Should I be concerned about my child’s headache?

Transcript

Cheryl Martin: Getting an occasional headache as an adult is usually seen as no big deal. But what if your child gets a headache, a recurring one? Should you be concerned? Here to answer that question and more is Dr. Blake Windsor, Chief of the Division of Pediatric Pain and Headache Medicine at Prisma Health. He’s also a board-certified headache specialist.

This is Flourish, a podcast brought to you by Prisma Health. I’m Cheryl Martin. Dr. Windsor, thanks for being on.

Dr. Blake Windsor: Thank you so much for having me.

Cheryl Martin: First, is it normal for a child to have recurring headaches?

Dr. Blake Windsor: I would say that it is common for a child to have recurring headaches. There are things that cause headaches, but they’re not always cause for concern just like when an adult has a frequent cause of a headache. And in just like most adults, those headaches can either be due to tight muscle tension. They could also be things like migraines. The trick is knowing when that headache is a sign of something else that’s occurring in the brain or in the head that requires further evaluation and further treatment.

Cheryl Martin: So how would a parent know that?

Dr. Blake Windsor: Well, fortunately, in the body, very few things cause pain by itself, or at least very few dangerous things cause pain by itself. So for instance, if an adult were to have a stress headache or a muscle tension headache, it’ll normally have some feeling of tightness around the temples and just caused pain without really any other symptoms that would be concerning. What we call a benign or a primary headache in a child will be the same. It’ll be a headache without any other scary red flags. Now, that’s in contrast to a headache that might occur with a fever or a headache that might occur with a seizure or a headache that occurs with slurring speech or weakness that occurs in a specific part of the body. Those are all much more concerning.

Now, fortunately in children, those are also very rare. And with those more dangerous causes of headache, they tend to be progressive, which means that it might start off as a mild headache. And over the span of days or weeks or months, they get progressively worse instead of a headache that comes and goes over the span of months, which is what we call more of a recurring headache instead of a progressively worsening headache.

Cheryl Martin: What typically causes these headaches?

Dr. Blake Windsor: Well, statistically, they are either muscle tension, headaches or migraines if you’re dealing with a child who is about school age and up. But again, it just depends on the context of what’s going on with these headaches. The younger a child is, you know, we’re talking two years old, three years old, the higher the risk that it is due to a more dangerous cause of a headache. Some of those causes can include the way that the skull is formed. And as the brain and skull is growing, it can impact parts of the brain. You can also start having brain tumors at around those ages or other genetic causes of headache disorders. So those younger children definitely need to be evaluated more thoroughly to understand if there is any additional or more dangerous cause for those headaches.

Once you start getting to school age years, you can still have those more dangerous causes of headaches, but it starts to flip in that the more common causes like migraines and muscle tension headaches are by and large the more common causes of headache starting at that age range. And I mean, we’ll go so far as saying that about 5% of all school-aged children will get migraines. So one out of every 20 school-age children can experience migraines and that increases as they get older, particularly into teenage years where it’s about the same frequency as it occurs in the adult population, which is again about 5% of males, but up to about 20% of females having a condition like a migraine.

Now, with muscle tension headaches and migraines, at least the data that I’ve seen, is that about 80% of people will have tension-type headaches, which I’m always kind of surprised that it’s not 100%. I want to know who those 20% of the people are who’ve never had a muscle tension headache. But in adult females, it’s about 20% of women have a migraine disorder. And in teenage years, that starts to approach that. So we’re looking at maybe 15% to 20% of teenage females having a migraine condition, which is a lot. I mean, that’s one out of every five, one out of every six teenage females having a migraine. And migraines by definition are a moderate to a severe headache. So, that’s quite a number of children who are being impacted in a substantial way by these what we call primary headaches because we say the term benign, meaning it’s not dangerous, but it can certainly affect somebody’s life in a really dramatic way, as I think only people who experience migraines will know.

Cheryl Martin: So, how would you, as a parent know if your child is having a migraine versus a tension headache?

