Tips for Dealing with Recurrent Headaches in Children

By Howard J. Bennett, MD

Everyone gets headaches from time to time. They usually occur if you’re sick with a cold, sore throat or fever. If a child gets headaches with fever or other symptoms, the headache is because she’s sick and your focus should be on the underlying illness.

Some children get headaches without an obvious cause. If this happens, you should contact your doctor to determine if there is another cause such as stress, dehydration, environmental allergies, too little sleep, medications, etc. In this case, you will still deal with the underlying problem.

A key question that comes up during a headache evaluation relates to the intensity of the pain.

Some doctors rate pain on a zero to 10 scale. A zero means you have no headache, and a “10”
means it’s the worst headache you can imagine. Others use a 1 to 3 scale. A “1” is mild and
doesn’t interfere with what you’re doing. A “2” makes you want to stop what you’re doing. A
“3” hurts so much you want to go to bed. A common diagnosis made by pediatric neurologists is called chronic daily headaches.

These headaches don’t literally occur daily. Rather, they typically happen 2 or 3 times a week. Chronic daily headaches are variants of migraine, but present without typical migraine symptoms such as a one-sided, pounding headaches, nausea or vomiting and photophobia (pain looking at lights).

The following advice comes from pediatric neurologists who treat children with chronic daily headaches. It also helps stress-related headaches.

General Comments if You Have Recurrent Headaches

1. Distraction: Do something you enjoy. Headaches often improve if you’re engaged in an activity, whereas focusing on headaches often makes them worse. Unless a headache is severe or you’re feeling sick in other ways, avoid talking about it with your parents.

2. Stay in the game. Try not to avoid things, including school, because you have a headache.
Working through the pain can teach your brain to ignore increased pain signals.

Preventing Headaches

1. Sleep: Aim for 8 to 10 hours of sleep per night. It helps to go to bed at roughly the same time each night. Avoid screens an hour or two before bedtime. On weekends and holidays, go to sleep within two hours of your regular bedtime. It’s not a good idea to stay up extra late and then “sleep in” the next morning.

2. Exercise: Get 30 to 60 minutes of exercise five times a week. The best type of exercise is the kind that makes you breathe fast and gets your heart racing (running, biking, swimming), but any exercise is better than none, even if you only get 15 minutes a day.

3. Diet: Eat three meals per day and have snacks if you’re hungry. Don’t skip breakfast. Try to eat a balanced diet.

4. Fluids: Drink 40 to 60 ounces of liquids per day, but avoid caffeine and artificial sweeteners.

5. Screens: Don’t spend too much time in one position. If you’re playing a game or looking at a TV or computer screen, take 5-minute breaks every 30 minutes or so. Stand up and move around to help relax your back and neck muscles.

6. Vitamins. Riboflavin (Vitamin B2) taken once daily for four months may improve recurrent headaches. Talk to your doctor about the appropriate dose based on your age.

What to Do If You Get a Headache

1. Fluids: Drink 12oz of a clear liquid within an hour of when the headache starts. Avoid Propel
and G2.

2. Pain medication. If needed, take an age-appropriate dose of ibuprofen (Advil, Motrin). If the headache persists, repeat the dose four to six hours later. Do not use ibuprofen more than three times a week. Take ibuprofen with food to reduce the chances of getting a stomachache. Neurologists discourage using acetaminophen (Tylenol) for recurrent headaches because it can cause “rebound” pain and make the situation worse over time.

3. Contacting the doctor. If the headache is severe, persistent or is associated with other
symptoms such as dizziness or visual disturbances, get in touch with your doctor right away.