Headache in children: a guide for parents

1. Headache and vomiting on waking in the morning, especially for several days in a row
2. Pain that wakes the child at night
3. Pain that becomes more frequent and stronger over weeks
4. Pain together with an unsteady walk, weakness, vision or speech problems, or a change in awareness
5. A sudden-onset, “worst of my life” pain
6. Fever with a stiff neck, or a rash
7. A new, persistent headache in a child under 5
8. Pain, vomiting or drowsiness after a head injury

If any of these is present, see a doctor the same day; for signs 4–6, call emergency services.

Migraine: it comes in attacks, often in the forehead and on both sides, with nausea and sensitivity to light and sound; the child wants to stop playing and lie down, and it passes after sleep. A family history of migraine raises the likelihood.

Tension-type headache: a pressing pain during the day, after school or after long screen time; the child can keep going with their activities.

In both cases, if the neurological exam is normal, an MRI and EEG are not indicated. The core of treatment is lifestyle and proper treatment of the attack: headache and migraine in children.

• As soon as the pain starts: a quiet, dark room, water, a light snack (going hungry is a frequent trigger), and a short nap if possible.
• A pain reliever at the right dose for age and weight (acetaminophen or ibuprofen), at the start of the attack; the “let’s wait, maybe it will pass” approach does not work in migraine.
• Pain relievers more than 2–3 times a week are a stop signal: frequent use makes the pain chronic. In that case, preventive treatment should be discussed.
• A headache diary: date, time, duration, intensity (0–10), what it started with (lack of sleep, skipped meals, screens, stress, a certain food) and what ended it. A diary kept for 2–4 weeks makes the diagnosis and the plan much more precise.

Lack of sleep and an irregular sleep schedule, skipping breakfast, too little water, long stretches of screen time without breaks, stress from school and exams, uncorrected vision problems, weather changes. In many children, simply regulating these factors makes the attacks less frequent.

The pain returns more than 2–3 times a month, makes your child miss school, pain relievers are needed often, or any of the 8 signs above is present. Come to the visit with the diary; if you have the result of an eye exam, bring that too.

This article is for educational purposes and does not replace an exam.