Headaches are the most common neurologic disorder in the general population. According to the National Headache Foundation, more than 10 million American children between the ages of 5 and 17 experience chronic headaches; this makes up 20 percent of all young people.

Headaches interfere with daily life, making it difficult for kids to concentrate at school and participate in sports and aerobic activities. When they become more chronic and severe, headaches can also result in school absenteeism. Headaches can even lead to secondary psychological problems, such as depression, anxiety and other mood disorders.

What is a headache?

A headache is pain or discomfort in the head or face area. Headaches can be single or recurrent in nature, and localized to one or more areas of the head and face.

What causes a headache?

The exact cause of headaches is not completely understood. It is thought that many headaches are the result of tight muscles and dilated, or expanded, blood vessels in the head. Other headaches may be caused by an alteration in the communication between parts of the nervous system that relay information about pain coming from the area of the head, face and neck. Occasionally, there is an actual problem in the brain, such as a tumor or malformation of the brain, although this is rare.

What are the different types of headaches?

Headaches are typically divided into two categories: primary and secondary.

Primary headaches are due to the headache condition itself and not other conditions. For example, they can be caused by tight muscles, dilated blood vessels, changes in communication between parts of the nervous system or inflammation of the structures in the brain. There are three types of primary headaches:

  • Migraines may start early in childhood, often in kids with a family history of migraines. The average age of onset is 7 years old for boys and 10 years old for girls. Some girls may have migraines that correlate with their menstrual periods.
  • Tension headaches are the most common type of headache. Stress and mental or emotional conflict are often factors in triggering pain related to tension headaches.
  • Cluster headaches usually start in children older than 10 years of age, and are more common in adolescent males. Cluster headaches usually occur in a series that may last weeks or months, and this series of headaches may return every year or two.

Secondary headaches are caused by problems in the structure of the brain, or by other health conditions and diseases. Secondary headaches are the least common type of headache and typically increase in frequency over time. They may be associated with other neurologic symptoms or signs, such as fever, excessive vomiting, double vision or periods of confusion that are otherwise unexplained.

How are headaches diagnosed?

The diagnosis of a headache is made with a careful history and physical examination. Occasionally, diagnostic tests such as magnetic resonance imaging (MRI) or lumbar puncture (LP) are done to rule out secondary causes of headaches. However, it is rare for patients with headaches to have a more serious problem, and the majority of patients with migraine headaches require no testing.

How do I prevent headaches?

Most patients with headaches respond to basic healthy lifestyle changes that reduce headache frequency and intensity. Common goals include drinking specific amount of fluids every day, avoiding caffeine and artificial sweeteners, daily aerobic exercise, regular sleep cycles and a healthy, well-balanced diet. In a recent study in the New England Journal of Medicine, more than 70 percent of children and adolescents showed improvement in their headaches when they performed these lifestyle changes for a period of several months.

For more information, watch this video with Pediatric Neurologist Marc DiSabella.


Marc DiFazio Marc DiFazio, MD, is Vice President of Ambulatory Services at Children's National. He is well-known to the community for his service, leadership and expertise in clinical child neurology, with particular emphasis in the areas of Tourette syndrome, headache/migraine, concussion and the use of botulinum toxin (Botox) for a variety of conditions including headache, spasticity and sialorrhea.
Marc DiSabellaMarc DiSabella, DO, is Program Director of the Child Neurology Fellowship; Medical Director of Neurology Education; and Director of the Headache Program at Children's National. His interests lie in the treatment of pediatric migraines and its related disorders through the use of lifestyle modification and behavioral strategies, in addition to oral, nasal and intravenous medications.

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