Children's Headache Disorders

When you think about someone having a headache, you probably think of an adult. But many kids have headaches, too, and for some of the very same reasons that adults have them.

Children and teens can experience tension-type or migraine headaches. Among school age children ages 5 to 17 in the U.S., 20 percent (10.3 million) are prone to headaches. Approximately 15 percent of these kids experience tension-type headaches and 5% are coping with migraines.

Chronic or frequent headaches can be tough to handle — and are even harder to understand when you are young — especially if you do not know anyone else who has them.

Goals

By the time they reach high school, most young people have experienced some type of headache. Fortunately, less than 5 percent of headaches are the result of serious disease or organic problems, such as a tumor, abscess or head trauma.

Most headaches are tension-type, the result of good and bad stress, sleep issues, or, in a few instances, environmental or food triggers. About 5 percent of recurrent headaches will be diagnosed as migraine.

Episodic headaches are those that occur a few times a month at most.

Chronic headaches occur with much more frequency, several times in a week. If, a child who has only had an occasional headache (once or twice a month) starts experiencing them more frequently (two, three or four times a week), then these should be considered chronic and medical attention should be sought as soon as possible. (Also refer to "Organic Headaches.")

One of the most frustrating aspects of chronic headaches is the stress factor. Avoiding a known trigger is usually easier than avoiding stress. Young people want to do well on tests and in school, and they want to attend important events. But anticipating a math quiz or musical recital, or eagerly looking forward to a party or being in the school play, can result in anxiety or excitement. And, for some kids, this leads to a headache.

Up to 4 percent of children do have their first headaches before they reach elementary school, and they may not yet know how to describe pain. If a young child has been crying or not eating, or has been inexplicably restless or irritable, consult with your doctor about finding the source of discomfort or pain.

The more school health professionals and educators, as well as parents, know about children and headaches — their triggers, symptoms, prevention, and treatments — the easier it will be to identify them and help kids live with them for a full and rewarding life.

Overview Migraine

Most kids who have migraines have inherited them. Approximately 5 percent of kids experiencing chronic headaches will be diagnosed with migraines. Some children have them as early as four years old. Prior to puberty, boys are slightly more likely than girls to get migraines. However after puberty, because of hormonal changes, migraines are twice as common in girls.

Migraine is frequently referred as a vascular headache; however, this is a misnomer because the blood vessels are not the primary problem. The primary cause of migraine is an electrical wave that spreads across the brain that leads to changes in blood flow and promotes inflammation.

Where do the blood vessels come in? The brain itself cannot sense pain so the pain felt in migraine actually comes from the other structures in the head that hurt, the blood vessels. The electrical wave sets up a cascade of inflammation that aggravates the blood vessels, which in turn triggers nerve cells to communicate back to the brain that there is head pain.

Symptoms of a Migraine

In adults, migraine's throbbing head pain usually occurs on one side of the head, but in children it can affect both sides. The migraine is often accompanied by nausea, vomiting, dizziness, blurred vision, sensitivity to light and sound, and changes in temperament and personality. A headache's duration varies from individual to individual. But, generally, unlike an adult's migraine, which can continue up to four days, a child's migraine might be as short as one hour or may last for a day or so. Children also improve more readily to sleep. So, the best treatment for children is a nap in a quiet, dark room.

About 15 percent of kids experience a migraine headache with an aura. A typical aura is seeing colored or flashing lights, blind spots, or wavy lines or feeling a tingling in the face or arm/leg. An aura alerts a migraine sufferer to the onset of a headache, warning the kid several minutes before the pain starts.A small percentage of migraine sufferers also encounter temporary motor weakness: they may lose their sense of coordination, may stumble, or may have trouble expressing themselves.

Young children with migraine may not have head pain at all but rather experience recurrent stomach problems or dizziness. These types of migraine are called migraine variants. Children who have or may develop migraine also are more prone to motion sickness.

