Healthy Child

If your child is past toddlerhood, chances are he has had at least one headache. And for many children, the increased stress levels and overtaxed eyes of back-to-school time make headaches all too routine.

For parents raised on a diet of made-for-TV movies, it's easy to fear the worst when children develop recurrent headaches. But the majority of headaches are not caused by brain tumors, says Dr. Trupti Gokani, a neurologist at Robbins Headache Clinic in Northbrook. Only one in 20 headache patients has any underlying disease, she says. And only a tiny portion of that group has tumors. Most headaches are caused by tension.

A tension headache, which people think of as typical, occurs on both sides of the head and is non-throbbing, non-nauseating and generally not incapacitating. The person may be sensitive to sound or light, but not both.

These headaches may be typical, but if they occur every day or every other day for two weeks, they still require a call to the pediatrician, says Dr. Kenneth Polin, a pediatrician with Town & County Pediatrics in Chicago. "When headaches occur that often, I want to check the child's blood pressure, examine the back of each eye and do a neurological exam," he says.

He suggests parents keep a diary to help pinpoint the cause of the headaches. Think of a headache diary as a way to record the "who, what, when, where, why and how" of your child's headaches. For example: Jot down where on her head the headaches occur; their frequency, including time of day; character, pounding or constant; the scale of pain from 1 to 10; what your child eats and does before and during headaches; how you relieve them and whether they interfere with daily activities.

"Sometimes the diary alone will tell us what to do next," says Polin. "I've had patients realize that too-tight ponytails were to blame, or that they only got headaches when reading or playing GameBoy, leading to a diagnosis of eyestrain."

Eyestrain is likely to be one of the first causes a parent suspects. But Dr. James McDonnell, director of pediatric ophthalmology at Loyola University Medical Center in Maywood, cautions that eyestrain-caused headaches aren't as common as people believe.

These problems, which occur when tiny muscles must compensate constantly, can be treated by an ophthalmologist or optometrist. Viruses, sinus infections and even strep throat are other common headache culprits.

Dehydration. Drink, drink, drink, but keep caffeinated beverages, such as soda, to a minimum. They actually make dehydration worse.

Weather. Barometric pressure changes wreak havoc on sensitive heads, so if this is one of your child's triggers, have him pay extra-close attention to other triggers on rainy days. Spring and fall are headache season, says Gokani.

Treatment and migraines As for treatment, try simultaneously applying heat to your child's neck and shoulders and ice to his forehead. Have him lie down in a darkened, quiet room. If you need more help, acetaminophen is safer but ibuprofen more effective, says Gokani.

Parents should also know that migraines-incapacitating headaches that may occur on only one side of the head-are common in children. Migraines often include nausea, vomiting and extreme sensitivity to sound and light. They run in families and often are controlled with medicine.

According to the American Council for Headache Education, 4 percent of U.S. children are diagnosed with migraines, but the group believes as many as 10 percent children suffer undiagnosed migraines.

Parents also should be alert for worrisome headache symptoms. Call your pediatrician about any headache that:

• is combined with confusion,

• coincides with a fever of 100.5 or greater,

• is present when the child wakes, but improves throughout the day.

Darcy Lewis lives in Riverside with her husband and two sons, ages 9 and 3.