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Ouchy Heads

By Dr. Scott Hamilton
June 8, 2021
Hamilton Blog Headshot Updated 12.21.21

In the movie Kindergarten Cop, Arnold Schwarzenegger plays a detective who goes undercover as a school teacher. In one scene, as he's reading a children's book to his class, he rubs his head and moans. The kids ask what's wrong, he says he has a headache, and one of the kindergartners helpfully pipes up, "maybe it's a brain tumor." Arnold snaps back in his goofy Austrian accent, "it's not a tumor!"

Children and teens get headaches just like adults. The majority are tension headaches, resulting from stressors like going to bed too late, anxiety from school or family troubles, and not drinking enough fluids. Poor diet habits like skipping meals, not eating enough fruits and vegetables and fiber, contribute as well. Too much screen time with phones and video games certainly doesn't help. Many kids also get headaches with infections. Strep throat, walking pneumonia, Influenza, colds and sinus infections, stomach viruses all can cause head pain along with their other symptoms. And kids get migraines too. More on that below.

When children complain about headaches, parents of course think the worst. Is this a brain tumor? Meningitis? A bleeding aneurysm? Fortunately, these bad things are rare in kids, and there's usually clear signs that the headache's not from more benign causes. If children have bad pain, moaning and wanting the lights off because it makes the headache worse, or crying with pain, bring them in. Acting tired, sleeping more than usual, is concerning too. Headaches that continue day after day, or are worsening, deserve a doctor visit. Finally, headaches that wake kids at night, are worse in the early morning, or cause vomiting, could be trouble. All these symptoms go with migraine headaches, but if kids don't already have a migraine diagnosis, they need checking. Probably however, as Arnold said, "it's not a tumor!"

Like adults, teenagers get migraines. They come in two flavors: kids who are sitting up and smiling; or the obviously miserable ones, lying down, wanting the lights off, mumbling their answers. Another "test" of a teen's misery: telling them the best way to relieve their pain is with IV medication. Those who say, "A shot? Ooh, no thank you, can I have a pill instead?" aren't so bad. Those who moan, "Give me anything to stop this pain!" are the real deal. Migraines are recurrent headaches, more painful than tension headaches, and often have other symptoms like nausea and vomiting. Occasionally they have weird alterations of sound and color perception or stroke-like signs like numbness, difficulty speaking, and paralysis.

Like we mentioned above, parents worry about brain tumors or strokes when kids get migraines. If their child has vomiting or weirder signs, this fear is understandable. If it's the first time for those symptoms, get them seen. Migraines are usually diagnosed with just a history and thorough neurologic exam, but sometimes CT or MRI scans reassure everyone that it's not something worse. As migraine sufferers discover, lying down and napping in a dark room often makes them go away. Ibuprofen or Tylenol also help, especially if taken right away. Waiting to take medication may give the headache time to "lock in" and be more difficult to alleviate. If the migraine is terrible like with our miserable teen above, we use IV medications. For chronic migraines, we prescribe medication like triptans if OTC meds don't work. Finally, neurologists talk about "migraine hygiene," using lifestyle changes to prevent migraines. These include eating three healthy meals daily, getting enough sleep, avoiding caffeine, and learning to manage stress. Good luck with teens on those things, except with kids who'll do "anything" to stop the pain!