What causes a migraine? For most kids, migraine is inherited from a parent. Migraine occurs because of alterations in a person’s genetic makeup.  An individual migraine attack is often triggered by a particular environmental or emotional event.  In some cases, triggers can be identified. Among the most commonly recognized ones are: good and bad stress, a change in routine or sleep pattern, bright lights or loud noises, or certain foods and beverages.

After a formal diagnosis, a doctor's goal is to help reduce or eliminate the symptoms of a migraine and prevent future attacks.

Identifying the Triggers

For many kids, migraines are aggravated by one or more external triggers. It's important to identify which ones apply to the child with headaches because avoiding the triggers can reduce the intensity and frequency of migraines.

Stress, good or bad:
Help alleviate stress through exercise, enough rest and sleep, and enjoyable activities and hobbies. Many people find they can reduce the impact and duration of a migraine by learning biofeedback techniques to control stress.

Regular eating times:
Never skip breakfast, and eat three balanced meals. Skipping meals lowers one's blood sugar level and can cause migraines. It’s also a good idea to carry a snack just in case a long time goes between two meals.

Caffeine:
People hear different things about caffeine as it relates to headaches. Caffeine can be helpful or harmful. In small amounts used for a migraine attack it can help stop an attack, that’s why caffeine is a common ingredient in over-the-counter headache medicines.

However, if your child is consuming a lot of caffeine in a day this can lead to rebound headaches. And if your child suddenly stops taking in caffeine after consistent use, this can lead to withdrawal headaches. It is important to note sources of caffeine in a child’s diet. Common sources include sodas (even diet), energy/sports drinks, and chocolate. Don’t forget to look at the medication he/she is taking for headache because it may also contain caffeine. Overall, a small amount of caffeine is probably not harmful but it’s best to try to keep it at a minimum or for special occasions.

Food:
For a few migraine sufferers, certain foods or additives can trigger a migraine: aged cheeses, pizza, luncheon meats, sausages or hot dogs containing nitrates, chocolate, yogurt and MSG (monosodium glutamate) usually used in Oriental foods.

Routines:
Try to maintain a consistent sleep, meal, and exercise routine throughout the year, even when travel, special events or illness might interfere.

Sleep:
A full night’s sleep is very important for the health of every child and particularly in those with migraine. Children usually need at least 8 to 9 hours of sleep at night and adolescents may need even more. As electronic devices become more prevalent they have lead to distractions during bedtime. Your child’s room should be a place only to sleep. Television, computers and phones should be off or removed from the bedroom.

Poor and disrupted sleep is a common complaint in children with headaches. Sometimes difficulty breathing at night — sleep apnea — can be an unnoticed trigger for headache. If your child snores, wakes up frequently or is very tired during the day, regardless of amount of sleep at night, it’s important to raise these issues with your doctor.

Ovulation and Menstruation:
Hormonal changes can trigger migraines or increase their frequency. Also, headache is a common side effect of birth control pill use.

Treating a Migraine

Treatment without Medication

Sometimes children, especially young children, do not need any medication to treat a headache. Often there are non-medication treatments that, used with medication, can provide added benefit.

During a migraine attack, a child should be allowed to rest, and even sleep, in a quiet, dark and cool room. Raising the child’s head up on a pillow and providing a cool compress for the eyes or forehead can help them feel more comfortable. When at school, a child should be allowed to go to the nurse’s office and rest. Sometimes a quick nap is all it takes and they can return to the rest of the school day.

Trigger avoidance and a regular schedule are preventive measures that can be taken to avoid the frequency of attacks. Often it is helpful to keep a diary of how often headaches are occurring to try to identify potential triggers and spot patterns.

Relaxation and stress management techniques can be helpful during an attack and to help alleviate stress before it triggers an attack. Daily physical activity is also very important in headache management and stress reduction. Two methods that have been well-documented to help children with migraine include meditation and biofeedback:

Relaxation techniques - such as deep breathing exercises, progressive muscle relaxation, mental imagery relaxation or relaxation to music - can be very effective in alleviating a migraine headache.

