Recurrent or persistent headaches in children are a source of worry for parents and of discomfort for 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 children are evaluated for recurrent headaches, doctors have a checklist of the possible causes and perform the necessary tests or evaluations for each item on the list. This checklist includes:
- Migraine headaches 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 abscess 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.
However, before one makes a final diagnosis it is essential 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 and eye examination is necessary.
The neurological examination tells us a lot about the child’s brain and nervous system. If based on the history and examination the symptoms are worrisome, or if there are abnormalities in the neurologist’s examination, then a CT scan or MRI of the head is performed. The child may be then referred to a neurologist and/or a neurosurgeon. 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 checklist” 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 checkups.
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