January 10, 2018

Chronic headaches in kids

Chronic headaches in children are common and only very rarely signal a more serious problem.

But for worried parents - concerned about managing their child's pain and ensuring they can still participate in school and normal daily activities - dealing with it all can be"¦ well, a big headache.

It's often difficult to pinpoint a single cause, but most chronic headaches in kids can be tied back to some key triggers, says Cassie Meffert, a physician assistant in UW Health's Pediatric Neurology Headache Clinic.

"Everything always comes back to lifestyle," Meffert says. "It's the cornerstone of the long-term management of headaches." And while medications may help in the short term, adjusting lifestyle factors that often contribute to headaches will likely help the most, Meffert says.

Anxiety and stress

This is one of the biggest contributors to headaches in kids — whether a child is being bullied or made fun of at school, or perhaps not doing well in a particular class or with a certain teacher. "The headaches are often more of a sign of other struggles they're going through," Meffert explains. So if there is any concern that a child may suffer from anxiety or depression, your child may benefit from working with a counselor to address both their mental health and the headaches.


Most of the patients Meffert sees in the pediatric headache clinic are teenagers, "chronically known for having poor sleep habits." And yet getting enough sleep is a critical factor in preventing headaches. So Meffert advises teen patients to aim for at least 9 hours of sleep her night.

"That's dramatically different than what a lot of kids are used to," Meffert says, citing a multitude of sports, extracurricular activities, jobs and more.

Some parents may resist the idea of reducing these activities to fit more sleep into their child's day, but Meffert urges parents to reflect on whether all those commitments are really beneficial to the child, or are they just creating more stress?

"It's often a tough decision and a tough discussion, but I try to emphasize the fact that health should really come first," Meffert says. "That's hard for a lot of kids — and a lot of parents — to think about."

Establishing a regular sleep cycle — a consistent time to fall asleep and wake up — is also important to stave off headaches. And that cycle, Meffert advises, should be carried through to weekends, school breaks and summertime.

And then there's perhaps the most difficult habit to break tied to sleep routines: turning off smartphones and other devices before bedtime. Many kids fall asleep with their phones, but they're actually working against some powerful natural forces by doing so, Meffert explains.

Melatonin is a natural hormone that helps control your daily sleep-wake cycles, also known as our circadian rhythm. The production of melatonin is triggered by darkness — that's why around dusk, when the sun and natural light starts to go down, our bodies begin producing melatonin. But too much bright light in the evening, like from a smartphone screen, can suppress melatonin production and shift your circadian rhythm later — making it harder to fall asleep.

To top it off, the screens in our tablets and smartphones emit a lot of blue light, which is the wave length of light that can throw off our circadian rhythm the most.

Essentially, Meffert says, a child's bed should be a place for rest and, ultimately, sleep — not a comfy spot to do homework and catch up on Instagram.

When kids don't get enough sleep, they'll often rely on naps to "catch up" during the day, Meffert says — but naps can actually trigger changes in sleep patterns, particularly long naps. Unless a child is trying to "sleep of" a severe headache, naps should be limited to an hour or less, Meffert says. Any longer and the child is less likely to sleep well that night, perhaps triggering a headache or migraine the next day.

"If you're really that tired, just take a power nap" Meffert says. "Or maybe try exercise instead."


Many patients Meffert sees in the pediatric headache clinic don't get any vigorous exercise (e.g., more than just the 10-minute walk home from school).

"But exercise makes a huge difference, with everything — it improves sleep, mood, headaches, overall well-being and mental clarity," Meffert explains.

Nutrition and hydration

Not eating on a regular basis and not getting enough water are also significant triggers for kids and headaches.

"I really encourage regular eating habits throughout the day — eating a balanced diet and a good amount of protein," Meffert advises. "We need constant input throughout the day. It's very common — kids who skip breakfast or lunch will get a headache later that day."

Chemicals in certain foods can also trigger headaches and migraines, such as those in aged cheeses and preservatives. Red dye in food products is a particularly big headache culprit, Meffert says.


Sometimes, adjusting lifestyle factors alone isn't enough to address chronic headaches in kids. Medications may also need to be used in combination with lifestyle adjustments. Often, the medications prescribed in the pediatric headache clinic aren't developed specifically for headache, but they're proven to be helpful in managing them — including anti-depressants or medications developed for blood pressure, seizure or allergy.

If a parent is concerned about a child's headaches and they're relatively infrequent, Meffert will often have the child start taking a daily multivitamin that contains magnesium, a supplement that's been shown to be effective in preventing some types of headaches. Other supplements - such as riboflavin and Coenzyme Q10 - may also help provide headache relief, but should be used under your medical provider's supervision.

When using over-the-counter medications for acute headache treatment, Meffert cautions against overuse, which can result in a phenomenon called "rebound headaches" This happens when a person develops a pattern of using an acute headache medication, such as Tylenol or ibuprofen, more than two days per week. At first, the medication works. But as the person takes the medication more frequently, it becomes less effective and they have to take more medication to get any relief.

What to do if you're concerned about your child's headaches

If your child's headaches involve frequently waking up at night vomiting, double vision or one-sided weakness, your child should be medically evaluated as soon as possible.

Otherwise, Meffert advises taking a hard look at lifestyle factors and what your child is doing — or not doing — every day that could be contributing to their headaches.

"Make adjustments and see what happens," Meffert says. "Make sure you have solid change for a good amount of time — changing these things for a week is not going to do it. But changing these things for a month or two, you might see a dramatic improvement."

If your concerns remain, schedule an appointment with your pediatrician, who may refer your child to a pediatric neurology clinic for further evaluation.