Biofeedback - Painless sensors connected to your body, monitor changes in several physical functions - including muscle tension, blood pressure and heart rate - and display feedback on a computer screen. While being monitored, a child or teen tries his or her preferred approach to relaxation and watches the screen to see if the technique produces the desired physiological changes...such as reducing tension and alleviating a headache. A biofeedback therapist also helps a kid learn to recognize the signs of tension, and teaches him or her, the physical skills that can release and control the tension.

Medications

Once a migraine has begun, several types of medication can alleviate the symptoms.

Analgesics, such as acetaminophen or ibuprofen, are first-line pain relievers for treatment of headaches in children and adolescents. Triptans can be helpful in those children who don’t find simple analgesics helpful. There are several different triptans available and two (almotriptan [Axert] and rizatriptan [Maxalt]) are FDA-approved for children. In addition, your doctor may also prescribe antiemetics to stop the nausea and vomiting or a sedative to help a child rest.

(There seems to be a link between children taking aspirin and their developing Reye's Syndrome, a rare disorder that children and teenagers can get while they are recovering from childhood infections, such as chicken pox, flu, and other viral infections. Reye's Syndrome symptoms include nausea, severe vomiting, fever, lethargy, stupor, restlessness, and possibly delirium. Therefore, aspirin is not a recommended analgesic for children and adolescents.)

Children and adolescents who experience migraine attacks more than twice a week and which interfere with school or social activities, may be prescribed a daily medicine to try to prevent headaches. There are no medications that have been specifically designed for migraine so they all come from other categories including anti-seizure, blood pressure and anti-depressant medications. Common preventive medicines include propranolol, tricyclic antidepressants, topiramate, and valproate. Please note: none of these medications are approved for migraine treatment in children. However, research in this area is ongoing.

Frequent headaches, especially those that occur more than once a week, deserve treatment — both medication and non-medication — options.  Headaches are not good for the brain and headaches often lead to more headaches. With the right treatment regimen your child can get his/her headaches under control and prevent further progression.

Abdominal Migraine or Cyclic Vomiting

Most children's migraines are also accompanied by some abdominal discomfort or pain, vomiting and nausea. A relatively small percentage of kids, however, do not experience the headache part of the migraine. Instead, they have cyclic vomiting or cyclic abdominal pain and other cyclic gastrointestinal symptoms.

Abdominal migraines include abdominal pain, vomiting, diarrhea and nausea. Cyclic vomiting is seen in some young children with strikingly high frequency vomiting — up to 10 times an hour. These symptoms, lasting from one to two days, can be misleading. Initially, adults may think their kids have the flu or have eaten something that disagreed with them. If the symptoms persist and regularly return, they should be discussed with a physician. After medical tests have eliminated other possible problems and abdominal migraine or cyclic vomiting is formally diagnosed, parents can often predict the next occurrence and a treatment plan can be put in place.

Treating the Abdominal Migraine

Several of the migraine preventive medications have been used in abdominal migraine and cyclic vomiting syndrome including cyproheptadine and propranolol.

Migraine Variants

In addition to cyclic vomiting or abdominal migraine, there are other less common forms of migraines that can affect children.

Hemiplegic Migraine
This results in weakness of the arm or leg on one side of the body. This can occur before, during or after the actual headache. The weakness usually resolves itself within 24 hours.

Ophthalmoplegic Migraine
Occurring in children or young adults, this rare headache affects the third nerve and results in drooping of the eyelid, dilation of the pupils and paralysis of the eye muscles along with a severe headache. It may last for weeks.

Basilar Migraine
This refers to a particular subset of migraine with aura that includes vertigo, change in hearing, sleepiness and weakness or sensory symptoms on both sides of the body.

Paroxysmal Vertigo
This syndrome occurs in children between 2 and 6 years of age. The episodes are sudden, intense and last only a few minutes, and the primary symptoms are the inability to maintain equilibrium, dizziness, and feelings as if the room is spinning around.

Paroxysmal Torticollis
This very rare disorder results in a child's neck being turned and head inclined to one side. Occurring in infants and young children, this migraine variant can also be accompanied by nausea and vomiting. Episodes may last from a few hours to a few days.

