Headaches
When a child comes into clinic complaining of headaches, there are immediate red-flag do-not-pass-go questions I always ask. These questions help to differentiate “normal” headaches that are mainly from stress or fatigue symptoms and their interactions with the blood vessels around and in the brain from those headaches that can be caused by structural abnormalities or growths (often called space-occupying lesions) in or on the brain. Things that make me more worried about headaches:
Headaches that regularly wake a child up from sleep
Headaches that cause vomiting and the vomiting relieves the headache
Changes in the way the patient is acting even when headaches are not occurring
Any other cranial nerve changes like changes to hearing, vision, balance, walking, and speaking even when headaches are not occurring
If I have a child with a fever and a headache, I always need to rule out meningitis, both bacterial (the scary kind) and viral (the not-as-scary kind). Intense pain with the inability to move the kiddo’s neck would indicate more concerning meningitis inflammation and would need testing to be done in the appropriate setting of an emergency room.
Headaches associated with the flu or other viral illnesses often have to do with fluid changes and shifts in the body and will be relieved with rest, Tylenol/acetaminophen or Advil/Motrin/ibuprofen, and good electrolyte solutions for hydration. Then we should expect as the cold or flu is over, the headaches should go away as well.
Now if I have a kiddo with recurrent headaches that last for a few days or happen every few weeks or so, then I start looking for possible triggers for the headaches such as stress, neck pain, depression, poor diet, or poor sleep. I also check with other family members to see if they experience(d) headaches or migraines, as these do run in families. I will also make sure a kiddo’s vision is good, as eye strain is a very common culprit of headaches in our screen-crazy world. If it is determined that the kiddo has these otherwise benign recurrent headaches, then we try to keep track of what works to help relieve these symptoms and come up with a good headache prevention and action plan for the kiddo and family. This plan could be as little as resting in a quiet dark room to daily migraine prevention medicine. It all depends on the kiddo and their symptoms.