Headaches are common in children. The majority are simple tension-type headaches that resolve within a short period. However, there are many causes of headaches in children, and serious causes need to be excluded.
Causes of Headaches in Children
- Tension headaches
- Migraines
- Ear, nose and throat infection
- Medication overuse headache
- Problems with vision
- Raised intracranial pressure
- Brain tumours
- Meningitis
- Encephalitis
- Carbon monoxide poisoning
Tension Headaches
Tension headaches are common. They produce an ache across the forehead and pressure in a band-like pattern around the head. They appear and resolve gradually and do not produce visual changes or pulsating sensations. They are generally symmetrical. They vary in duration from minutes to hours.
Symptoms may be very non-specific in younger children. They may become quiet, pale, tired and stop playing.
Triggers for tension headaches in children include:
- Stress, fear or discomfort
- Skipping meals
- Dehydration
- Infection
Management includes reassurance, analgesia, regular meals, avoiding dehydration, and reducing stress.
Migraines
Migraines are a complex neurological condition that causes headache and other associated symptoms. They occur in “attacks” that often follow a typical pattern.
There are several types of migraine:
- Migraine without aura
- Migraine with aura
- Silent migraine (migraine with aura but without a headache)
- Hemiplegic migraine
- Abdominal migraine
The pathophysiology of migraine has been studied for decades. Various mechanisms and theories have developed. It is likely a combination of structural, functional, chemical, vascular and inflammatory factors.
Migraines present differently from tension headaches. Symptoms tend to be:
- More severe
- Throbbing in nature
- Take longer to resolve
Migraines in children are commonly bilateral, while migraines in teenagers and adults tend to be unilateral.
Migraines are often associated with:
- Visual aura
- Photophobia (discomfort with lights)
- Phonophobia (discomfort with loud noises)
- Osmophobia (discomfort with strong smells)
- Nausea and vomiting
- Abdominal pain
Management of migraines in children:
- Rest, fluids and a low-stimulus environment
- Paracetamol
- Ibuprofen
- Intranasal sumatriptan (licensed from 12 years, tablets are not licensed in children)
- Antiemetics (e.g., metoclopramide or prochlorperazine)
Where the migraines are having a significant impact on life (e.g., frequent attacks or missing school), prophylactic treatment can help reduce the frequency and severity of attacks. A specialist usually guides this.
Options for migraine prophylaxis include:
- Propranolol (avoid in asthma)
- Pizotifen (often causes drowsiness)
- Topiramate (very teratogenic – females with childbearing potential need highly effective contraception)
Children are more likely than adults to suffer from abdominal migraines, which may occur in young children before they later develop traditional migraines. Episodes involve central abdominal pain lasting 1 to 72 hours. Examination will be normal. There may be associated:
- Nausea and vomiting
- Anorexia (lack of appetite)
- Headache (may be absent)
- Pallor
TOM TIP: When a patient presents with possible migraines, ask about recurrent central abdominal pain as a child. They may have a history of abdominal migraine that started before the headaches.
Infections
Infections can cause headaches in children. In a child with a new headache, check for symptoms and signs of a viral upper respiratory tract infection, otitis media, sinusitis and tonsillitis. The headache should resolve along with the infection. Paracetamol and ibuprofen can be helpful for symptomatic relief.
Sinusitis causes a frontal headache associated with inflammation in the ethmoidal, maxillary, frontal or sphenoidal sinuses. It produces pain behind and around the nose, forehead and eyes. There may be tenderness over the affected sinuses. Sinusitis is most often viral and usually resolves within 2 – 3 weeks.
Last updated January 2026
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