Confusional Migraine
Some children do have more dramatic auras that can include change in level of consciousness, confusion and even bizarre visual illusions and spatial distortions associated with their migraine headache. These symptoms can be prolonged, lasting for many hours. Any child that has headache and the above symptoms should always be evaluated by a physician to ensure no more serious underlying cause can be found.

Tension-Type Headaches

Tension headache is the most common cause of recurrent headache in children. However, tension headaches are mild headaches that respond well to medication and rest, so often they do not come to the attention of a doctor. There are two versions of the tension-type headache, episodic and chronic. The episodic headache can occur several times a month, while a chronic headache can occur almost every day.

Symptoms of a Tension-Type Headache

Episodic tension-type headaches produce a mild-to-moderate pain, sometimes described as a pressure or band around the head. Episodic headaches often occur in the middle of the day, begin gradually and can last from 30 minutes to all day.

Chronic tension-type headaches, on the other hand, seem to be always present. They usually produce a dull throbbing around the front, top and sides of the head, the constricting band sensation, aches, and soreness. Some kids will be bothered by sleepless nights and will awaken earlier than they would like.

A child's tension-type headache is frequently caused by tension or stress, depression, or insufficient rest. Tension-type headaches do not have the hereditary factor that migraines do, and they are not caused by organic problems or serious diseases.

The first step toward effective treatment is a correct diagnosis by your child's pediatrician or family physician.

Identifying the Triggers

Tension-type headaches are triggered by emotional stress related to family, school or schoolmates, or friends.

• Problems and tension at home

• New brother or sister

• Parents who are either too strict or demanding, too permissive or inattentive

• Self-image, such as being overweight

• Being made fun of by other children

• No close friends

• Insufficient or irregular sleep

• Going to a new school

• Learning difficulties

• Competing in activities or sports

• Pressure to be an "A" student

• Too many extracurricular activities

• Tests and exams

• Death or separation from a loved one, e.g., a sibling going away to college or the death of a grandparent)

It is important for kids, their parents and school health care professionals to learn to identify the stressful situations or events that trigger tension-type headaches. Once the triggers are identified, adults can help the child develop ways to cope, or can help either eliminate or reduce some stressful activities.

Treating the Tension-Type Headache

Treatment without Medication

Medications are helpful, but there are other ways to relieve and even stop a tension-type headache. These strategies include an ice-pack on the painful area of your head, a nap, a walk, or warm bath or shower neck massage. Or, while resting in a dimly lit room, try to release the tension in your head and neck area through progressive relaxation techniques and exercises.

Stress Management

Medications and non-medication treatments are very effective, but they are not substitutes for learning to recognize stressors. Once headache sufferers understand their headaches, they can develop ways of dealing with them.

Counseling

Counseling helps a child or adolescent better understand and appreciate his or her personality and nature - can help kids and families identify stressful situations and then learn how to manage them. Counseling can come from several sources: Family physician, pediatrician or pediatric neurologist; school health care professional; school or private practice social worker; or psychologist. Talking freely and confidentially with an objective professional can help a child or teenager successfully manage stress.

Relaxation techniques

Techniques such as deep breathing exercises, progressive muscle relaxation, mental imagery relaxation or relaxation to music -- can be very effective in reducing or eliminating the tension that produces a headache.

Biofeedback

Painless sensors, connected to the body, monitor changes in several physical functions including muscle tension, blood pressure and heart rate - and display feedback on a computer screen. A biofeedback therapist will help a child or adolescent learn to recognize the signs of tension, apply a relaxation technique, and teach him or her, the physical skills that can release and control the tension. Biofeedback can help a kid reduce tension and alleviate headaches.

Medications

Over-the-counter medications are very helpful in relieving the symptoms of either episodic or chronic headaches. Your physician might suggest acetaminophen (Tylenol®), ibuprofen (Advil®) or naproxen sodium (Aleve®). Remember these medications are safe to take every once in a while. However, these medications can have side effects if taken frequently or on a long-term basis including stomach, liver and kidney problems. If you find you’re giving your child medication more than twice a week it is a good idea to talk to your doctor about other treatments including the non-medication based treatments discussed above. Generally, children under 14 are not advised to take aspirin because of its connection to Reye’s syndrome. (Refer to the explanation of Reye's in the previous section on migraine headaches.)

