Children sometimes complain about the appearance of headaches, and parents, without a moment’s hesitation, go to the first-aid kit for syrup or an anesthetic tablet, give it to the child and forget about the problem.
Such a frivolous attitude to headaches in children is fraught with sad consequences. After all, a headache is not a disease, it is a symptom, a kind of body signal about problems. Perhaps the baby was simply overtired or overheated in the sun, but recurrent headaches, especially those that appear abruptly, are a dangerous symptom that requires attention.
Complaints about headaches are the second most “popular” after abdominal pain in children. Moreover, not only grown-up children who can complain, but also very young children, even newborns, suffer from them.
The equivalents of headaches in infants can be considered increased tearfulness, agitation, vomiting, sleep disturbances and regurgitation with a fountain. In a year or two, children can talk about fatigue instead of complaining of a headache, they want to lie down and require attention. It is believed that up to 40% of girls and 30% of boys of school age periodically complain of headaches.
Types of headache
Headache, or cephalgia, in children can be conditionally divided into three fairly large groups:
pains of an organic nature due to volumetric or infectious processes in the head (meningitis, encephalitis, cysts, tumors or impaired outflow of cranial fluid).
functional pain – due to a violation of the blood supply to the brain as a result of diseases of the internal organs, fatigue or any other reasons leading to irritation of pain receptors in the vessels of the head.
Migraine is a neurological disease. It is manifested by attacks that can occur with different frequencies – from 1-2 times a year, to several times a month. The main manifestation of a migraine attack is a headache, which can be very severe.
In children, the most common causes of headaches are, first of all, infections of a general nature – SARS, pneumonia, infections of the kidneys, digestion, and infections of the nervous system. In addition, headache can be a symptom of mental disorders, neurosis, migraine, traumatic brain injury. These reasons, fortunately, do not occur very often. Usually, a child’s head hurts for more banal reasons: prolonged stress, emotional stress, excessive workload, too short or too long sleep, sitting at the computer or watching TV for a very long time, problems at school or family. They can cause quite severe overwork headaches due to sports, poor nutrition, especially in teenage girls who want to lose weight. A headache can also be a sign of an allergy to foods such as milk, cheese, or chocolate.
If your head hurts from tension
Due to fatigue, overwork and tension, the head in children hurts most often – usually it happens on emotional days, when the weather changes, after studying or exams, from sitting at the monitor.
Usually children describe it as a strong pressure from inside the skull, but, nevertheless, they tolerate it well, it does not deprive them of activity and the opportunity to do things. With her, there is no nausea, fever, she can pass by herself after sleep or rest.
Dependence on age
If your child is still quite a baby, he usually cannot complain about a headache or show the exact place where he hurts. Then you can indirectly suspect a headache in him by irritability, tearfulness, anxiety, the baby can rub his head against you, put it in your palm. With a headache, the whites of the eyes may turn red, yawning may appear. Older children may complain of headaches, and you should always respond to their complaints without considering them a simulation.
In schoolchildren, fatigue is usually the cause of periodic headaches. But if such pains still do not go away even after rest or sleep, they are systematic, prevent the child from studying and resting – this is a reason for examination. Plan your child’s day so that he has time to relax after school, but not at the computer, but on the street or in training, although you should not be zealous there either. It is important to intelligently and moderately combine mental work, housework and sports. During headache attacks, stay with the child, but do not turn his pain into something supernatural, otherwise the child will begin to take advantage of his painful position. Headache is a subjective sign, it can be simulated.
Sometimes the occurrence of a headache is a serious symptom of anxiety and requires urgent medical advice or an ambulance call. These are the following states:
- sudden onset headache with vomiting, nausea, fever, convulsions, loss of consciousness or weakness in the limbs,
- severe headache after a fall, hitting the head, injury,
- severe headache with otitis media or sinusitis,
- headache with nosebleeds,
- headaches in the morning, after exercise, after rest.
How to relieve a headache attack
In cases where the child complains of a headache, and there are no other manifestations in the form of nausea or the symptoms described above, you can give him a mild Nurofen painkiller or half the dose of paracetamol, and put the child to bed. This is usually enough for the headache to go away.
Important: do not give children under 12 years of age aspirin, analgin, citramon and any other “adult” means to relieve headaches – they negatively affect the child’s blood and stomach. How to examine children For recurrent headaches, parents should take the child to see a pediatrician or neurologist, although an ENT doctor and an ophthalmologist will then be included in the examination.
What tests to take for a headache
It will be necessary to pass general tests – blood and urine: this will eliminate anemia and infections. And then carry out encephalography, ultrasound of internal organs and other studies up to computed tomography and magnetic resonance if volumetric processes of the head are suspected. If necessary, the child will even be admitted to a hospital for treatment. However, we hasten to reassure parents: in the vast majority of cases, headache attacks have the simplest causes – stress, fatigue, excessive workload, anemia or malnutrition. When they are corrected, the headache quickly disappears.
