What to Do?
Sometimes the situation isn’t clear-cut, in which case, it’s better to bring a small child with headaches to medical attention than to wait. In a doctor’s office, the evaluation will start with a very thorough history. At times, a child or his family will be asked to keep a headache diary for several weeks to get important details: When? How long? How often? In what circumstances? What are other associated symptoms? How severe? What makes it better? What makes it worse? Often the explanation becomes clear to both family and doctor from the details in a headache diary.
The next step is a very good physical exam. A normal physical exam is reassuring, especially with headaches that have been present for many months. If further information is needed, a CT scan or MRI provides an image of the brain, detecting masses in the brain or hydrocephalus (too much liquid surrounding the brain). Some children require a pediatric neurologist for specialty care. Fortunately, the cause of the majority of childhood headaches can be uncovered with a detailed history and physical exam and the cause treated.
How to Treat Headaches?
Luckily, most headaches in children are not caused by serious illness. Still, there remains the issue of the pain. A quiet, darkened room and a cool cloth on the forehead usually help, especially for migraine headaches. As for medicines, the important principles are to give enough and to give it early. While caregivers should never exceed the recommended dose of a medicine (any medicine), relief from head pain usually requires the entire dose, not a portion of it. Acetaminophen and ibuprofen are most commonly used in children. Aspirin is no longer used in pediatrics, with rare exceptions. Pain medicine is more effective when given as soon after the pain starts as possible. A certain dose is more effective at preventing maximal headache pain, as it is in controlling maximal pain once already present. Timely treatment is even more important for chronic headaches such as the tension or migraine types.
The ultimate goal for headache management is to uncover and treat the cause, relieve the pain, and send the child off to resume his normal day.