Prescription medications might be recommended as preventive therapy to reduce the frequency and severity of chronic tension-type headaches. Some preventive agents such as amitriptyline have been shown to be helpful.

Organic Headaches

Fortunately, less than 5 percent of children's headaches are the result of serious disease or physical problems, such as an abscess, head trauma, tumor, blood clots, intracranial bleeding, or bacterial or viral meningitis. Nevertheless, your physician will want to rule out organic causes.

Fever

A fever may produce a headache, which can be the result of the "flu" or a bacterial infection. A fever, headache and neurological symptoms together can also signal a central nervous system infection. But, on a rare occasion, a high fever and headache combination is the sign of meningitis or encephalitis, especially if these symptoms are accompanied by a stiff neck, weakness, seizures, lethargy, personality changes, nausea and vomiting. It is urgent that these diagnoses be made as quickly as possible, because delayed diagnosis can result in long-term, negative effects.

Head Trauma

Most children have bumped their heads and a few may have suffered more severe head traumas or concussions. Sometimes it affects the scalp or bone without damaging the brain; in other cases, there may be no evidence of bone damage, but the brain is affected. The child will most probably have a headache and maybe initial nausea or vomiting. But if the headache continues for more than a few days and gets even worse, and definitely if there seems to be neurological changes (changes in response, level of consciousness, continued dizziness or nausea), then the child should be immediately examined by a physician.

Sinus Infection, TMJ & Dental Problems

Sometimes individuals attribute their headaches to a sinus infection, TMJ or dental problems. Although headaches can accompany TMJ (temporomandibular jaw dysfunction), most of these are actually undiagnosed tension-types or migraines.  In order for the sinuses to be a cause of headache there needs to be an ongoing sinus infection including fever, yellow/green discharge and facial tenderness. Chronic sinusitis is not a cause of recurrent headaches. If the symptoms are mostly head/facial pain, it is likely to be migraine. Actually, stuffy nose and congestion are very common symptoms of migraine.

Tests

When organic causes are suspected, laboratory tests can confirm them. Often times, some simple blood tests can help identify if there are any problems. Imaging of the head is also helpful. Usually an MRI is the preferred method because it provides better detail than a CT scan and does not expose the child to radiation. However, in an emergency setting, CT scans are very helpful. Unless a child has abnormal movements or has lost consciousness, an EEG (electroencephalogram) is usually unnecessary. There is no test that will prove that someone has migraine or tension headache -- bloodwork and scans are normal.

Importance of a Diagnosis

Determining the cause and type of headache can be challenging even to an experienced physician.

In order to develop an accurate diagnosis, the evaluation process should include a very detailed history from the child and parents (who should partner with their doctors throughout the diagnostic and treatment process), a thorough physical examination, and a complete neurological examination.

When taking a history, your family doctor or pediatrician will become a detective looking for clues.

  • What does the headache feel like?
  • Where is the location of the pain?
  • What is its severity?
  • Does it appear without warning, or are there signs of it coming?
  • Is there weakness, nausea, sensitivity to light or noise, lethargy, dizziness?
  • Are there auras (bright lights, blind spots, changes in vision)?
  • How long does the headache last? Do headaches occur after eating certain foods or beverages (soft drinks with caffeine, pizza or chocolate)?
  • Do certain situations, events or physical activity produce a headache?
  • Are the child's headache symptoms similar to those experienced by other family members? These are just a few of the questions.

A physical and neurological examination will check for muscle weakness, balance or vision problems, and other neurological signs that could contribute to a chronic or recurrent headache.

If the symptoms persist, or are not adequately handled through medication or treatment without medication, then you should consider consulting a specialist.

Who Should Be Consulted?

