Most parents are at least somewhat concerned when their child first reports a headache. When deciding whether it is serious, consider the story behind it. For instance, is your child sick or generally feeling well? Is this the first headache or one of many? Did it come on suddenly, or have headaches bothered your child for a few days or even weeks?

If your child is quite sick with fever or has had a serious head injury, see a doctor as soon as possible. As well, although most causes of headaches are not serious, you should watch for other 'red flags.' They include a headache that:

wakes your child at night or occurs upon waking in the morning
hurts more when coughing or bearing down (such as when going to the bathroom)
gets worse over time (days, weeks, months)
is located in the lower back part of the head (occipital region)
is accompanied by continuing nausea and/or vomiting
includes difficulty walking or changes in mental status (for instance, if your child seems 'out of it' or is not responding).

With any of these symptoms, get immediate medical attention.

Step Two: It's not urgent … now what?

Luckily, most headaches are not serious or life threatening. Many can be explained by common causes like a cold, or an ear or sinus infection. They can be treated as part of the symptoms of the illness. After assessing your child, your health care provider can give you a plan of action.

Headaches can also be caused by mild trauma, such as a bump on the head from falling off a slide or swing, or getting knocked down in hockey or football. Again, an assessment by your family doctor will help ensure an appropriate plan is in place to help your child feel better. Once serious causes of headache have been ruled out, and temporary causes dealt with, two common types of headaches usually remain.

Step Three:"But my head still hurts!"

After a careful review of history and a thorough physical exam, your child may be given a diagnosis of either migraine or tension-type headaches. Though each has its own characteristics, there is often overlap between them. Migraine and tension-type headaches have no external cause, like a fever or trauma. Still, they can be very painful and bothersome.

In children, a migraine headache often affects both sides of the head. (In adulthood, it might only affect one side.) A migraine is gradual in onset, and gets worse as time goes by. The pain is often pulsating and can be severe, often made worse by routine physical activity. Attacks can last between one and 72 hours. Your child may experience some nausea and vomiting. Being bothered by bright lights or too much noise is common. The child will prefer to rest or even sleep in a dark, quiet room, and will usually feel better upon awakening.

Some children have what is called migraine with aura. An aura is the sensation of seeing, hearing or smelling something that is not really there. The most common type of aura children experience (usually before the pain even comes) is a strange visual sensation. This might include bright lights, zigzag lines or dark spots. Having an aura does not mean that something is wrong with the brain. It is a common part of the migraine picture.

Migraine headaches tend to run in families. Often, if a child suffers from migraines, mom, dad or an aunt or uncle do as well.

The tension-type headache is the other very common type of headache children experience. These headaches also tend to affect both sides of the head. Your child might describe pressure or tightness, like a band squeezing. Pain comes and goes over time and the duration varies. Often, children with tension-type headaches can continue with usual activity, since movement does not usually make the pain worse. However, rest might help. Nausea or vomiting is rare, and there is no aura prior to the pain.

Step Four: Identifying the problem

Your doctor will begin by asking questions to help figure out what is going on. For instance:

What is the quality of the pain? Is it stabbing? Throbbing? Shooting?
Where is the pain? Is it one-sided? Across the front? In the back?
How bad is the pain? Mild, moderate or severe?
Is the pain worse at certain times of day? Worse in the morning? Worse at school but better at home?
What makes it worse? Bright lights? Loud noises? Physical activity?
What makes it better? Rest? Coming home from school?
How often do these episodes occur and how long do they last?

It can be difficult to remember all the details when you visit your doctor, especially if your child is not having headaches very often. To get the story straight, try keeping a headache diary. Write down as much information as you can about each headache to make your visit to the doctor more productive.

Once your doctor knows the story, a physical exam will be done. For headaches, doctors use something called the neurologic exam. Think of it as examining the brain. You may have experienced this kind of physical exam in the doctor's office before. Your doctor will look in your child's eyes, check for abnormalities of the head and neck, and watch the child walk in a straight line or stand with the eyes closed (not unlike a test for too much alcohol!). Afterward, the doctor can either reassure you that nothing serious is going on, or decide further investigation is needed.

For most headaches, further testing, such as imaging of the brain, is not usually necessary. A good understanding of the background story, combined with a thorough physical exam, is often enough to tell what is going on. As well, there is a chance that tests may cause unnecessary harm. For instance, a CT scan has a lot of radiation. To have an MRI, some children might need sedation, which could be quite scary. These types of tests are reserved for children who have worrisome findings in their story or physical exam. It is important to balance potential harm with potential benefit.

Step Five: About chronic headaches

Managing migraine or tension-type headaches in a positive way is key. Such headaches are usually chronic, which means that they continue, on and off, over time. Make the most of your child's ability to function. For instance, you will not want your child to miss too much school. Continuing favourite activities will also be important. Be sure your child gets proper rest, fluids, daily exercise and good nutrition. A healthy breakfast and regular snacks will also keep your child from getting too hungry.

Identifying and avoiding triggers can also be useful. Both types of headaches can be brought on by excessive tiredness, not enough liquids, or being hungry. Stress is another common trigger. Stress comes from many sources, including worries about school, problems at home, or relationships with friends. Understanding how your child is coping with the world can go a long way to relieving stress and the related headaches. Other issues, such as trouble sleeping, mood swings or anxiety, may also contribute to headaches. Identifying and getting help for such concerns can also lessen the effects of headaches. With migraines, triggers often include certain types of foods, like chocolate or caffeine.

Lastly, keeping medications to a minimum is also important. Sometimes parents offer over-the-counter medicine like Tylenol® or Advil® to ease the pain. However, use pills carefully since medication overuse can actually make a headache worse. If it turns out medications are necessary, your health care provider will help you develop the best plan for your child.

Headaches in children are common. Although there are certain symptoms to watch for, serious causes are rare. If you are worried, have your child seen by a medical professional, not only for diagnosis but also for a management plan. Living with headaches might be challenging, but it need not be disabling.

"Mommy, My Head Hurts!" Signs to watch for and how to help

Step One: Is it serious?

Step Two: It's not urgent … now what?

Step Three:"But my head still hurts!"

Step Four: Identifying the problem

Step Five: About chronic headaches

"Mommy, My Head Hurts!"
Signs to watch for and how to help