Possible Causes of Headache
A true headache in a child, like pain elsewhere in the body, deserves an explanation. Sometimes the reason is obvious. A vague headache is often the first symptom of an infection. The flu, a common cold, or strep throat can all begin with a headache, but other symptoms soon follow and provide the explanation. Headaches are also very common after concussions. Even a seemingly mild concussion can lead to a headache. At times, these post-concussive headaches can go on for weeks.
In a school-aged child whose headache comes on towards the end of the school day or after reading, vision difficulties are often the reason. The eye strain/headache in these cases disappears with the right pair of glasses. Older children, like adults, can experience both tension headaches and migraines. A tip-off to a tension headache is achiness and tenderness in the muscles of the neck and shoulders. Migraines are trickier to detect in children and are probably under-diagnosed. Migraines are rare before five years, but one study estimated that between seven and ten percent of school-aged children were affected, though perhaps as few as ten percent of those children were accurately diagnosed.
Compared to adult migraines, childhood migraines usually don’t last as long, are less likely to be accompanied by nausea and vomiting and are more likely to involve both sides of the head. Though some children experience the typical ‘aura’ preceding a migraine, others will show a change in behavior, such as irritability.
Among the causes of childhood headaches are very dangerous ones as well, though fortunately most of those are also quite rare. Meningitis and encephalitis are two life-threatening infections of the brain or structures surrounding the brain that feature a headache, often a severe one. High fevers, lethargy, a stiff neck (or reluctance to move the head), or confusion would be other signs of these infections.
A headache in the setting of a serious blow to the head is also concerning. A bad headache in this situation, particularly if accompanied by confusion, weakness, or in a child who is difficult to arouse, can signal dangerous bleeding within the skull or brain. Any sudden, excruciating head pain in a child who has been previously well can (rarely) be a sign of bleeding from a malformed vessel within the brain, another life-threatening situation.
And, finally, there is the uncommon but dreaded possibility of a brain tumor. The headache from this cause can be subtle at first and may not have the classic characteristics, but typically, it will steadily worsen over time. Unlike most other headaches, it can also be present first thing in the morning, or even awaken a child from sleep. Usually, along with the headaches, there are other changes in intellect, personality, or weakness on the physical exam. Within four months of developing headaches, the majority of children with brain tumors will have other findings as well.