Dr Aman Sohal is a respected specialist pediatric neurologist in Dubai. He works in the Neuropedia Children’s Neuroscience Center clinic along with the best child neurologists and psychologists in Dubai, a specialist in treating conditions such as epilepsy, ADHD, autism, speech problems and cerebral palsy. You can find out more here.
Childhood headache – An expert view
It isn’t unusual for children to suffer from headaches, but as a parent, it can be very worrying. What is causing the problem? Is it an ordinary one-off headache or ongoing, and is the pain an indication that something, somewhere is going wrong? I’m Dr Aman Sohal, and here are the facts.
The facts about childhood headaches
20% of children aged less than five years old suffer headaches, 37% to 51% of seven-year-olds experience head pain, and the number increases to 57% to 82% by the time a child reaches the age of 15. If the pain is severe it can lead to time off school, missing the activities they enjoy, and an inability to fully enjoy life.
At our Paediatric Neurology Clinic, we see various kinds of childhood headaches, some of which are common. Here they are, and this is how we recommend dealing with them.
Cluster headaches in children
As the name suggests, cluster headaches come in clusters. They can be severe and painful. A child might suffer from bad headaches for a few weeks or even several months, then experience a long period without any pain. This type of headache is often unilateral, affecting just one side of the head, and it can make the child’s eye water on the affected side, make their nose run, and make their face feel hot. As you can imagine, with a headache this painful, it’s important to treat it fast.
While we don’t fully understand the cause, we do know that cluster headache affects the parasympathetic nervous system and might also affect the hypothalamus, which can explain the regularity. Strong smells can bring them on, as can too-warm environments. To treat the problem we recommend pain relief when an attack is happening, plus prevention, first ruling out any other causes. Paracetamol and ibuprofen don’t work well for cluster headaches, so we use other relieving medication during an attack to reduce how long each headache lasts and cut the pain involved.
Childhood migraines – A common causes of headaches
Migraine headaches are defined as at least 4-5 attacks of intense unilateral pain, accompanied by a throbbing sensation. In younger patients we frequently also see nausea and vomiting, sensitivity to sound and bright light. An attack can last as little as an hour or as long as 72 hours.
Some children also see ‘aura‘, which involves visual symptoms like vivid colours and moving patterns. Others can smell strange smells, have blurred vision, and parents may see changes in the way their child speaks. Occasionally a child will also suffer from stomach pains – something known as abdominal migraines – or even go into an exhausting and distressing cycle of vomiting, dizzy spells and vertigo.
The reason behind these worrying symptoms? We think it’s a blend of genetics, which accounts for roughly 60 – 70% of the risk, plus environmental factors. If there’s a family history of migraine, your doctor needs to know. Other theories include vasogenics, to do with the veins, and there’s also a neuro-vascular theory which is supported better by science.
How to treat childhood migraines
An experienced doctor is essential. They’ll take a detailed history of the child’s background and also carry out a few basic bedside tests before making a firm diagnosis. For example, we might take a look at the back of the child’s eyes, something called fundoscopy. It’s rare that we need to undertake a CT scan or MRI brain scan, since the child’s history plus a regular neurological examination usually delivers enough insight for a reliable diagnosis.
The treatment? I usually recommend a two-tier approach involving both lifestyle modifications and medical management. Part of the task includes recognising the triggers that cause the pain – often specific types of food, commonly including caffeine – and teaching the child to avoid them. It’s also important for the child to drink enough water and get good quality sleep, and for parents to manage any stress in the child’s life. Regular exercise is important and also boosts your child’s health and fitness in many other ways.
Before embarking on a regime of medication, we recommend the child or a parent keeps a headache diary, detailing the frequency, intensity and symptoms of the migraines.
Once we have identified the right medication, if indeed medicine is needed, it is important to give the child the medication as quickly as possible after noticing the signs of a migraine. That way, the medicine will work faster to decrease the headache’s intensity. On the other hand, if your child is suffering from two or more migraines a week, or has to use an abortive medicine regularly, we often recommend a prophylactic medicine. Prophylactics are taken every day for a certain amount of time, generally a few months, then the child is slowly taken off the medicine, hopefully leaving them migraine-free afterwards.
Chronic daily headaches in children
Some children suffer from chronic daily head pain, featuring anything from a dull ache to severe pain. It can occur when a child is given painkillers for too long a period, or they have migraines that aren’t treated properly or tension headaches that are ignored. Some of the time, though, there’s also a psychological component that makes the headache worse.
Chronic regular headaches like this are a challenge to treat, and a multi-disciplinary approach is often the best. The child may be taken off painkillers and the parents might need to make lifestyle changes. If there’s a psychological problem behind the pain, a childhood psychology specialist is a good idea. They can teach the child relaxation techniques and may even harness cognitive behavioural therapy to help the child manage the pain, and feel more in control of their mood.
Tension headaches in children
As many as 15% of young people suffer from tension headaches, which are less painful than migraines as well as shorter-term and bilateral, occurring on both sides of the head at the temples. They can also affect your child’s neck and upper back, and the pain tends to worsen later in the day and into the evening.
Our focus with headaches like this is on reducing or removing the reason behind the child’s stress. I often also recommend basic painkillers like ibuprofen or paracetamol, both taken at low doses to avoid something called ‘medication overuse’ headaches.
Always take headaches in children seriously
Childhood headaches can have many causes, and treatment often demands a multi-disciplinary approach. The sooner the problem can be dealt with, the happier the child will be.
