Headaches affect children of all ages, from toddlers and preschoolers to teenagers. Although most headaches are not caused by serious medical conditions, frequent headaches can negatively affect your child’s school, sleep, activities, and time with family and friends.

If your child has been experiencing frequent headaches or migraine attacks, you don’t have to figure it out alone. Our team at Norton Children’s Neuroscience Institute includes physicians with specialized training in pediatric headache medicine.

We understand that headaches in children can look and feel different than headaches in adults, and that a 3-year-old and a 15-year-old need very different evaluations. The symptoms of a headache look different depending on a child’s age, development and ability to describe what they are feeling. Every child needs a plan built around their specific needs, not a one-size-fits-all approach.

Our goal is simple: help your child feel better so they can get back to being a kid – learning, playing, participating in activities and enjoying everyday life.

Headaches in Young Children (Ages 2 to 5)

Preschool-age children may not be able to say, “My head hurts.” Young children often communicate pain through changes in behavior instead of words.

Sometimes, abdominal pain can be a clue to a headache. Young children frequently describe a headache as a “tummy ache,” and stomach symptoms can accompany headaches at this age. A preschooler who reports stomach pain, avoids bright light and wants to lie down may be describing a headache in the only vocabulary they have.

Signs of a headache in young children may include:

• Holding, rubbing or pulling at the head or ears
• Becoming unusually irritable or clingy
• Refusing to play or suddenly losing interest in normal activities
• Wanting to lie down or rest in a dark, quiet room
• Squinting, closing the eyes or avoiding bright lights
• Nausea or vomiting
• Complaining of a stomachache or abdominal pain
• Sudden tiredness or loss of energy
• Changes in eating or sleeping patterns

Because many of these symptoms also occur with common childhood illnesses, parents should pay attention to when symptoms happen, how long they last and whether they follow a pattern. This information can help the healthcare provider determine a diagnosis when the child is too young to describe their symptoms in verbal detail.

Headaches in School-age Children and Adolescents

Older children usually are better at describing their headache symptoms. They may report:

• Throbbing or pulsing pain
• Pressure or squeezing around the forehead or head
• Pain on one or both sides of the head
• Sensitivity to light, sound or smells
• Nausea or vomiting
• Vision changes or an aura before a headache
• Neck or shoulder tightness
• Difficulty concentrating at school
• Fatigue or changes in mood

Keeping a headache symptom diary, including timing and possible triggers, helps the child’s provider determine the specific type of headache that may be occurring.

When to Seek Emergency Care

Most headaches in children are not a sign of a serious condition. However, certain symptoms need prompt evaluation.

Call 911 or go to the nearest emergency room if your child has:

• A sudden, extremely severe headache that peaks within seconds
• A headache with high fever and a stiff neck
• Persistent vomiting, confusion or unusual sleepiness
• A headache that wakes your child from sleep or is worse early in the morning, especially with vomiting
• A headache following a fall, sports injury, car crash, head injury or concussion
• Weakness in the arms or legs, or drooping on one side of the face
• Numbness, trouble walking, trouble talking or loss of balance
• Significant changes in vision
• A seizure
• A sudden or significant change in behavior, personality or alertness

Contact your child’s pediatrician if you notice your child’s headaches arebecoming more frequent or more severe; are interfering with school, sleep or normal activities; or start to feel different from previous headaches.

Four Main Types of Pediatric Headaches

Headaches in children can vary in their symptoms, frequency and severity — and the same headache type can look entirely different in a preschooler than it does in a teenager. Our pediatric headache specialists care for children with a range of different headache conditions.

Migraine Headaches

Pediatric migraine headaches can occur in young children and teenagers.

In young children, migraine typically does not last as long as in adults, sometimes only one to two hours, and may not have the same symptoms as a headache. For example, a child may suddenly become tired, pale, nauseated or irritable. The child may develop abdominal pain or vomiting, cry, and want to sleep or stay in a dark room. Parents often describe it as a child who was fine one moment and “shut down” the next.

