Headaches in childhood
Headaches and migraines are uncommon before the age of four, but all types of
headaches seem to increase as children get older. A study done in 1962 among
9,000 school children demonstrated an equal rate of increase in prevalence of
headache in boys and girls up to the age of 10 to 12 followed by a faster rate
in girls thereafter. Later studies totaling more than 27,000 children reported
a prevalence of headache of 37 to 51% in seven-year olds, increasing to 57 to 82% by
the age of 15.
The male to female ratio below age 12 is 1:1, compared to 1:1.5 in
teenagers and adults. The prevalence rate of migraine in boys increases from 4 % at age seven
to 6.5 % at age 13. In girls the prevalence increases from 3.6% at age seven to 15% at
age 13. 70 percent of children experience headache at least once a year with a
prevalence of greater than 90% at age 12-13. Most childhood headaches are
migraine or tension-type in origin.
Different kinds of headaches
Because no one clearly understands the causes and basic mechanisms of headaches in
children and why age-related differences occur, classifying headaches is
not straightforward. One way is to categorize them according to their severity
and frequency. Another way is to think about them is as primary headaches—those that
seem to have no underlying cause, such as migraines, cluster-type headaches and tension-type headaches—or as
secondary headaches, those that occur because of other treatable problems, such as
problems in the structure of the brain (the least common type).
- Migraines in children - Multiple studies suggest that
migraine headaches, especially those that are accompanied by an aura, do
indeed have a genetic component. The most common triggers are stress, sleep
deprivation, dietary factors, illness and travel, although sometimes no
trigger is identified.
- Migraine without aura represents 70 to 85% of childhood migraine. A
visual aura is not present, but the child may be pale or lethargic.
- In migraine with aura , a visual aura is most common and may include
bright lights, moving lights, and a "blind spot" in the child's visual
field. These symptoms typically occur 15 to 30 minutes before the headache.
Both types may be associated with abdominal pain, nausea, vomiting, and an
aversion to light and to noise.
Current theories about migraine
headaches - One theory suggests that migraines are caused by an initial period
vasoconstriction (narrowing of the blood vessels in the brain) followed by
vasodilation (a relaxing of the vessels), which causes the pain. However,
studies of the blood flow in the brain do not seem to support this view.
Another theory that seems to be gaining acceptance suggests that some people
are genetically susceptible to certain substances that cause an inflammation
of the thin membrane (the dura) that covers the brain.
- Cluster headaches - Cluster headaches usually start in
children older than 10 years of age, and are more common in teen boys. Cluster
headaches usually occur in a series that may last weeks or months, and this
series of headaches may return every year or two. While every child may
experience symptoms differently, the following are the most common symptoms of
a cluster headache:
- Severe pain on one side of the head (usually behind one eye) the eye
that is affected may have a droopy lid, small pupil, or redness and swelling
of the eyelid
- Runny nose or congestion
- Swelling of the forehead
- Tension-type headaches - These are a benign
condition without underlying cause and without paleness and lethargy. Pain is
typically in the front or back of the head with a squeezing/tight sensation.
Neck muscles are often sore. The headache occurs at least 15 times per month
and lasts 30 minutes to 7 days.