Dr. Blake Windsor: That’s a great question. And you need to rely on the child in some ways to give you that information. So the way you would know in a school-aged child, you know, a kindergartner or a second grader is very different than how you would in a teenager. With all things in pediatrics, you know, we have to be a bit of detectives and we have to be able to observe. We have to oftentimes use our best guess and see how the child is responding. With migraines in that age range, you can see it on their face. So parents will often report that their kid looks like they’re getting sick. They’re getting these glassy sick eyes, or they’re getting darkness underneath their eyes, or they’re getting pale. They’re more likely to have vomiting with migraines when you’re in this age range compared to older teenagers or adults where they might just feel sick to their stomach, but not actually throw up. Migraines often will also typically slow someone’s activity. So if you’ve got a six-year-old rambunctious boy who says that their head hurts and they want to go lie down on the couch, that’s probably a migraine because it’s going to take something like a migraine to take that active six-year-old boy and make them want to lie down. So behaviors like that will be the first clue.

The second thing is, and this is a little bit more on the physician side of it, but when a parent is concerned enough about the cause of a headache that they’re bringing in the child to their doctor with the main complaint being a headache, It’s almost always a migraine. A muscle tension headache will be something like they come in for a well visit or they’re coming in for a cough, and a nurse or a doctor says, “Oh, by the way, does your child have headaches?” And you might say, “Sure, they have headaches, but that’s not why I brought them here.” But when it’s concerning enough to the parent, it’s probably a migraine.

Cheryl Martin: I have often described a migraine, and is this correct? It’s pounding. It’s like a pounding, intense headache. Is that correct?

Dr. Blake Windsor: That is correct. So there is no objective test, meaning an MRI, a CAT scan, a blood test that will tell you that something is a migraine. We rely on these diagnostic criteria and there’s four main ones. And one of them is that sensation you just described, which is a pounding or a throbbing. And children, they sometimes don’t have the language to describe things like that. So sometimes I’ll ask them, “Does it feel like your heartbeat in your head?” And that can be a helpful way that they can understand and characterize it. Those other features are that it’s a moderate to severe level of headache. It gets worsened when you move or it makes you want to stop moving and lie down. And it’s typically one-sided in an adult. But in the child’s brain, it can be certainly both sides of the head.

Cheryl Martin: Do you know what triggers migraines in children?

Dr. Blake Windsor: It’s different for everybody. So that’s part of treating migraines and the best way to treat migraines and children is to identify what those individual treatments are. The more that we study migraines in children, the more that we realize that like a one-size-fits-all approach doesn’t really work that well. So some of the common causes of migraines in children are not drinking enough water, skipping meals and letting their blood sugar drop, stress, anxiety, bad sleep. All those are the major triggers in kids.

Cheryl Martin: Can migraines in a teenager be connected to PMS, menstruation?

Dr. Blake Windsor: Oh, absolutely. It can either be connected in somebody who never gets migraines outside of their menstrual cycle, or it can be someone who frequently gets migraines and it gets worse during menstrual cycles. And that’s an important distinction, because the treatment’s different. Probably what goes on in the brain is a little bit different. We would say one is called a menstrual migraine, meaning you only get it during menstrual cycles or around that time. Or you can have just migraines with a menstrual trigger, which means that it is one trigger amongst a few other triggers.

Cheryl Martin: So what treatments for chronic headaches are safe to use with children before you go to the doctor?

Dr. Blake Windsor: The best thing that I could recommend a family do is to play detective a little bit. And now, unlike with an adult migraine, where people are often looking at a very specific dietary trigger, like some people will say that red wine might trigger a migraine or chocolate or something along those lines, with kids, it’s less likely tied to a very specific dietary trigger and it’s more related to their overall healthy habits. So an important thing that can be done is just to try to keep track to the best of somebody’s ability, what those possible triggers may have been. So was it a bad night’s sleep the night before? Has there been a little bit more stress with upcoming exams or standardized testing? Is there a little bit of separation anxiety in a younger child? And does it seem to be related to events like going to school or change in routine at home? Just doing everything you can to draw those links.

