Pediatric Headaches and Migraines

Photo of two children playing with a rock that is out of the frame

The pediatric doctors at OHSU Doernbecher understand how headaches behave differently in young patients than in adults. If your child’s primary care doctor recommends an exam with our specialists, we offer:

  • Complete examination to identify the type of headache your child is having and any underlying problem.
  • team-based approach to care, with pediatric specialists who work together to tailor treatments to your child’s specific needs.
  • The most advanced imaging equipment should scans be recommended.

Understanding headaches

Headaches are common in young people and only rarely indicate a more serious problem. In most cases, your child’s primary care doctor can recommend medication and other remedies.

In other cases, headaches can disrupt relationships and activities such as school. Early diagnosis and treatment can keep problems from getting worse. Your child’s primary care doctor can help determine when more specialized treatment is needed.

Headaches are characterized in several ways, including:

Primary: These headaches arise on their own and are not caused by an underlying condition.

Secondary: These are caused by another health condition, such as a sinus infection or concussion.

This is the most common type and is often caused by stress or anxiety. Symptoms can include:

  • Steady or dull pain
  • Mild to moderate pain
  • A feeling of tightness or pressure as if from a band around the head
  • Tight muscles in the head or neck

Migraines can run in families. In children, these headaches are characterized by: 

  • Moderate to severe pain on one or both sides
  • A throbbing or pulsing sensation
  • Pain that gets worse with physical activity
  • Nausea or vomiting
  • Sensitivity to light and sound
  • Stomach pain
  • Lasting two to 72 hours

Migraine with aura: In this type, a child or teen experiences an “aura,” or changes in vision, speech or other perceptions less than an hour before the headache begins. This type is less common than a regular migraine.

A sinus headache can accompany a sinus infection. A child or teen may have a throbbing headache along with a cough, fever and stuffy or runny nose.

This type occurs on fewer than 15 days a month.

This type occurs on at least 15 days a month. 

Chronic migraine headache: This type occurs when a patient has headaches at least 15 days a month, including at least eight migraine headaches a month.

This type is unusual in children younger than 10 and less common than migraine. Symptoms include:

  • Repeated episodes
  • Intense pain on one side of the head
  • Pain behind one eye
  • Redness and swelling in the affected eye
  • Runny or stuffy nose

Patients with chronic headaches who frequently take medications (or combinations of medications) such as ibuprofen and aspirin can develop headaches caused by the medications themselves. A doctor can help a patient withdraw and/or switch to another medication.

When to call a doctor

In rare cases, a headache can indicate a more serious problem. See a doctor right away if your child has one or more of the following: 

  • Frequent severe or worsening headaches, especially first thing in the morning or in the middle of the night
  • Nausea or vomiting, especially in the morning
  • Seizures
  • Unconsciousness
  • A headache after a blow to the head
  • Problems with vision or hearing 
  • Problems walking, breathing, speaking or swallowing
  • Weakness in the face, in an arm or leg, or on one side of the body
  • Numbness or tingling in an arm or leg
  • Changes in personality, behavior or mood 
  • Fever with neck pain or stiffness 

Diagnosis

Your child’s primary care doctor or a pediatric specialist at OHSU Doernbecher Children’s Hospital can assess the cause and type of headache with examination and, if needed, diagnostic imaging.

  • Medical history: The doctor will ask you and your child about the headaches, symptoms and when they started. The doctor will also ask about any family history of headache. You may be asked to log your child's headaches in a diary to detect patterns and triggers.
  • Physical exam: The doctor will examine your child, taking measurements such as height and weight, for example, and listening to your child's heart.
  • Neurological exam: A pediatric neurologist will assess your child's movement, sensation, thinking abilities and other functions to detect any problem with the brain or other parts of the nervous system. 
  • Diagnostic imaging: If exams indicate the need for imaging, Doernbecher has the most advanced MRI and CT equipment to take scans of your child's brain or other internal structures.

Treatment

These are the most common ways doctors help parents treat primary headaches in children and teens. 

Avoid triggers: A parent or patient may be asked to keep a diary to identify factors or situations that lead to headaches. Once a parent and child understand these triggers, they can try to avoid or manage them. Common triggers include:

  • Lack of sleep
  • Hunger
  • Dehydration
  • Stress from problems at home or school
  • Too much caffeine
  • Eating processed foods with nitrates or monosodium glutamate
  • Disruptions in routine
  • Too much time in front of a computer screen
  • Menstruation

Manage stress: This can include:

  • Setting healthy routines, such as making sure your child gets enough sleep and exercise
  • Making sure your child doesn't have too many activities
  • Offering reassurance and support
  • Setting reasonable expectations
  • Relaxation exercises

Medication: Your child's doctor may recommend over-the-counter or prescription pain relievers.

Learn more

It’s important to note that some of these pages contain useful information but are not specific to children. If you have concerns about your child or teen, please consult your child’s doctor or your care team at Doernbecher Children’s Hospital.

For families

Call 503-346-0640 to:

  • Request an appointment.
  • Seek a second opinion.
  • Ask questions.

Location

Parking is free for patients and their visitors.

Doernbecher Children’s Hospital
700 S.W. Campus Drive
Portland, OR 97239
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