Migraine in children: features
It occurs in any childhood and may debut before the age of 3 years. The main distinguishing features of a migraine attack in children are a short duration (from 30 minutes to several hours) and bilateral localization of the headache. Lateralization of the headache with an emphasis on one side (hemicrania) is usually noted in adolescence. The most common localization of headache in children with migraine is in the forehead (60.9%), in the temporal (38.67%) and periorbital zone (53.17%) 9, 10.
The nature of the pain during an attack in children may also differ, usually it is a pounding, squeezing headache with elements of pulsation. In most cases, a migraine attack in a child is accompanied by distinct vegetative manifestations (pallor, general weakness, non-systemic dizziness, “dark circles” in the periorbital zone, swelling of the face, sometimes nasal congestion). It has been established that the peak incidence of migraine with aura in boys is observed at the age of 10–11 years, and in girls at the age of 14–17 years The development of the first migraine attack is almost always an indication for a detailed examination of the child and the exclusion of secondary causes – , intracranial volumetric formations, anomalies in the development of the craniovertebral junction, etc.)
Practical difficulties are noted in the diagnosis of migraine before the age of 5 years. Here are a few basic recommendations to help diagnose migraine in children:
- migraine attacks in children are significantly shorter than in adults (from 30 minutes).
- Migraine in childhood is characterized by bilateral pain of frontal localization.
- The severity of headache in children is preferably assessed by assessing changes in the child’s daily activities during an attack.
The presence and severity of concomitant symptoms (photo-, phonophobia) should also be assessed by the child’s reaction to surrounding sources of noise and bright light and, to a lesser extent, with the help of direct questions.
GB only occipital localization requires increased attention and clarification of the causes of pain. Moreover, if the occipital headache is not accompanied by abnormalities in the development of the child, neurological status, there are no other indications of the symptomatic nature of the pain syndrome, then the isolated localization itself is probably not an increased risk of developing secondary headache.
The classic characteristics of migraine are usually noted in the late teens. Before the age of 12–13 years, the clinical manifestations of migraine may mimic tension headache. The paroxysmal nature of headache, identification of triggers, autonomic accompaniment of headache, concomitant manifestations in the form of the phenomenon of motion sickness in transport, children’s periodic syndromes help to make the correct diagnosis.
Accompanying a headache attack with non-systemic dizziness and a feeling of stuffy ears, a combination with seasickness are characteristic of childhood migraine.
- The frequent occurrence (about 70%) of vegetative symptoms is a distinctive feature of a migraine attack in childhood. Unlike adults in children, vegetative symptoms, as a rule, are bilateral.
Treatment of migraine in children
• non-drug therapies; • treatment of a migraine attack • prophylactic treatment of frequent and chronic forms of migraine.
The main non-drug methods of migraine treatment are: sleep schedule, regular health-improving sports load, adherence to the diet and exclusion of food provocateurs.
Treatment of migraine attacks:
For the symptomatic treatment of mild to moderate migraine attacks in children and adolescents, simple analgesics (paracetamol) and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used.
With the ineffectiveness of NSAIDs and severe migraine attacks, international recommendations show the use of triptans, anti-migraine drugs, selective agonists of serotonin 5-HT1B and 5HT1D receptors.
Currently, in the United States, Canada and the European Union, 3 representatives of the triptan group are approved for use in children: sumatriptan, rizatriptan, zolmitriptan. It should be noted that in the Russian Federation, none of the representatives of triptans is approved for use in patients under 18 years of age.
A migraine attack in children is often accompanied by nausea, sometimes vomiting, which can significantly reduce the effectiveness of pain relief. Thus, for the successful relief of a migraine attack in children with concomitant nausea and vomiting, the combined use of antiemetics and analgesics is recommended. Antiemetics (metoclopramide, domperidone, hydroxyzine) should be used at age-specific dosages, preferably in the form of a suspension, suppositories, or parenterally for severe attacks.
Preventive therapy for migraine
For the preventive therapy of migraine in children and adolescents, drugs of various groups are used: β-blockers (propranolol), antihistamines (hydroxyzine), antidepressants (amitriptyline), anticonvulsants (topiramate, valproic acid, levetiracetam), calcium channel blockers (flunarizine), NSAIDs ( ibuprofen, naproxen short course)
The course of preventive therapy in adolescents should take at least 6 months. In children aged 3 to 9 years, it is advisable to use short courses of treatment (8-12 weeks) with gradual withdrawal of the drug and dynamic monitoring. The drugs of first choice for the prophylactic treatment of migraine in pediatric practice are: propranolol, flunarizine*, topiramate, amitriptyline. For rare attacks, you can prescribe vitamin B2 together with magnesium and focus on non-drug methods of prevention.