Why take headaches seriously in school-age children?
In working with children with headaches, we should remember that:
- Headaches can be debilitating, and the child’s school performance may decline
- Headaches may affect the child’s willingness to participate in activities and social events
- Headaches may affect their relationships with friends and other family members
- Headaches may also be a signal that there is other trouble in the child’s life such as lack of sleep, poor eating habits, home stress, depression, or other illness or health concern
- Headaches may be a signal that there is something more seriously wrong with the child (infection, tumor, head trauma)
- Children may not tell the teacher or parent about their headaches because they do not want to be “different” or they may fear there is something seriously wrong.
- Parents may not be open and willing to discuss their child’s health history with the school.
Are headaches common?
Yes, headaches are a common problem in children. Most children under the age of 18 will have headaches at one time or another. When a child complains of a headache, they may have other several different kinds of headache, or headaches that come back over and over again:
- Recurring headaches occur in 38% to 83% of children 7 to15 year of age
- Recurring headaches occur in 1% to 37% of children 3 to 6 years of age
Migraine headaches occur in approximately 1.2% to 11% of children. During puberty, the frequency of migraine headaches increases in females, compared to males. This has been attributed to the changes in estrogen levels that occur with starting their menstrual cycle.
What types of headaches do children suffer from?
The two most common types of headaches are migraine and tension-type headache. Both of these are primary headache disorders. Primary headaches include:
- Migraine
- Migraine with aura
- Tension-type headache
- Cluster headache
Secondary Headaches: These occur as a result of some other health problem such as head injury, tumors, fever, medication side effects, or infection. Secondary headaches are rare.
How migraine is recognized in children?
When a child comes to the nurse’s office complaining of headaches, there are several questions that may be helpful in determining their medical needs:
- Ask the child if they have ever been to the doctor for headaches. This tells us if there is a history of headache that has not been added to the student’s school records.
- Ask if they had ever been told they have migraine or other types of headaches. This tells us if there is an established diagnosis of headache that has not been added to the student’s school records.
- Ask if they have sensitivity to light, are nauseous or have difficulty doing tasks or activities (disability).
These are three common symptoms of migraine. If the child has 2 or 3 of these symptoms, they likely to have migraine and should see their doctor.
Look for warning signs in students who complain of headache. In rare circumstances (less than 1% of the population), headache is caused by another condition. Warning signs to look for include:
- Consistently awakens from sleep due to headaches
- Early morning vomiting without nausea
- Worsening of more frequent headache
- Personality changes
- Complaints that “this is the worse headache I’ve ever had!”
- Changes in headache features
- Accompanying fever or a stiff neck
- Headaches that follow a head or face injury
What medications are appropriate?
Before any medication is given, it is important to have parental consent for treatment.
Acute treatment for headaches
- MIGRAINE HEADACHES
General analgesic medications
- Acetaminophen (Tylenol®)
- Ibuprofen (Advil®, Motrin®)
- Isomethepene Combination Products (Midrin®)
Migraine-specific medications — Triptans
- Almotriptan (Axert®)
- Eletriptan (Relpax®)
- Frovatriptan (Frova®)
- Naratriptan (Amerge®)
- Sumatriptan (Imitrex®)
- Rizatriptan (Maxalt®)
- Zolmitriptan (Zomig®)
- TENSION-TYPE HEADACHES
- Acetaminophen (Tylenol®)
- Ibuprophen (Advil®, Motrin®)
Preventive treatments
Antiepileptic Medications
- Divalproex sodium (Depakote®)
- Topiramate (Topamax®)
Antidepressants
- Tricyclic antidepressants (amitriptyline)
- SSRIs (fluoxetine [Prozac®])
Beta-blockers
- Propranol (Inderal®)
How can teachers help a child with headache?
Plenty of fluids
Children and adolescents need from 4 to 8 glasses of fluid a day. Many teachers allow water bottles in class to help reduced dehydration in children.
Regular sleep
Most children need a regular 8 to 10 hours of sleep a night. Too much and too little sleep are triggers in the headache world. Encourage the children to get their work done early and maintain regular sleeping routines.
Regular meals
Well-balanced and regular meals are very important-skipping meals is a common cause for headache. Certain foods can trigger a migraine: the biggest examples of food triggers are processed meats and cheeses, caffeine, MSG, and chocolate.
Reduce stress
The child may be doing too many activities, and discussions with the family and student may help maintain an acceptable schedule.
Encourage self management
Allow children to go to the nurse to seek appropriate care for their headaches.
School nurses and teachers have a great opportunity to make a true difference in a child’s life.