In older children and teens, migraine more often follows the pattern adults recognize: throbbing or pulsating pain across the forehead or on one side of the head, along with sensitivity to light or sound, nausea, vomiting or visual changes.

Tension Headaches

Tension headaches cause steady pressure rather than throbbing pain.

In young children, this may look like restlessness, irritability, rubbing the forehead or neck, or unusual trouble settling down for a nap or bedtime.

In older children and teens, symptoms are usually described as:

• Dull or aching pain
• A band-like squeezing pressure around the forehead
• Tightness in the neck or shoulders
• Headaches tied to fatigue, school stress or long periods of concentration

Cluster Headaches

Cluster headaches are uncommon in children and extremely rare in very young children. When they occur, they cause severe, piercing pain around one eye. Symptoms may include:

• Eye watering
• Redness around the eye
• Nasal congestion or drainage on the affected side
• Eyelid swelling or drooping

Children with symptoms of cluster headaches should be promptly evaluated by a healthcare provider.

Chronic Headaches

Chronic headaches occur 15 or more days per month for at least three months.

In young children, this rarely is verbalized as pain. It more often appears as ongoing fussiness or irritability, reduced activity or recurring behavior changes over weeks or months that have no obvious explanation.

In older children and teens, it usually means mild to moderate headache pain on many days of the month.

Frequent use of over-the-counter pain medication also can contribute to headaches caused by medication overuse, sometimes called “rebound headaches.” Your child’s healthcare provider can help determine how often headache medication can be used safely.

Common Headache Triggers in Young Children and Teens

Many headaches in children are linked to everyday factors that disrupt the body’s normal routines or nervous system. Symptoms can vary from child to child.

Common headache triggers in young children:

• Dehydration
• Missed meals or snacks
• Disrupted naps or changes in sleep schedule
• Viral illnesses or fever
• Vision strain
• Stress from changes in routine or environment, such as starting preschool
• Too much physical activity without enough food or fluids

Common headache triggers in school-age children and adolescents:

• Academic or social stress
• Irregular sleep
• Skipping meals
• Dehydration
• Caffeine
• Extended screen time
• Hormonal changes during puberty
• Changes in daily routine

Diagnosis and Pediatric Headache Care

Diagnosing headaches in children begins with a detailed medical history and a physical and neurological examination.

For young children, providers inquire about a parent’s observation and use examination techniques designed for small children. Neurological exams are done gently and in a way that isn’t frightening.

What a parent notices at home can be helpful for a diagnosis. Information about behavior changes, sleep, appetite, vomiting, light sensitivity and activity level often is more useful to a provider than what a 4-year-old can put into words.

The child’s provider may ask a parent to keep a headache diary that tracks:

• When headaches happen
• How long symptoms last
• What your child was doing beforehand
• Foods and fluids consumed that day
• Sleep patterns
• In younger children, any behavior changes that may signal pain
• Other symptoms
• Medication given and whether it helped

Imaging and more advanced testing are not necessary for every child with headaches. The child’s provider will determine whether further testing is appropriate based on symptoms, examination findings and medical history, and refer additional testing when needed.

Pediatric Headache Treatment

Headache treatment depends on the type of headache, the child’s age, their symptoms and how often headaches occur. Each plan is personalized based on the child’s condition and unique needs. A headache treatment plan may include:

• Age- and weight-appropriate medication. Dosing is calculated specifically for growing bodies, with particular care in the youngest patients
• Nonmedication strategies. Hydration schedule, consistent meals and snacks, regular sleep and nap routines, and adjustments to daily routines that may be contributing to headaches
• Stress management and behavioral health support
• Treatment of any underlying medical conditions
• Preventive medication when headaches are frequent or severe
• Advanced options: For children with complex or hard-to-treat symptoms, migraine treatment options such as Botox and acupuncture are available when medication alone isn’t providing enough relief

At Norton Children’s Neuroscience Institute, care is coordinated seamlessly across a multidisciplinary team — your child’s pediatrician, pediatric neurologists and child life specialists — so that your child’s treatment plan is appropriate for their age, stage of development and lifestyle.