When Noreen Rishko's son Kevin was a toddler, he often complained that his head hurt. "I used to won der how a little kid could get headaches," says Rishko, an Agoura real estate agent and mother of three boys.
Headaches are actually fairly common among children: studies show that from 21% to 55% of children get them, and from 4% to 10% of children have migraines. The American Academy of Pediatrics says that most teen-agers have at least one headache a month.
For most parents, the biggest concern is to rule out the small chance that the headaches could be caused by something serious, such as a brain tumor, said Dr. Maurice Fields, a pediatrician and coordinator of pediatric education for Northridge Hospital Medical Center's Family Practice Residency program. Physicians typically perform a neurological examination to rule out such problems, he says.
By far the most common cause of headaches in children is tension, Fields says. Not only do kids have their own concerns, but children sense their parents' anxiety and problems.
"There's an increasing amount of stress with the world around us, and even younger children react to the reaction of their parents," he says.
Headaches also are frequently caused by allergies and infections--such as sinusitis, viral infections, strep throat and urinary tract infections. Not getting enough fluids, skipping meals or fatigue can also trigger headaches. Alcohol, cocaine, amphetamines, diet pills and other drugs also may cause them. And problems such as dental infections, jaw-alignment problems or eye-muscle strain can be associated with headaches.
Occasional headaches are not cause for concern, Fields says. But if a headache persists over a period of a few days, or if there is a high fever, seizure, blurred vision, stiff neck, head injury or changes in vision, the child should be seen by a physician.
The American Academy of Pediatrics also suggests that children should be medically evaluated if they get headaches more than once a week, or if the pain prevents a child from such activities as going to school or playing.
For most headaches, the most effective treatment is rest, relaxation and acetaminophen (Tylenol) or ibuprofen (Advil), Fields says. "Use a common-sense approach and create a situation that minimizes stress, making the child as relaxed as possible."
Sometimes such measures are ineffective. In Kevin Rishko's case, his headaches began to get increasingly intense, and more and more often he was becoming nauseated and would vomit as the headache emerged. After he was checked out by a physician, the family learned that Kevin's headaches could be genetically caused; his father has migraines. At least 75% of children with migraines have a parent or close relative who gets them.
Noreen Rishko treats Kevin's biweekly headaches with Tylenol, which she always carries in her purse. If he can fall asleep, he usually wakes up feeling fine, she says.
For children for whom those basic efforts do not work, attempts at prevention may be effective.
Physicians may ask parents to keep a detailed food diary to help them look for possible headache triggers, such as cheese, nuts, chocolate, fish, smoked foods and processed meats, says Dr. Sanford Schneider, a professor and head of the division of child neurology at Loma Linda University.
In some cases, medications that are most commonly used to treat high blood pressure in adults, such as Inderal and Verapamil, may be tried. Schneider says those drugs are effective for about half the children who take them.
Some children are relieved of headaches through biofeedback, which helps them learn how to relax tenses muscles, or relaxation therapy--such as deep-breathing exercises, self-hypnosis and meditation. For others, following a regular eating and sleeping schedule can help.
About one-third of the children who suffer from headaches will outgrow them as they mature, Schneider says. The others, however, may find the problem increasing as the hormones of adolescence and adulthood add new stimuli--and possibly, more stress.
Where and When Information: For a free copy of the American Academy of Pediatrics booklet, "Important Information for Teens Who Get Headaches," send a self-addressed stamped envelope to the American Academy of Pediatrics, Dept C, Headaches, P.O. Box 927, Elk Grove Village, IL 60007-0927.