When first discussing the child's headache with your family physician, ask about the plan of action and time frame. Then, if headache symptoms continue or become more frequent despite treatment and different approaches, ask your family physician or pediatrician for a referral to a specialist: for children, a pediatric neurologist; for adolescents, a headache specialist. With the proper diagnosis and targeted treatment plan, a young person can enjoy a fulfilling, rewarding life.

To find a headache specialist, ask your family physician for a reference, or go to http://www.headaches.org/physicians to find a listing of physicians in your state. You can also call our toll-free number for more information at: (888) 643-5552.

Impact on School

When children experience chronic headaches, it affects them at home and in school. Their success in life depends not only on a correct diagnosis and effective treatment but also on understanding responses from parents, educators and school health care professionals. The following section — for parents and school professionals — offers insights and tips for helping young people with headaches.

Parents

Parents want their children to lead normal, active and happy lives. It is natural, then, to be concerned when a child or teen has been diagnosed with tension-type or migraine headaches.

And, if the headache is migraine, some parents feel unnecessarily guilty because their child may have inherited this condition. Or, if a parent also has migraines, his or her identification with this issue could inhibit objectivity when helping the child.

As a parent, you should, of course, be sensitive to your child's headaches, not only about the actual pain but also about the fact that a kid will, at times, feel left out of family, school or friends' activities because the headache keeps the child from participating. Acknowledge their concerns, and help them understand what is happening. But, remember, too much attention or pampering is counter-productive. Over-reaction doesn't help a child put the headache in perspective, and it could create problems with other siblings or your kid's friends.

Once a child's pediatrician or pediatric neurologist has diagnosed the headache, and ruled out organic causes, you should help your child pursue a rewarding lifestyle.

Educators and School Health Professionals:

You want your students to do as well as they can academically and to participate in school and extracurricular activities. But it is true that chronic headaches — migraine or tension-type — could affect a child or teen's concentration, performance and attendance to some degree. Nevertheless, a young person with headaches can, with your understanding, do very well in school.

Tips for Parents

Stress
Tension-type headaches are almost always caused by emotional stress, and migraines can be aggravated by stress. So, it is critical to understand what causes your child's stress, as well as your own, and how you both can manage it. Counseling can be very helpful in identifying stress (which is particularly relevant for tension-type headaches), and in teaching a child how to more effectively deal with headaches in daily life. If counseling is possible, you may wish to try it. If your healthcare plan or HMO does not cover it, a note from your child's pediatrician can occasionally overcome this obstacle. Your kids cannot avoid stress, because it's everywhere. But if parents help their children deal with both good and bad stress, they will be helping them learn necessary life- management skills.
Headache at Home
When your child develops a headache or feels one coming on, suggest a dimly lit room, offer medication, and an ice pack if it helps. Be responsive and sensitive to the headache without pampering, and treat this child the same as you treat your other children.
Healthy, moderate lifestyle
Successful control and management of headaches includes balanced, nutritious meals (especially breakfast), regular sleep patterns and a full night's sleep, physical exercise, activities, and avoiding food or environmental triggers. During the course of a headache, however, kids should minimize physical activity because it may aggravate the headache.
School and communication
It is important for parents of younger children, and for adolescents themselves, to discuss the headaches with school health professionals and teachers. Your child's doctor can write a letter about the tension-type or migraine headache, explaining the importance of treatment when the headache starts. Give the medications and instructions for use to the school nurse. Explain to each teacher, every semester, that the moment a child feels the warning signs of a headache, he or she should be allowed to leave class, go to the nurse's office for medication, and rest there until the symptoms have decreased.
Missing School Days
There will be times when a headache will cause a child to be late to school, to leave school early, or to miss a day of school, but your kid should not miss more than five days per semester as a result of headaches. If a child misses more than five days, then further evaluation may be indicated. If a child misses more than 20 days a year, then parents should look for signs of stress. Discourage "school refusal," and home schooling should not be considered a solution for headaches.
Parents and Physicians
Some children, once diagnosed, will find immediate relief from prescribed treatment. With other kids, doctors might have to try a few approaches before achieving success. And, there are a few young people who will find some relief but not a totally successful treatment. Generally, however, if the symptoms persist despite the best efforts of your family physician or pediatrician, then it's time to ask your family doctor for a referral to a pediatric neurologist or headache specialist.
Activities
While a child with headaches should remain active, avoid over-commitment or too many activities. If a particular activity triggers a headache, avoid it if possible, and, if it cannot be avoided, discuss how it might become more manageable. Your pediatrician, psychologist, teachers or other kids might have suggestions for alternate activities.

