Headache and lifestyle in children-A pediatric neurologist’s perspective. (Dr. Saurabh Chopra)
Updated: Aug 3, 2020
Are headaches common in children?
Headaches in not an uncommon complaint in children. 5-8% of school aged children experience headaches.
Do headaches in children suggests a tumour or other serious conditions?
Although headaches are usually not associated with serious medical conditions but a careful assessment is needed as, at times, headaches may be harbingers of sinister conditions which we cannot affolrd to miss. Headaches associated with viral fevers, URIs, Malaria, Typhoid, various other nonspecific illnesses are the commonest headache type in children and usually subside with the underlying illness. On the other hand headaches associated with serious brain conditions like- Meningitis, Meningo-encephalitis, Space Occupying lesion(Tumour) etc are much less common but need to be carefully checked for. Another common but less recognised form of headaches in children are the Primary headaches(headaches without an underlying cause)- Migraine, Tension type headache and the less common cranial neuralgias.
Should I take my child with headache to a doctor?
A one off headache with a common cold or minor viral fever may not need to be checked by a doctor. Recurrent ongoing headaches are better evaluated by a doctor. A good doctor will check a child with headaches in detail, checking for a detailed history regarding its onset, duration, trigger factors, behaviour of the child during the headache episodes and the relieving factors. Doctor may also want to examine
· How well the brain is able to control the motor movements and co-ordination in your child
· Blood pressure measurement
· Fundus examination (examination of the back of the eye)
Brain scans are sometimes ordered in children with headaches especially if the examination is not normal or there are other medical conditions or the child is very young.
My child has headaches since a very long time and I am very worried. What should I do?
Children with headaches lasting longer than 6 months and who are otherwise normal in between their headache episodes are unlikely to be having any serious life threatening condition. But a child with regular headaches may need to be checked by a pediatric neurologist who would have adequate understanding of children and their neurological problems.
Do children get Migraines? What are Primary Headaches?
Yes some children especially whose parents have had migraines also can get migraine headaches.
Migraine can be recognised with its episodic quality and the child remaining well in between attacks. It is associated with at least two of the following-
· Photophobia or phonophobia –ie worsening of headache with light or sound and/or preferring to be in dark and silent surroundings during headache.
· Nausea and/or vomiting during some of the headache episodes
· location in the front or side of the head with pulsatile/ hammering quality
· Family history of similar headaches
Migraines are usually associated with child avoiding daily activity like playing, watching TV etc during the headache period.
Migraines with frequency of 4 or more per month or frequent disruptions in the daily routine, do need daily medication. Acute pain medications are important in all migrainous headaches irrespective of frequency. In the long term, parental understanding of migraine is important to bring about lifestyle changes.
Other primary headaches incude-Tension type headaches
These are also episodic with a characterless quality. None of the characters of migraine are present in this type of headache. Thus tension type headaches present with generalised aching/heaviness/tightness. Psychogenic factors should be actively looked for in children with all headaches but this is especially true in this group.
What can I do to reduce headaches in my child?
Lifestyle that encourage overall wellbeing and a headache free existence include the following-
Sleep Hygiene- Literally means to clean out ones sleep routines.
· Kids follow what their parents do and a regular sleep regime needs to be followed by the entire family for it to stick.
· Regular sleep rituals (changing into night wear, brushing ones teeth, reading a story etc )
· Shutting down all electronic entertainment avenues at least 1 hour before sleep time.
· Having a sacrosanct sleep time/schedule including fixed sleeping and waking up timing which are followed on weekends as well.
The various types of electronic screens (televisions, mobiles devices etc) have started to take up more and more of our waking hours. Children as young as a few months are being “entertained” and screens are also being used as “babysitters”. This is a worrying trend. Excessive use of screens can be quite harmful for young children where there is a clear link with poor social and language skills and even autistic features. The only strategy that works to get children off these is to replace them with alternative entertainment which gives them opportunity to interact socially eg- going to the park to play, joining a an activity of interest (like a dance class). Restricting screen time to no more than 1 hour per day goes a long way in reducing and preventing headaches, additionally this time is spent in more fruitful activities with their peers which helps build social skills that will help them throughout their life.
Living in a warm country, fluid intake is very important. Children need to be encouraged to consume adequate fluids as they are too “busy” to remember drinking water throughout the day. Adequate fluid intake improve overall health and prevent and reduce headaches as well. Having secure and clean washrooms in schools also goes a long way in keeping children, especially girls, confident to consume enough water during their school hours, as they do not dread their trips to the loo.
Regular physical activity is also important for one’s overall health and prevent headaches. Children need to be encouraged to have a daily outdoor play schedule that helps them build a health body that lasts a full lifetime but also healthy and long lasting friendships. (till the covid period this can be replaced by innovative and fun family exercise schedule or physical play schedule that can be done in the safety of one’s home or outdoor activities that can be done with good social distancing, like cycling)
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