|: Children get headaches too
DEAR DR.PAUL: I have a nine-year-old daughter who is generally
healthy, except she gets a lot of headaches, often several a week.
This has been going on for two years. She has seen a neurologist
who did a CT scan which was normal. I can't figure out what is
causing all these headaches. Any ideas?
PEDIATRICIAN DR.PAUL Answers: Recurrent or persistent
headaches in children are a source of worry to parents and of
discomfort to the children. Assessing a child with headaches
is not as straightforward as it might seem because there are
a lot of possible causes of headaches.
These range from migraines to stress, and in rare instances,
to serious conditions such as tumors. This is why your neurologist
performed the CT scan of the head and I am reassured, as I am
sure you are, that the CT scan is normal. In some cases we cannot
find any cause for the headaches.
When I evaluate children for recurrent headaches, I go through
a checklist of the possible causes, and perform the necessary
tests or evaluations for each item on the list. This checklist
However, before I start thinking about the above list, I want
to make sure that there are no signs of a physical condition in
the brain. Clues to a tumor for example, include worsening of
headache severity and associated symptoms such as body or specific
limb weakness. A thorough physical examination including taking
the blood pressure (high blood pressure can also cause headaches)
and a complete neurological examination is necessary.
- Migraine headaches which do occur in children (there is
usually a family history of migraines)
- Recurrent or chronic sinus infections or severe respiratory
(nasal) allergies which can cause pressure and pain around
the sinus or nasal area.
- Visual problems: children who cannot see well often squint
and this is a source of headaches, so a visual screening is
a good idea.
- Another physical cause of headaches that may not be obvious
is a dental problem. Sometimes a dental abcess or a poorly
positioned tooth (particularly wisdom teeth) can cause pain
that is "referred" to the head area, so a dental evaluation
is also important.
- In situations where there is no obvious physical cause,
we must think of stress. School-related or other stress can
give a child headaches. In some instances, stress-induced
headaches can be linked to specific stresses such as exams,
new schools etc. School-related headaches, may only occur
during weekdays and not during the summer or weekends.
The neurological examination tells us a lot about the child's
brain and nervous system. If I feel that the symptoms are worrisome,
or if there are abnormalities on the neurologic examination, then
a CT scan of the head is performed. Whether a child needs a CT
scan depends entirely on the individual situation. Once the possibility
of a serious problem has been eliminated, then I proceed to the
"Headache check list" I outlined above.
The treatment of headaches in children depends on the cause, and
varies with each child and each situation. If your child has persistent
headaches, it's a good idea to keep a calendar of symptoms to
review with your doctor during subsequent check ups.
The information provided in this site is
designed to be an educational aid only. It is not intended to
replace the advice and care of your child's physician, nor is
it intended to be used for medical diagnosis or treatment. If
you suspect that your child has a medical condition, always
consult a physician.
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