Headaches in Children and Adolescents: When Should a More Serious Problem be Suspected?

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Headaches are very common in children and adolescents. In fact, one study reported that 56 percent of boys and 74 percent of girls between the ages of 12 and 17 have a headache within any given 30-day period.

Most headaches in children and adolescents are the result of stress and muscle tension or migraine. Headaches are also common symptoms of sinus infections, colds and the flu. Many parents worry that their child’s headache is a sign of a brain tumor or serious medical condition. This is usually not the case, but only your doctor can evaluate your child’s headache to precisely determine the underlying cause.

Headache evaluation
During the headache evaluation, your child’s headache history will be taken. This involves asking your child or you about your child’s current and previous headaches -- their frequency, duration, and associated symptoms. Your doctor will also perform physical and neurological exams to look for signs of an illness that may be causing the headache.

What information might indicate a more serious health problem?
A more serious problem should be considered when the child’s general or neurological history and exams reveal any of the following:

Symptoms

  • Headaches that are progressive in frequency or severity
  • Headaches that don’t respond to simple therapy
  • Headaches that awaken the child from sleep
  • Problems with balance, motor movement or strength, or vision; loss of consciousness
  • Headaches that are accompanied by a stiff neck
  • Headaches that are accompanied by symptoms such as projectile vomiting, blurred vision and confusion
  • No family history of similar headaches
  • A family history of neurological disease

Neurologic symptoms (which may indicate a problem in the brain as the cause of the headache) include:

  • Seizures—loss of consciousness
  • Ataxia — impaired ability to coordinate movement, loss of balance
  • Lethargy — sluggish, sleeping way too much
  • Weakness — especially on one side of the body
  • Nausea and vomiting — especially very frequent, early morning, or progressive vomiting
  • Visual problems — blurred vision, double vision, blind spots
  • Personality change — inappropriate behavior or a change from previous behavior, feeling sad or depressed, rapid mood swings from happy to sad or sad to happy

Signs

  • Abnormalities of temperature, breathing, pulse or blood pressure
  • Inflammation of the optic nerve (the nerve in the back of the eye); a condition also called papilledema
  • An enlarged head
  • A noise or bruit in the head heard through a stethoscope
  • Coffee-colored spots on the skin
  • Any abnormality on the neurological exam
  • Problems with balance, motor movement or strength, or vision (eye movements or double vision)

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Last Updated: 7/23/2007

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