Headache Program

A headache is a pain that is felt anywhere in the head or neck. Headache symptoms vary for each child, with the most common being head pain itself. This can occur continuously, intermittently or reactively, and the pain may be dull, sharp, stabbing or throbbing, or a combination of different types of discomfort. Headaches may be caused by anything from anxiety and tension to sleep deprivation, stress, certain medications, injury and illness.

If your child is suffering from headaches, it’s important to have them evaluated by a pediatric neurologist, especially if they’re experiencing any of the following:

• Headache that wakes them from a sound sleep
• Headaches that worsen over time in severity or frequency
• Headache that changes your child’s personality
• A new severe headache of acute onset
• Headache resulting in weakness or papilledema
• Recurrent headaches that have been present for at least six months and are not responding to standard medical treatment including lifestyle modification and acute (or abortive) treatment for symptom relief
• Headache that is resulting in missed school days and/or diminishing school participation (e.g., declining grades, extracurricular activity limitation)

Frequent headaches can affect your child’s quality of life. At the Cohen Children’s Headache Program, we are committed to finding the cause of your child’s headaches and creating a treatment plan that works for them. Our dedicated neurologists will take a medical and family history and ask questions to get a better understanding of your child’s symptoms. We’ll also conduct a complete examination of your child’s head, neck, muscles, senses, reflexes and coordination. These tests are extremely important in making sure the proper diagnosis is reached. Occasionally, an MRI (magnetic resonance imaging) may be needed to rule out underlying causes of the headaches. Once the possibility of a serious medical condition has been eliminated, the doctor can determine the proper treatment for your child’s pain based on the type and frequency of the headaches.

To help us establish the most accurate diagnosis, we ask that you bring the following to your child’s consultation:

• A headache calendar for at least one month including:
  • Dates of headaches
  • Location
  • Severity
  • Associated symptoms
  • Time at onset and resolution
  • Activities preceding headaches including diet
  • Treatment provided
  • A complete list of medications used for headache treatment including doses and frequency of use (include any abortive or preventive medications used)
  • Copies of tests, labs, imaging films/CDs (not just reports), and any other additional information that may be helpful

We will classify your child’s headaches into one of two general categories:

Primary headaches—Headaches in which the head pain is the problem itself. The most common primary headaches include migraine, tension-type headache and cluster headaches (one-sided head pain).

Secondary headaches—Head pain that is a symptom of an underlying condition. The most common secondary headaches include those attributed to:

• Head or neck trauma
• Cranial or cervical vascular disorders
• Nonvascular intracranial disorder
• Use of a substance or withdrawal
• Infection
• Disorder of homeostasis
• Psychiatric condition
• Disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth or other facial or cranial structure
• A result of a brain tumor or abnormal blood vessel (in rare cases)

With secondary headaches, your child may also have a range of associated headache symptoms along with the head pain, including:

• Sensitivity to light or noise
• Nausea and/or vomiting
• Skin sensitivity
• Worsening pain with movement
• Difficulty with hearing, speaking, balance and/or coordination
• In severe cases, mood can be affected and social interactions damaged

Treatments for headaches vary, depending on diagnosis and trigger identification. When there is no underlying medical cause, headaches are often due to lifestyle factors and are best treated by changes to those factors—a well-balanced diet, exercise and sufficient sleep can go a long way. Other safe and effective treatments for headaches in children and teens are self-regulation techniques such as mindfulness meditation, progressive muscular relaxation, self-hypnosis and biofeedback.

Sometimes, pain relievers or migraine medication may be necessary. The type of medication prescribed depends on the diagnosis. Some examples include:

• Over-the-counter medications—Medications like ibuprofen, naproxen or Excedrin are helpful to the majority of people with headaches.
• Abortive medications—In other cases where the headache is difficult to treat, we use abortive medications, such as medications in the triptan family or nutraceutical agents such as riboflavin, magnesium and coenzyme Q.
• Preventive medications—These are rarely used in children and teenagers as these medications have not been demonstrated to be effective and have side effects.

 All medications used for the treatment of headaches have their own spectrum of side effects.  Your prescribing doctor will review all possible side effects with you and your child.