Headaches are common in children. However, they are always a reason for concern for parents, because their children may not be able to describe their headaches. They may become cranky, withdrawn, vomit, or prefer a darkened room. The most common causes of headaches in children are migraines, eye problems, sinus infections, and lifestyle.

Migraines
Research shows that 4% of children between 7 and 15 years of age experience migraines. Before age 10 years, boys are more likely to have migraines, but after puberty, girls are more likely to develop them. A family history of migraines, especially on the maternal side, is present in approximately 90% of children with migraines. In adulthood, 5-10% of men and 15-20% of women experience migraines.

Factors that contribute to migraines include family history, hormonal changes, stress, bright flashing lights, and foods (see below). History of motion sickness in childhood is associated with migraines later in life as well.

Foods that may provoke migraines:
Cheese
Chocolate
Herring
Soybeans
Nuts
Yeast (especially in homemade bread)
Dried fruits (raisins)
Mushrooms
Salty foods
Red plums
Ripe avocados and bananas
Lunch meat (nitrates)
Caffeine
Alcohol

A common migraine in children is characterized by a throbbing or pounding headache that usually lasts 1-3 hours, but may persist for up to 24 hours. A migraine headache is often accompanied by intense nausea, vomiting, and abdominal pain. On occasion, children complain about aversion to odors, light, or noise, as well as tingling in the feet and hands during a migraine headache or experience an aura before the onset of the headache. Visual auras are not common in children, but may include blurred vision, distortion of objects, zigzags, or flashes of light. Some children complain about dizziness or light-headedness.

Eye Problems
Nearsightedness in infants and school age children is not common. Its incidence increases during the school years, especially during the preteen and teen years. However, if your child has been complaining of headaches for a while, and perhaps you’ve noticed that he/she squints to see faraway objects or comes close to the television set, a visit to an optometrist is recommended. Poor vision produces eye muscle strain that may lead to headaches. If your child’s headaches do not go away after their vision is corrected, or if they are ever accompanied by the red flag symptoms (see below), take your child to a health care provider for an evaluation ASAP.

Red flags of a headache:
Rapid onset of the first headache
The worst headache ever
Progressive headache lasting for days
Headache present with straining (during coughing, sneezing, bowel movement)
Weight loss or fever
Seizures
Loss of consciousness
Stiff neck
Morning headache, possibly accompanied by vomiting

Sinus Infections
On occasion, a cold or uncontrolled allergies may turn into a sinus infection. Usually, cold symptoms are the worst on days 3 and 4 and then gradually improve. A sinus infection should be suspected if your child’s cold symptoms are more severe than usual, or if the symptoms persist for longer than 10 days. Headaches are very common with sinus infections and your child may complain of facial and tooth pain. If you suspect a sinus infection, take your child to her/his health care provider, as antibiotics are needed to treat the symptoms.

Lifestyle
Many headaches in children can be contributed to irregularities in their lifestyles. For example, sleeping in or staying up late over the weekend, or skipping meals can result in headaches. This can be easily prevented by exercising good sleep hygiene (see below) and eating regular meals: breakfast, lunch, and dinner, and healthy snacks in between (listed below).

Practicing good sleep hygiene:
Go to bed and wake up at the same time each day
Avoid napping during the day
Avoid caffeine 4-6 hours before bedtime
Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime
Exercise regularly, but not right before bed
Try a light snack before bed
Establish a pre-sleep ritual

Healthy snacks:
Fresh fruit
Cheese packs or cubes
Yogurt
Cheese or peanut butter on low-fat crackers
Pretzels
Trail mix
Dried fruits
Granola bars
Whole wheat pizza w/hummus
Low-fat, microwave popcorn
Veggies w/low-fat dip or yogurt
Bananas or apples w/peanut butter and cream cheese
Baked taco chips w/salsa