Chronic Headaches Can Cause Psychological Problems in Kids

“My head hurts.” Like many parents, we occasionally hear this complaint from our children. We offer our sympathy, a beverage, a snack, a comfortable place to rest, and--sometimes--a child’s dose of acetaminophen. Almost always, the symptoms quickly pass.

About 60% of all school-age children have had a headache. For these children, the conservative “treatment” described above is the best approach. But about 20% of children suffer from frequent headaches, from a few times a month to every day. For them, the headaches can cause not only severe pain, but also missed school days and significant social and psychological problems.

In such instances, a casual approach is not appropriate; an accurate diagnosis is essential to treat recurrent headaches and prevent future ones.

The two most common types of chronic or recurrent headaches are the same as those experienced most frequently by adults: migraine and tension headaches. They differ significantly in what causes them and in the way they should be treated.

There are two forms of migraine headaches. The “classic” migraine (or migraine with an aura) is preceded by a warning period, during which a child may complain of visual disturbances, such as blind spots or flashing lights, or unusual sensations of smell or touch. The other form of migraine, migraine without aura, is not associated with these warning symptoms.

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Debilitating Affect of Migraines

In all other ways, the two forms of migraine are quite similar. The pain is typically described as “pounding” or “throbbing “ and can last anywhere from one hour to two days.

The pain of a migraine headache is so severe that 50% of children cry during a migraine attack, and more than 95% are forced to lie down and withdraw from their normal activities. Although the pain usually involves only one side of the head, it can (particularly in children) affect both. During a migraine attack, a child may be extremely sensitive to light or sound and may complain of abdominal pain or nausea.

The cause of migraine headaches is not fully understood but may be related to temporary changes in blood flow within the brain. Imbalances in certain brain chemicals, particularly serotonin, are likely responsible for producing these changes.

A variety of things can trigger the reaction that leads to a migraine headache, including stress and other psychological factors. For example, in children, anxiety about an impending school examination or excitement over a social event or athletic competition can set one off.

More tangible factors, such as loud noise, bright light, strong odors or extreme temperatures are also known to trigger migraines. Missing a meal, not getting enough sleep, getting too much sleep and a sudden increase in physical activity have also been implicated.

In some children, specific foods can be responsible. (Kid-friendly foods that can be problematic include chocolate, yogurt, nuts, citrus fruits and bananas, pizza, smoked and processed meats such as bologna, pepperoni and hot dogs.)

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The Nature of Tension Headaches

A tension headache tends to be less severe than a migraine but can be just as disruptive to a child’s life. The pain, which typically affects both sides of the head, is often described as a “steady ache.”

The muscles of the face, scalp and neck contract causing head and neck pain. In most children with tension headaches, the episodes occur relatively infrequently and with no particular pattern. However, some youngsters can experience this type of headache on a regular (even daily) basis.

Just as for adults, emotional factors play a major role in the development of tension headaches.

Any problem--whether at school or at home--can create stress that causes the muscles of the head and neck to tighten up, leading to pain.

It’s important to note that recurrent headaches in children can also be caused by simple things such as poor eyesight (usually cured by eyeglasses) and occasionally by such serious medical problems as brain tumors and meningitis.

For this reason, any child who has recurrent headaches--or even a single severe headache that does not resolve after treatment with simple analgesics--should be evaluated by a physician.

Determining the cause of chronic headaches in children usually does not require complicated or expensive testing.

Typically, the diagnosis can be made with only a detailed medical history and a thorough physical examination. If any nervous system abnormalities are found during the exam, or if the child’s history suggests that an underlying medical problem may be responsible for the headaches (for example, a history of seizures or “blackouts”), the doctor will order more elaborate tests to determine the cause.

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To Prevent Pain, Avoid Triggers

The best way to prevent headaches is to avoid the things that trigger their start. However, that can be harder to do than it sounds. Triggers differ from child to child, and sometimes it’s difficult to pinpoint the culprit.

Many parents find it helpful to keep a headache diary for a few weeks, documenting all of their child’s headaches along with any physical, dietary or psychological factors that may have set them off.

Simply maintaining a regular schedule at home can often be helpful in reducing the frequency of headaches.

Select a reasonable bedtime and stick to it to assure that the child gets enough sleep; establish a set schedule for meals and snacks to prevent the child from going too long without food. Develop a homework routine to avoid stress, and keep extracurricular activities in check to allow for down time.

If prevention strategies don’t eliminate the headaches, medications may be needed to control the pain and permit the children to do the things they normally do. The type of medication will depend on the type of headache and the degree of pain.

Although jokes abound about the way adults use headaches to escape unwanted tasks, it’s important that parents not jump to the conclusion that their child is using them this way.

In most cases, the symptoms are real and should be treated with the same seriousness and sympathy that any other chronic illness would receive.

For additional information, contact the National Headache Foundation at (888) NHF-5552 or www.headaches.org.

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Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. Their column appears the second and fourth Mondays of the month. Send questions by e-mail to ourhealth@dhs.co.la.ca.us. They cannot respond to every query.