for a headache is to sleep it off. That's not always easy when you are in pain, but lying in a cool, dark room and closing your eyes helps too.

Prevention

The number one best way to treat a headache is to prevent one in the first place. Teach your headache prone child to sip plenty of cool water throughout the day, and eat at regular intervals. Dehydration and 'low blood sugar' are common causes of headaches. Also try to keep to a fairly regular sleep schedule. Everyone has late nights now and then, but it's better to get up at a regularly scheduled time and then go back to bed for a mid day nap than it is to sleep in when it comes to headaches. Try extra hard to get a migraneur into bed at a reasonable hour, too. Even just an hour off of their normal bedtime can trigger an attack.

Try not to overuse medication. Although not exactly addictive, over using even over the counter medications can set the body up to anticipate and create a headache, needing more medication. These are known as rebound headaches and the only way to treat those is to go without medication until they wear off. Likewise, if you're used to too much caffeine, suddenly going without can trigger a headache. So limit the sodas and mochas in general and don't drop them cold turkey.

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Moving On

Sometimes, there is a cure for whatever is causing pediatric headaches. Sometimes they just go away on their own after a few miserable months. And sometimes they become a permanent member of the household. There's no way to predict how long your child's headaches are going to be here for or how severely they will affect your day to day family life.

The best thing you can do for your children's headaches is to teach them how to deal with them. Teach them when to try to take a pill to dull the pain and keep going, and when to call it quits. Encourage them to make simple lifestyle changes (that prevention section above) and why it's important to drink that water, or keep to their sleep schedule.

It's not easy to live with headaches, but you can move on and learn to live despite those headaches!

Please Note:

While most headaches turn out to be simple tension, sinus or stress headaches, there are a couple of red flags that should send you straight to the pediatrician or the Emergency Room. If your child is in severe discomfort, the worst headache they've ever had, and/or it comes on suddenly like an explosion, it should be evaluated immediately. If the headache is accompanied by a stiff neck and the child resists turning his or her head to the side or touching their ear to a shoulder, take them straight to the ER for evaluation. If the headache wakes them from a deep sleep and is consistently worse in the mornings, talk to the pediatrician immediately.

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