8 things to watch for when your child has a headache

Claire McCarthy, MD
Claire McCarthy, MD, Faculty Editor, Harvard Health Publications

Headaches are common in childhood. Most of the time, they are nothing to worry about and are caused by common minor illnesses, a mild bump to the head, lack of sleep, not getting enough food or drink, or stress. Migraines can also be seen in childhood, but with awareness and avoidance of triggers, they don’t usually cause problems.

Sometimes, though, headaches are a problem — and something to worry about. Here is when you should worry:

1. When a headache is accompanied by a fever and a stiff neck. Your child should be able to look up at the ceiling, touch his chin to his chest and shake his head back and forth. If he can’t, you should bring him to an emergency room to be sure he doesn’t have meningitis.

2. When the pain is severe and unrelenting despite acetaminophen or ibuprofen. Any bad pain anywhere deserves medical attention.

3. When a headache is accompanied by frequent or persistent vomiting, especially in the absence of other signs of illness like fever or diarrhea. It may just be a virus, and children may have vomiting after a head bump, but it’s worth a call to the doctor, as vomiting can be a sign of pressure on the brain.

4. When along with a headache, your child is unusually sleepy or has trouble walking, talking, or doing other normal activities. Again, it could just be a virus — but you should check in with your doctor.

5. When a headache wakes your child from sleep. Sometimes children wake up for other reasons and realize they have a headache; that doesn’t count. But if the pain itself is waking the child from sleep, that’s not the average headache and you should call your doctor.

6. When a headache is worse lying down. The way you most commonly notice this is that the headache is at its worst first thing in the morning and gets better as the day goes on. This is the opposite from the way most headaches happen, and can be a sign of increased pressure on the brain. If you notice that this is the pattern, call your doctor.

7. When the headaches are frequent — or are interfering with daily life. If your child has headaches two or more times a week, or they are making it hard for your child to do homework, play, or otherwise live a normal life, give your doctor a call. It doesn’t necessarily mean that something serious is going on, but it’s worth a visit to be sure — and to find ways to manage and hopefully prevent the headaches. This is particularly true if you find yourself giving your child medication frequently; it turns out that giving medication frequently can cause headaches to be more frequent.

8. Whenever there is something about a headache that worries you, even if it isn’t on this list. I always respect a parent’s instincts — and always want to allay a parent’s anxiety. So if something doesn’t seem right to you, or if you have a question, call your doctor. That’s what we are here for.

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