Headache in Children
Headache, which we usually encounter in the adult age group, is frequently seen in children with age. Do not underestimate headaches that may be a sign of serious illness in children. Headache is a very common complaint in society. Approximately 91% of men and 96% of women have headaches at least once a year. The frequency of headache in children increases with age. While it is 20-24% in preschool period, it reaches 75% in adolescence. 8-10% of the patients admitted to pediatric neurology for the first time consist of headache patients. 12% of children cannot go to school at least once a year due to headache. Studies show that migraine is the most common type of headache and occurs in 3-10% of children. The frequency of headache is higher in males between 3-5 years of age, but increases in girls after 5 years of age and is seen equally in both sexes between the ages of 9-11.
Why does headache occur?
Headaches occur as a result of physical, chemical or inflammatory effects of pain-sensitive structures of the head. The brain and most of the membranes that cover the brain do not have structures that perceive pain, which are called “pain receptors.. Pain-sensitive structures of the head; membranes covering the inner surface of the skull in the head, periosteum, vessels inside the brain, especially the vein walls, while outside the head; scalp and arteries, gums and muscles. Diseases of the paranasal sinus, eyes, teeth, head and face bones can also cause headaches.
Risk factors leading to headache
Infections (Meningitis, “encephalitis”, inflammation of brain membranes and brain tissue, sinusitis, mastoiditis, ear-eye-mouth-neck infections)
Intracranial hemorrhage, head trauma
Space occupying formations (tumor, cyst, hematoma)
Systemic diseases (cancers, fever, hypertension, brain edema, hemorrhages, “hypoxia”, oxygen deficiency, düşük low blood sugar and blood sodium ”hypoglycemia and hyponatremia)
Epilepsy attacks and post-seizures
Procedures (long-term stretching of the head during surgery, brain-spinal cord, etc.))
Increased intracranial pressure (Drugs, vascular inflammation, hypo-hypervitaminosis)
Tension, depression, anxiety, stress, psychogenic causes
Types of Headaches
Acute Headaches: Sudden onset, increasing headaches; If local, it may be sinusitis, ear, eye, dental infections or an initial migraine attack. If there is widespread pain; systemic infection, fever, trauma, hypertension, hypoglycemia, central nervous system infection, electrolyte disorder, or first migraine attack.
Migraine: The most common cause of acute-recurrent headache in children. The incidence of migraine in children has increased in the last 20 years. Headaches are accompanied by attacks, restlessness, nodding, malaise, discomfort from light and sound. The pain is often bilateral and throbbing behind the eyes, forehead, behind the ears. Nausea, vomiting may accompany pain. Pain, stress, fatigue, insomnia, exercise, hunger, noise, journey, cold weather, various odors, caffeine, nitrite, monosodium glutamate can initiate foods containing.
Migraine with aura: Sensory, visual and motor symptoms seen 30-60 minutes before headache.
Migraine-Simple Migraine: It constitutes 85% of migraine attacks in children. Pain may include excessive mobility, restlessness, depression, excessive thirst and pallor. Headaches can last for 1-72 hours. Light and sound may be uncomfortable. The patient can sleep 8-10 hours after severe pain.
Tension Type Headache: It is caused by muscle contractions. Exacerbations may be short-lived for 30 minutes or pain for 1 week. It is the most common type of headache in the community. It is usually double-sided, compressive, compressive, does not increase with physical activity, can spread to the back of the head and neck. It is mild and moderate.
Chronic, Daily Headaches: Headaches lasting all day long for 15 days or more in a month. It was found that 45% of these headaches were accompanied by psychological causes.
Chronic Progressive Headaches: Pain with the worst prognosis of all headaches. Causes of intracranial pressure increase, mass lesions, tumor, abscess, hydrocephalus, etc. should be investigated.
Cluster Type Headache: It is rare in children and adolescents. Unilateral and pain behind the eyes. Together with the eyes flushing, live and runny nose is observed.
In which situations is brain imaging performed in children with headache?
• Very sudden onset of severe headache
• Chronic, progressive headache
• Abnormal neurological examination findings
• Abnormal eye movements
• Sleep-waking headache, vomiting when waking up
• Pain and balance disorder
• Under 3 years
How is headache treated?
Patients with headache usually present when the pain becomes more frequent, increases in severity or disrupts daily activity. History, examination and necessary investigations should be performed to show that headache is not related to an underlying cause (secondary headache such as infection, tumor, bleeding, etc.). Showing that headache is not a serious cause relieves parents and children.
Occasional, short-term, and mild pain in children is common, usually does not require treatment. Headaches with moderate or recurrent or progressive adverse effects on daily activity, social life and school are required.
The education of the patient and family is important in controlling headache. The headache diary with the family should be created.
Non-Drug Treatments
Especially in migraine, it is necessary to avoid the factors known to initiate pain, to detect foodstuffs known to trigger migraine, and to remove the fabricated foods containing additives from the diet.
Regular sleep, school and homework times should be set, meals should not be skipped, the school bus should be prevented from being hungry.
School and friend problems are an important factor that causes headaches in children. Collaboration with school and teacher is necessary.
During a headache, especially in migraine attacks, children want to sleep in a dark and quiet room, and their attacks can be resolved with sleep, which should be known as a treatment.
Behavioral therapies, relaxation exercises, cognitive therapy, stress management are effective in pain control up to 80%.
Drug Treatments
When headache attacks occur 3-4 times a month and / or start to affect school and other activities, preventive medications may be used to reduce the frequency and severity of pain. If more than three prophylactic drugs have been used and have not benefited, they should be investigated for psychological factors and depression.
At the onset of acute pain, pain medication and nausea-vomiting medication should be started and the child should be allowed to rest or sleep in a quiet room. Pain medications should not be given more than 2-3 times a week. In most patients, medication and non-medication may need to be combined.
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