Tips for Educators

Legitimate Biological Disease
A child or adolescent's chronic tension-type headaches are real responses (not excuses) to personal, family or school-related stress or challenges. Whether it's a pop math quiz, an anticipated grammar test, or the school play, each child responds differently. While a kid suffering from migraines has most likely inherited a predisposition to them, these headaches can also result from food or environmental triggers.
Identify Stress
It is important to help a child identify the sources of school stress, for example, problems learning math, science or another language, or an upcoming test. A caring teacher's recognition, understanding and encouragement can help a young person with headaches.

Missing School
If a child with headaches seems to be missing too much school, then you should discuss this with the student and his or her parents. When a youngster knows the school environment is understanding and supportive, then headaches should not be used as a reason for missing school, or for more than a minimal amount of time. When a child gets a headache during school, encourage him or her to lie down in the nurse's room during a headache, or until the symptoms diminish to a more manageable level, but return to class or school afterward.
Communication
When a child (or his or her parent) alerts you to the student’s chronic headaches, offer a sensitive (but not over-indulgent) reaction that does not embarrass the child in front of classmates. If, however, a child is repeatedly suffering from headaches, but the teacher or school health care professional has not been informed of a specific condition, a school professional should discuss the headaches with the parents.

Allow Immediate Treatment
Children with migraine eventually learn the warning signs. These sometimes include dizziness, nausea and sensitivity to light and sound. The actual headache may be accompanied by vomiting. If, during a class, a child explains that he or she has to take medication, then encourage the student to go to the nurse's office, because taking medication as soon as the first signs of a headache appear is important. Waiting until class is over could put a young person in a more vulnerable situation, and force he or she to miss more school days than necessary.

During the Headache
Young children experiencing or recovering from a migraine might not want to play with other kids and may find the activity of school recess periods difficult. Offer an alternative, such as lying down in the nurse's room or, if the child feels like it, reading a book. Or, if a migraine diminishes a young person's appetite, then instead of lunchtime in the cafeteria, ask if he or she would prefer to rest and relax instead of eating. While it is important to acknowledge and appropriately respond to the fact that the headache period presents challenges to some kids, it is also important for the child not to be, or feel, separated or isolated from other students.
Frequency
By the time they are teenagers, girls with migraines will probably experience more headaches due to hormonal changes.
Attitude
Treat children with chronic headaches the same way you would treat any other child.

Additional Resources

Books

Headache and Your Child
by Seymour Diamond and Amy Diamond

Conquering Your Child’s Chronic Pain: A Pediatrician’s Guide for Reclaiming a Normal Childhood
by Lonnie K Zeltzer and Christina Blackett Schlank

Be the Boss of Your Pain: Self-Care for Kids (Be the Boss of Your Body)
by Timothy Culbert M.D. and Rebecca Kajander C.P.N.P., M.P.H.

Relieve Your Child’s Chronic Pain: A Doctor’s Program for Easing Headaches, Abdominal Pain, Fibromyalgia, Juvenile Rheumatoid Arthritis, and More 
by Elliot J. Krane MD

Meditation

Indigo Ocean Dreams: Children’s Stories Designed to Decreased Stress, Anger and Anxiety while increasing Self-Esteem and Self-Awareness
by Lori Lite

Websites

seattlechildrens.org/clinics-programs/biofeedback/resources
(Recommended reading section on Seattle Children's website)

www.migraineandme.ie
(Children's headaches)

www.migra-zone.ie
(Connecting Teenagers with Migraine)

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