• Reference Number: HEY1265/2021
• Departments: Emergency Department, Paediatrics
• Last Updated: 10 December 2021

What is a headache?

Headaches are a symptom of pain in the head or neck area and are very common in children and adolescents. Children can have headaches the same as adults, but their symptoms may be slightly different and they may not be able to describe them. Most headaches, in adults and children, are not serious and do not require tests or scans.

Headache causes

Headaches can be split into primary and secondary headaches. 

The most common type of primary headache in children is migraine. Sometimes children with migraine will have a warning sign that comes before the headache, such as vision changes, strange taste or smells, or changes to their balance. The headache can be on one side of the head or both sides.

Tension-type headaches are also a common primary headache in children. These feel like a ‘tight band’ around the head.

Secondary headaches are due to an identifiable cause, the most common of which is viral infections such as colds, sinus or ear infections. Very rarely secondary headaches are caused by something more serious, but your doctor will ask lots of questions to determine if this might be the case.

How is a headache diagnosed?

The doctor will take a detailed history from you and your child to find out what might be causing the headaches, and to see if there are triggers that can be identified. This might involve asking about problems at home or at school. A physical examination will be performed. The doctor will also ask you which headache treatments you have tried and if they have worked.

If there is nothing concerning in the history or examination, then it is unlikely that any further tests will be required. Parents often worry about their child having a brain tumour, but this is a very rare cause of headache. Your doctor will specifically consider this when they assess your child and think about whether a brain scan or other tests are needed.

Treatment for headaches

Most headaches can be treated at home. 

Non-medicine treatments: when a headache first begins, try offering your child something to eat or drink and a lie down to relax. A cool wet cloth on the forehead can sometimes relieve the pain, and if your child has tightness in their neck or shoulders, massaging or stretching these can help.

Medical treatment: often simple, non-prescription pain relief medication work best for headaches, such as paracetamol and ibuprofen. Make sure you follow the instructions on the packet. If your child is needing pain relief medication for a headache for more than 3 days please speak to your doctor, as overuse of pain relief medication can cause worsening of headaches in the long term.

Prevention: often headaches can be prevented by ensuring you child has a good balanced diet, plenty of exercise and good sleep. 

When to seek help

If your child starts to experience frequent headaches it is helpful to keep a headache diary so that when you see your doctor, they may be able to identify potential triggers. You should list activities that your child has done and foods they have eaten on each day they have a headache. You could also include how they have slept and whether they have been worried about anything in particular.

Some headaches can be serious so if you are concerned, speak to your doctor. 

Your child should be assessed by their doctor if:

• The headaches are getting worse
• They are having a headache more than once a week
• The headache wakes your child from sleep
• Your child wakes with a headache or it is worse first thing in the morning
• The headaches begin to disrupt your child’s school, home or social life
• You identify that stress is causing your child’s headaches but cannot manage it without further help.

You should attend the Emergency Department or call 999 if:

• Your child is having seizures
• Your child becomes very drowsy or difficult to wake up
• Your child becomes floppy
• The headache is associated with vomiting, high fevers, neck stiffness or rashes

Useful sources of information

The Migraine Trust has a wealth of resources on headache www.migrainetrust.org

Also see: www.nhs.uk/Livewell/headaches/Pages/Headachesinchildren.aspx

And for information on brain tumours, see: https://www.headsmart.org.uk/