Now, sometimes it can be quite challenging to figure this out because, with migraines, it rarely happens in isolation. Some people can have migraines and not have anything else going on. But for children who have migraines, they often have other disorders, either developmental or behavioral disorders that can go along with it. So for instance, about 30% of children who have migraines also have an anxiety disorder. It’s not all of them, but it’s a higher percentage than the general population of children. About 20% will have other family stressors going on, such as a history of parent divorce, a history of, you know, just other things that have occurred in the family that might have contributed to stress in the child. There’s about two to three times the rates of attention or ADHD problems in kids who have migraines and also with learning disorders.

So, there’s a lot of things that can occur that the parent might have a hard time teasing apart. But you know, to the best of their ability, they should try to come in to the doctor with as much information about what the possible links are.

Cheryl Martin: And I’m glad you brought that up. So at what point should the parent bring the child in to the doctor or maybe even going to the emergency room?

Dr. Blake Windsor: Yeah. So, a lot of times, I start to counsel parents about the causes of scary headaches and when to go to the emergency room. And honestly, it really comes down to the things that would scare most parents are the scary things. So for instance, are you worried your child has a headache and a seizure? Are you worried that your kid is having fever and is not acting themselves? Is your kid dropping things or having fainting episodes? I mean, those are the things that would scare any parents. So it would be very normal to bring them to the emergency room.

But just coming to your general doctor is when sometimes parents have a harder time drawing that line. They’re not so scared that they need to bring them urgently in the middle of the night, but they do want it to be checked out. And you should have it checked out in, I would say, one of two circumstances. The first one is if the headache is really interfering with life. So meaning that the child is missing out on activities, on school, on interactions with friends because of the headaches. And the second one is when the headache is progressing. So it started off maybe three weeks ago with a mild headache. And now, every day it’s gotten progressively worse and now we’re dealing with a more moderate to severe headache that definitely needs an evaluation.

I’ll tell you that the headaches that come and go over the span of months to years tend to be the more common causes, migraines, tension-type headaches. The ones that started someone says, “My headache started three weeks ago and it’s getting worse day by day,” those are the ones that we need to be acting faster on to get an understanding and a diagnosis as to what’s causing the headaches.

Cheryl Martin: Anything else you’d like to add on this? Any final thoughts on this topic?

Dr. Blake Windsor: The only thing I’d like to add is that the best treatments for children with migraines are actually non-medication-based treatments. So, they are trying to understand what are the triggers what are the other disorders or other things that might be going on in the child’s life, whether it’s someone could come to see me for headaches. And then, we find out that the problem is sleep apnea, right? So a lot of helping children with their headaches is just being a good general doctor or a good general detective to try to optimize a lot of things that are going on in life.

Sometimes we do have to start medicines to try to prevent them. But the other thing that’s most important is having a really good plan for knocking out the headache when it occurs. And that is one of the most important issues to help promote a kid’s wellbeing overall, is that you have an effective rescue plan when a bad headache does occur.

Cheryl Martin: Is it safe for a parent to give the child some of the headache medicine over the counter that that parent uses when he or she has a headache?

Dr. Blake Windsor: Oh, absolutely. The anti-inflammatories like ibuprofen and Naproxen have better evidence to support their use than say, like acetaminophen or Tylenol. So if reaching for that, that’s where I would recommend going first. The medicines like triptans, sometimes parents will have those medicines for themselves because migraines often run in families, shouldn’t be used for a child without seeing a doctor first. but those are prescription-based medicines, which isn’t necessarily what you asked about, but I just thought I would chime in with that.

Cheryl Martin: Dr. Windsor, thanks so much for answering the questions that any concern parents would have if their child is experiencing recurring headaches. That was Dr. Blake Windsor, Chief of the Division of Pediatric Pain and Headache Medicine at Prisma Health. He’s also a board-certified headache specialist. for more information on other topics, visit PrismaHealth.org/Flourish. Thanks so much for listening to Flourish, a podcast brought to you by Prisma Health.