Many people believe headaches are only an adult disorder, but often headaches begin during childhood. By age 15, more than 80 percent of children have complained of headaches at one time, and it is not uncommon to have children under two years of age complain of headaches as well.
The reason people get headaches is not completely known for sure, but research suggests that both genetic predisposition and environmental factors play an important role.
“Most children present with primary headaches, such as migraine, tension, or daily chronic headaches,” says Dr. Farhad Sahebkar, pediatric neurologist and director of the Sutter Pacific Medical Foundation Pediatric Headache Clinic at California Pacific Medical Center.
Secondary headaches, or those caused by more serious conditions, such as tumors, are rare. To rule out secondary headaches, a neurologist does an exam and evaluates a patient’s history. He also checks for any red flags, like persistent vomiting, head pain that wakes a child from sleep, or severe pain that increases in frequency or intensity. If he needs more information, he may order an MRI.
In order to determine a primary versus secondary headache, the clinician needs to spend time learning about the whole patient. This holistic approach is the bases of the Pediatric Headache Clinic.
During a patient’s visit in The Pediatric Headache Clinic, they will meet with our multidisciplinary team.
A dietician looks at what a child is eating, since certain foods can trigger headaches. Then a social worker looks into a child’s psychosocial history, including stressors like being bullied at school. “What’s happening in a child’s family and school is extremely important,” says Onica Kuch, pediatric nurse practitioner and co-director of the Clinic.
The Clinic also offers a supportive component. “It’s sometimes impossible to remove stressors, so we educate kids on how to keep stress from affecting their body,” says Kuch. A biofeedback therapist helps patients learn how to control their autonomic nervous system, while a social worker might intervene at home or school to mitigate triggers there.
“A thorough evaluation that assures a child’s family that he doesn’t have a secondary headache helps us avoid unnecessary tests, treatments and emergency room visits,” adds Sahebkar. “It also decreases a patient’s anxiety level.” We treat the whole patient, not just the headache.
Because there are dozens of classifications for headaches, there is a wide range of medications to treat them. “In the past you had a tension headache or a migraine headache,” Sahebkar recalls, “but actually a headache can lie anywhere in the spectrum.” Some headaches are coupled with impaired balance. Others are preceded by light sensitivity, nausea or vomiting. One classification of migraines in children even presents as abdominal pain, not head pain.
“There are two main components to treatment. One is abortive, when you give a patient medication like ibuprofen or acetaminophen to stop the headache. The other is preventive, when frequent, severe headaches justify preventive medication, like Topiramate or Amitriptyline.”
Since headache treatment is complicated, Sahebkar cautions patients against using the wrong drugs. “Avoid frequent intake of over-the-counter pain medication,” he says. “It can cause rebound, or withdrawal, headaches which then turn into frequent headaches. If you are treating your child more than twice a week, you should have her evaluated.”
Sahebkar also urges headache sufferers to avoid narcotic treatments. “Sometimes patients are mistakenly given morphine or Vicodin in the busy ER. One time use is okay, but frequent usage doesn’t treat the real cause of the headaches and can lead to a bad habit.”