Headache in Children

Just like adults, children also have headaches. It has been shown that the frequency of headaches increases with the start of school life. Recurrent headaches can cause school problems and learning difficulties. Parents often dismiss children's headaches by attributing them to reasonable causes before their complaints become serious and chronic. The underlying causes may be ordinary causes or they may be a sign of life-threatening problems. Therefore, it is necessary to evaluate headaches in children in detail and reveal their causes.

What are the sources of headaches in children?

We move our head inside the skull (intracranial) and We can consider it as organs and structures other than (extracranial). Our brain itself, located within the skull, is not sensitive to pain. However, any situation that compresses the brain, puts pressure on it, and affects the fluid and blood flow inside it causes us to feel pain through the pain-sensitive brain membranes, vessels and nerves coming out of the brain. In other words, headache is the harbinger, or alarm, of the disorder that has occurred.

The arteries and veins of the face and head, the striated muscles of the head and neck, teeth, sinuses and the mucosa and bone membranes there, and the eye socket are structures outside our skull that are sensitive to pain. .

Studies show that age, gender, family history of headaches (primarily in the mother and father) and presence of motion sickness are important factors that increase headaches. While headaches occur equally in boys and girls until the age of seven, their frequency gradually increases in girls after this age. While the frequency of recurrent headaches is 2.5% until the age of seven, this rate increases to 15% at the age of 15. It is twice as common in girls than in boys during early adolescence.

What are the types of headaches in children?

Headaches are scientifically classified as primary and secondary headache disorders.

Primary disordersWe primarily see migraine, tension-type and cluster-type headache disorders. These types of headaches are usually repetitive and chronic. they said. They are not life-threatening, but they negatively affect the quality of life. Environmental factors can be triggers for this type of headache. For example, noise, excess light, hunger, fatigue, insomnia, stress, windy and high-pressure weather, and some foods (cheese, chocolate, caffeinated drinks, some fruits, ready-made foods containing monosodium glutamate, etc.) increase headache attacks. Except for the crises, the patient is completely normal.

Headaches, which we call secondary typedisorders, occur more frequently and for more reasons. They are generally not recurrent, but they can be chronic depending on the cause. Although they are frequently encountered as a cause of headache (e.g. acute sinusitis), very few of them are sudden, life-threatening and progressive (aneurysm rupture, brain tumor, etc.).

• Head and neck trauma. related
• Due to head and neck vascular events (bleeding, aneurysm, anomaly, etc.)
• Due to events that occupy non-vascular space in the head (tumor, etc.)
• Habitual due to substance or its withdrawal
• Due to infection (meningitis, encephalitis, etc.)
• Due to coagulation disorders (thrombosis, etc.)
• Skull bones, nape, eyes, ears, nose , sinuses, teeth, face or other structures
• Due to systemic diseases (hypertension, etc.)
• Due to sleep disorders or excessive fatigue (including excessive use of computers, tablets, phones)
• It may be due to psychiatric disorders.

What information should we learn in the history of a child with a headache?

How and when did it start?

The course of the headache: sudden, initial pain, recurring, every day, gradually increasing?

Is the headache uniform or are there different forms?

How often does it come and how long does it last? ?

Do you know when a headache is coming?

Where is it located and its characteristics (throbbing, compressing, stabbing, etc.)

Are there any accompanying symptoms? Runny nose, vomiting, dizziness, numbness?

What helps or worsens headache? Activity, medications, foods…

Does the headache interfere with daily activity?

Headache is a special symptom. Is it specific to the period or time period?

Are there any other symptoms when there are no headaches?

Are there medications used for treatment?

Are there any other medical problems?

Does anyone in the family suffer from headaches?

How many hours are spent on mobile devices (computer, TV, phone, tablet, etc.) per day?

Sleep patterns and What is its relationship with pain?

Is there anything you think is the cause of your headache?

What examinations should be performed in children with headache?

Laboratory strong> examinations are requested for differential diagnosis. Blood tests are especially important for detecting anemia. In cases of severe anemia, there is a complaint of headache. Sinus radiographs may be requested in cases suggestive of infection. If a postnasal discharge that the physician sees during the examination is accompanied by clinical findings, a sinus film is unnecessary. Head radiography is very rarely necessary and is normal in most patients with headache. Considering the harmful effects of x-rays, it is not desired unless absolutely necessary.

EEG: not recommended as part of the routine evaluation of headache. However, headaches are very common after epileptic seizures. EEG is useful when the patient is thought to have a loss of consciousness, a change in consciousness, or an epileptiform disorder, or when the cause of headaches is unknown. In migraine with aura, those with seizure-like symptoms should be examined for differential diagnosis.

Cranial imaging (MRI, Tomography, etc.): Not everyone with a headache needs an MRI or tomography. According to the globally accepted American Academy of Pediatrics criteria, routine imaging is not required if the neurological examination is normal in a child with recurrent headaches. Imaging is primarily recommended for children with a history such as the following:

Those with new onset severe headache (less than 1 month in duration), those with a change in headache type, those with neurological disorders

Those with an abnormal neurological examination. Imaging is recommended in children (focal findings, increased intracranial pressure findings, significant change in consciousness) and if seizures are accompanied.

Headache that wakes up from sleep, brain tumor history in relatives. Imaging may also be done for reasons such as extreme anxiety of the family or exclusion of rare conditions.

How is headache treated, what should be taken into consideration?

Occasional short-term and Mild pain is common and usually does not require special treatment. Treatment is necessary for pain that is moderate or severe, recurring or progressive.

The first step of treatment is to identify the causes of headaches and try to avoid these causes before drug treatment.

Acute treatment of headaches and the onset of crises. Drug treatments to prevent its occurrence are different and should be done in accordance with the doctor's recommendation. Continuous and excessive use of painkillers without medical supervision may cause damage to vital organs such as the kidneys and liver. First of all, a treatment approach should be chosen to eliminate the cause. For example, the medication chosen for sinusitis and the treatment chosen for hypertension are different. Likewise, while surgical intervention is required in the treatment of hydrocephalus and brain tumor, appropriate glasses can be therapeutic in vision-related headaches such as refractive error.

Since eye and vision problems in children cannot always be easily detected, routine eye examinations may be performed even if there are no complaints. It is recommended to go away.

Unless the conditions causing the headache are eliminated, treatments will either provide short-term benefit or be ineffective.

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