Q: In the past six months or so, my 13 year old son has started complaining about headaches-they have even caused me to keep home from school on several occasions. Are these types of headaches normal in children, and how do I know if I should have his headaches evaluated by our physician?

A: Headaches in children are very common, with at least 40 percent of children experience a headache by age seven. The good news is that most headaches are not serious, and your pediatrician can help you develop strategies for preventing and managing headaches.

When evaluating recurring headaches, your child's doctor may ask you to gather information in advance of the appointment. Some questions may relate to:

  • Qualities of the headaches, such as frequency, location, severity and duration.
  • Past treatment methods.
  • Family history of headaches.
  • Lifestyle factors, such as nutrition, fluid intake, sleep patterns, exercise habits and stress.

Most children's headaches fall into two categories: tension and migraine. The pain of tension headaches usually starts slowly and may feel dull, like a band around the head. The pain usually is mild to moderate. Tension headaches typically do not involve stomach discomfort or sensitivity to light or sound.

Migraine headaches feel like a throbbing or pounding pain in the head. Children may also experience light and sound sensitivity, nausea, or vomiting with these headaches. Children with migraines often have family members who have migraines. Medications can be given at the time of the headache if they occur infrequently, but if they happen more than once per week or are very severe, a daily preventive medication may be needed.

For both tension and migraine headaches, lifestyle changes may help. A regular schedule of meals, adequate fluids and consistent sleep is very important. Stress management techniques can also help reduce the frequency or severity of pain.

In rare cases, headaches may be a symptom of a greater problem. Seek medical attention if your child's headaches are accompanied by changes in responsiveness or personality, vision problems, difficulty walking or talking or persistent vomiting. Your child's pediatrician may treat your child or refer you to a pediatric neurologist for further evaluation.

Tammy Langhoff, RN, MS, CPNP, is a nurse practitioner in the Headache Clinic in the Neuroscience Center at Children's Hospital of Wisconsin. The staff combines specialized care with current research and community outreach to provide the best care possible. Pediatric neurologists and neurosurgeons work together with child development, neuropsychology, genetics, rehabilitation, speech and other areas to address the unique needs of each child. For more information, visit www.chw.org/neurology.