Health & Exercise Forum

Headaches in Children: Part 1 of 2

Special Feature “Health & Exercise Forum” with Geisinger Commonwealth School of Medicine, the 3rd Monday of every month!

Kelley German, MD3

Guest Columnist: Kelley German, MD3

Kelley German, MD3 is a third year medical student at Geisinger Commonwealth School of Medicine. She is originally from Pittsburgh, PA and graduated with a Bachelor’s of Science from the University of Notre Dame with a minor in Science, Technology, and Values. Kelley is interested in children’s health and wellness.

Parents, have your children ever complained to you, “Mom, Dad, my head hurts.” You are not alone. In fact, one of the most common chief complaints in the pediatric population is a headache. By age eighteen, more than 90% of children report having a headache. There are many reasons a child may be having a headache, some of which are more serious than others. As a parent, you should know what symptoms warrant a visit to the emergency room versus a visit to your pediatrician’s office.

Medically, we define headaches as primary and secondary headache disorders. Primary headache disorders include migraines, tension-type, and cluster headaches. Migraines are characterized by a throbbing pain that worsens with activity and may be accompanied by nausea, vomiting, light or sound sensitivity. Tension-type headaches present as a diffuse, non-throbbing pain that does not worsen with activity and is not associated with vomiting. Cluster headaches are associated with symptoms such as teary eyes, runny nose or redness of the eyes. If your child is having these symptoms, be sure to call your pediatrician so that your child can be evaluated and receive the appropriate treatment.

Secondary headache disorders are caused by an underlying condition. Some of these underlying conditions include the common cold, post-traumatic head injury, visual problems, medication side effects, meningitis, brain tumor, intracranial high blood pressure or bleed. These causes often warrant a thorough physical exam in addition to a complete medical and social history. If there is an abnormal finding on physical exam, your pediatrician will determine whether or not more testing is needed to diagnose your child.

Conditions Associated With Headaches:

1. Strep Throat: Many parents think a strep infection must present with a sore throat, however, it can actually present solely as a headache and therefore must be evaluated in order to receive the appropriate antibiotic treatment.
2. Teeth Grinding: This is another common cause of headache symptoms in the pediatric population. If you notice your child grinding his or her teeth at night and experiencing headaches, inform your pediatrician. Typically a mouth guard is all that is needed to resolve the headache.
3. Sinusitis: Headaches caused by sinusitis are often misdiagnosed. Sinus cavities do not fully develop until puberty, thus sinusitis headaches are extremely uncommon in a patient below that age.
4. Vision Problems: Children and adolescents with poor vision can also experience headaches from squinting hard in an effort to clearly see the white board or when reading. Be sure to see your eye doctor for an eye exam on a regular basis.
5. Concussions: Another topic involving headaches worth mentioning is traumatic brain injury or a concussion. After a concussion is diagnosed, it is critical that a child not resume physical activity until fully recovered. Post-concussion syndrome is diagnosed when patients have persistent concussion symptoms despite adequate rest period. When the diagnosis is suspected, a referral is usually made to a specialist.

A key aspect of diagnosing headache disorders is being able to obtain a full history regarding the headache. This is why it is important for pediatric patients and their parents to come to appointments prepared with all the necessary information. Many headache specialists recommend keeping a headache diary. Parents should write down at what time of the day their child’s headaches occur, the intensity of the headache, any associated symptoms, what if any intervention was taken and if that intervention was effective in relieving your child’s headache. Use a pain scale of 1 to 10 (0 representing no pain and 10 being emergency room pain), to describe the intensity of the headache. Parents should also note what their child is doing when the headache begins, including the child’s diet because headaches can oftentimes be triggered by certain foods.

After creating this headache diary, make sure to inform the pediatric office why you are making the appointment and request extra time for the appointment so your doctor can appropriately discuss, examine and assess your child’s symptoms in order to create a treatment plan. You should not wait for all headaches to be evaluated by your pediatrician. Oftentimes, time is critical and a child with a headache needs immediate medical attention. If your child is experiencing any of the following symptoms, he or she may need further medical evaluation:

• Loss of consciousness
• Confusion, memory loss or unusual behavior
• Nausea or vomiting
• Shallow breathing
• Double vision or pupils that are not responding to light

These are all signs of increased pressure surrounding the patient’s brain, which could be caused by a number of causes including a bleed within the brain, meningitis or a brain tumor. Headaches can present in a variety of ways and range in severity, duration, and associated symptoms. Approximately twenty percent of children from ages four to eighteen report having frequent or severe headaches in the past twelve months. It is important to make sure your child receives the appropriate medical attention based on symptoms. Hopefully, the more aware parents are, the better health care professionals are able to care for your child.

Medical Contributor: Lori Shipski, MD, PA-based Locum Tenens pediatrician with special interest in headaches, asthma, and smoking-cessation.

Read Dr. Mackarey’s Health & Exercise Forum – every Monday. ***Next week will discuss two additional common causes of headaches in children and adolescents... poor posture and stress………..

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine.