A Neurologist Explains Pediatric Headaches

Chronic headaches are common in childhood, which has a lot of parents wondering how to manage them and when to see a doctor. In a recent Stanford Medicine Children’s Health podcast, child neurologist Susy Jeng, MD, discusses the topic. She also weighs in on commonly asked questions below.

Can kids get ordinary headaches, or are all headaches dangerous?

Susy Jeng, MD

Kids can have ordinary, or primary, headaches. Primary headaches aren’t dangerous, but they can be debilitating if they cause a child to miss school or activities. Secondary headaches are headaches caused by something else and are usually accompanied by other red-flag symptoms, such as a fever, a headache that’s worse at night, vomiting, vision changes, imbalance, or other neurologic signs. It’s important to be seen by a pediatrician or pediatric neurologist if your child’s headaches are new, severe, or bothersome.

Do kids get migraines?

Yes, migraines are a kind of primary headache. In fact, 10.6% of children ages 5 to 15 have migraines, and up to 28% of teens ages 15 to 19, making it one of the top five health problems of childhood. However, they don’t always have the same symptoms as adults, such as a one-sided throbbing headache or visual changes. Often, children look very pale, vomit, or have fatigue along with the headache. There are also migraine precursors that kids can get while they’re young, and then later they develop migraine headaches. These include colic, cyclic vomiting syndrome, and benign paroxysmal positional vertigo.

Why can’t the doctor just prescribe a pill to make the headaches go away?

We try not to use medications on children unless it’s necessary. What helps more in the long run to prevent headaches is eliminating triggers and having a healthy lifestyle (which, unlike medicine, have no side effects). Sometimes a rescue medication is appropriate (Advil or Tylenol, Excedrin, Aleve), and triptan medications, such as sumatriptan and rizatriptan).

How should my child take rescue medication?

Rescue medications should be taken in the full dose right when a headache starts. However, taking too much can cause overuse headaches. I recommend giving no more than two or three days a week of the same rescue medication. If your child has overuse headaches from taking too much rescue medication, the only treatment is to stop using that medication for a period of time.

Why should I keep track of my child’s headaches?

There are often triggers to headaches, so it’s important to keep a headache diary to get a sense of what these triggers are, and to track how the headaches improve or get worse over time. Common triggers are dehydration, poor sleep, stress/anxiety, and warm weather. Certain foods can be triggers, such as processed meats, MSG, caffeine, and chocolate. The number or intensity of headaches influences what types of treatment your child needs.

What are preventive treatments?

Episodic headaches (less than twice a week) can be treated with rescue medications alone, but if headaches happen more than 15 days a month, your child should take preventive treatment as well as rescue medications. These can include vitamins and supplements (such as magnesium, riboflavin, coenzyme Q10) or prescription medications (such as amitriptyline, topiramate, or propranolol). Your child takes this every day regardless of whether or not your child has a headache. Over a period of weeks, it builds up in the body and lessens the number of headaches overall.

What are nonmedication treatments?

Nonmedication treatments are effective and can work better than medications. Many alternative treatments for headaches address triggers, such as stress and muscle tension. For example, physical therapy to stretch and strengthen the neck and shoulders, acupuncture, muscle relaxation therapy, and biofeedback can all help.

Can my child tough it out without taking medicine?

Don’t try to tough out a headache without medication. The headache pain cycle involves communication between parts of the brain and brain stem that are reinforced the longer the headache lasts. So the longer you wait, the harder it is for the headache to respond to the medication. This is also why it’s important for your child to be able to have rescue medication at school, so they don’t have to wait until they get home to take it.

How do specialists at Lucile Packard Children’s Hospital Stanford approach pediatric headaches?

We have a multidisciplinary approach, and I work closely with many colleagues, including a neurologist who offers Botox injections for chronic headaches. In our Stanford Medicine Children’s pain clinic, our pain anesthesiologists can do nerve blocks and acupuncture if needed, and there is always an evaluation by a pain psychologist to address the psychological aspects of pain. Our physical therapists have regimens that help with tight muscles and posture, and our occupational therapists are trained in biofeedback and relaxation therapy.

To learn more about how Stanford Medicine Children’s Health remains ready to provide high-quality care to our patient families, please check out the podcast.

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