My child has headaches. When should I worry?

The short answer

Usually, you don’t need to.

Most headaches in children are migraines or tension-type headaches. They can hurt a lot and make a child miss school, but they are not caused by something dangerous in the brain. A few warning signs mean your child should be checked quickly. They are listed below in the red box.

What to do next

Keep a headache diary. Write down the day, time, how bad it was from 1 to 10, what your child was doing, and what helped. Bring it to the visit.

Treat early. Give the pain medicine your child’s doctor recommends as soon as a migraine starts, then rest in a dark, quiet room. Medicine works best when it is taken early.

Build steady habits. Regular sleep and wake times, three meals a day, plenty of water and daily activity can make headaches happen less often.

Watch how often pain medicine is used. Taking it on many days each month can cause more headaches. If your child needs it more than 2 or 3 days a week, talk with the doctor.

The most common kinds of headaches

Migraine often comes with a throbbing or pounding pain, an upset stomach or throwing up, and being bothered by light or noise. In children, a migraine is often felt on both sides of the head and can be shorter than in adults, sometimes as short as 2 hours. Migraines often run in families.

Tension-type headache feels like pressure or a tight band around the head. It is usually mild to medium, and children can often keep doing their activities.

Headaches also come with common illnesses, like a cold, the flu or a sinus infection. These go away as the illness gets better.

What can bring on a headache

Not enough sleep, or a changing sleep schedule
Skipping meals or not drinking enough water
Stress, or busy weeks at school
Hot weather, bright lights or strong smells
Being sick

A diary helps you and the doctor spot your child's own triggers.

Does my child need a brain scan?

Usually not. Most children with typical headaches and a normal exam do not need a CT or MRI. A scan rarely changes the treatment, and a CT uses radiation.

Doctors order a scan when there are warning signs, like changes on the nerve exam, a new pattern of headaches, or the signs in the red box below.

How doctors help

Your child's doctor will ask about the headaches, check the nerves and eyes, and look at your diary. Treatment usually includes a plan for each headache, healthy habits, and, if headaches happen often, a daily medicine or skills like relaxation training to prevent them. Many children get much better with this plan.

When to call the doctor or 911

Call 911 or go to the ER now if

It is the worst headache your child has ever had, or it starts suddenly and is severe.
The headache comes with a fever and a stiff neck, or a rash that does not fade when pressed.
Your child has weakness, trouble speaking, walking or seeing, or one side of the face droops.
Your child is very sleepy, confused, hard to wake, or has a seizure.
The headache started after a hit to the head, especially with throwing up or sleepiness.

Call your child's doctor if

Headaches wake your child from sleep, or are worst on waking and come with throwing up.
Headaches are getting worse or happening more often over weeks.
Your child is younger than 6 and has new, repeated headaches.
Headaches come with changes in vision, balance, behavior or school work.
Your child needs pain medicine more than 2 or 3 days a week.

References

Oskoui M, Pringsheim T, Holler-Managan Y, et al. Practice guideline update summary: Acute treatment of migraine in children and adolescents. Report of the American Academy of Neurology and the American Headache Society. Neurology. 2019;93(11):487-499. PubMed 31413171 doi:10.1212/WNL.0000000000008095

Rossi R, Versace A, Lauria B, et al. Headache in the pediatric emergency department: A 5-year retrospective study. Cephalalgia. 2018;38(11):1765-1772. PubMed 29256253 doi:10.1177/0333102417748907

Camargo A, Kanekar S. Neuroimaging in pediatric headache. Neurol Clin. 2022;40(3):679-698. PubMed 35871791 doi:10.1016/j.ncl.2022.02.007