Headaches in children

Headaches are common in children and adolescents. A headache is a symptom of pain in the area of the head, face or neck. Headaches can happen once in a while. Or they may happen often. Headaches can be caused by many things, including colds, stress, hunger, dehydration, lack of sleep, eye problems (e.g. straining to read), infections, caffeine, medicines, hormonal changes, stress, allergies, head injury, meningitis, brain aneurysm and brain tumor. Fortunately, most headaches in children are not due to a serious underlying problem, but they can be upsetting for the child and have an impact on schooling, sport and play activities.

Headaches are often divided into 2 groups, based on what causes them:

1. Primary headaches. These are not linked to another health condition. They are usually caused by tight muscles, widened (dilated) blood vessels, changes in nerve signals, or swelling (inflammation) in parts of the brain.
2. Secondary headaches. These are a less common type of headache. They are caused by a problem in the brain, or another health condition or disease.

Types of primary headaches include:

• Tension headache. These are the most common type of headache. Stress and mental or emotional conflict can trigger tension headaches.
• Migraine. Migraines may start early in childhood. Researchers estimate that nearly 1 in 5 teens has migraine headaches. The average age they can start is 7 years old for boys and 10 years old for girls. There is often a family history of migraines. Some girls may have migraines that happen with their menstrual periods.
• Cluster headaches. Cluster headaches usually occur in a series that may last weeks or months. This series of headaches may return every 1 to 2 years. These headaches are much rarer than tension headaches or migraines. They can start in children older than age 10. They are more common in teen boys.

Some primary headaches and their symptoms are:

• Tension headache – feels like a tight band around the head. A tension headache is usually a dull, steady ache felt on both sides of the head, but may be felt at the front and back of the head.
• Migraine headaches – often described as a throbbing feeling, which may be on one side of the head. Migraines are sometimes accompanied by symptoms of dizziness, nausea, vomiting and visual disturbances.
• Cluster headaches less common, and can be associated with sudden, one sided, facial pain, and nasal congestion or lots of tears (tears without actually crying).

If your child’s headaches are severe and persistent, and cause them to miss school or activities more often than once a month, they should be checked by their doctor.

Headaches in children key points to remember:

• Headaches are common in children and generally not serious.
• A headache is pain or discomfort in one or more areas of the head, neck or face. In addition to head pain, your child may have nausea or vomiting.
• Headaches can happen once in a while. Or they may happen often.
• Headaches can have an impact on schooling, sport and play activities.
• Keeping a headache diary can help identify the things that trigger your child’s headaches, so you can try to avoid them.
• Regular healthy meals, and enough sleep and exercise are important to help prevent headaches.
• Some headaches can be serious, so see your doctor if you are concerned.
• Primary headaches are not linked to another health condition. They are usually caused by tight muscles, widened (dilated) blood vessels, changes in nerve signals, or swelling (inflammation) in parts of the brain.
• Secondary headaches are the least common type of headaches. They are caused by a problem in the brain, or another health condition or disease.
• Your child may have an magnetic resonance imaging (MRI) or a CT scan to help diagnose what may be causing a headache.
• Treatment may include resting, taking medicines, managing stress, getting more sleep, and not having certain foods or drinks.

Which children are at risk for headaches?

A child is more at risk for headaches if he or she has any of the following:

• Stress
• Poor sleep
• Head injury
• Family history of headaches or migraines.

Causes of headaches in children

Researchers don’t fully understand the exact cause of headaches. Children and adolescents who experience primary headaches often have other family members who get headaches. Common triggers for headaches in children with migraine or tension headaches are not getting enough sleep or being stressed. In rare cases, exercise can also trigger these types of headaches.

Many headaches may be caused by tight muscles and widened (dilated) blood vessels in the head. Stress and mental or emotional conflict can trigger tension headaches. Migraine headaches may be caused by changes in brain chemicals or nerve signals.

Other headaches may be caused by a change in pain signals from nerves in the head, face, and neck. Lack of sleep and poor sleep quality are often the cause of chronic headaches.

Common causes of secondary headaches are viral infections such as colds, sinusitis, or ear infections. Rare causes of secondary headaches are brain tumors or intracranial (inside the skull) bleeding.

Each type of headache may be treated differently. A detailed history and physical exam help your pediatrician figure out what kind of headache your child has. Based on your child’s diagnosis, your pediatrician will create a plan with you on how to best relieve your child’s pain.

Table 1. Common types of headaches

	Common symptoms:	Call pediatrician if your child has:	Seek emergency care if your child has:
Tension headaches	Mild or moderate headache Typically develops during the middle of the day Constant, dull or achy pain Sensation of tightness that feels like a band or circle around the head Pain located in the forehead or on both sides of the head Neck pain Fatigue	Daily headaches Headaches caused by straining from coughing, sneezing, running or having a bowel movement. Headaches that occur along with pain in the eye or ear, confusion, nausea or vomiting, sensitivity to light and sound, or numbness. Headaches that keep coming back and get worse. Headaches following a head injury that don’t go away after a week. Headaches severe enough to wake from sleep. ​​	Sudden, severe head pain happening for the first time–especially if your child has double vision, seems confused, sleepy, hard to wake up, has numbness or projectile vomiting. Headache with a stiff neck, or complaints of neck pain, especially with a fever. ​​
Migraine headaches	Throbbing pain that is often on one side of head, but can be on both sides–particularly in children Light and/or noise sensitivity Fatigue Nausea and vomiting Mood changes An aura: flashes of light, zig-zag lines or other odd vision changes that may appear before or during a migraine Note: Some symptoms of a migraine may be slightly different in children than adults.	Daily headaches Headaches caused by straining from coughing, sneezing, running or having a bowel movement. Headaches that occur along with pain in the eye or ear, confusion, nausea or vomiting, sensitivity to light and sound, or numbness. Headaches that keep coming back and get worse. Headaches following a head injury that don’t go away after a week. Headaches severe enough to wake from sleep. ​​	Sudden, severe head pain happening for the first time–especially if your child has double vision, seems confused, sleepy, hard to wake up, has numbness or projectile vomiting. Headache with a stiff neck, or complaints of neck pain, especially with a fever. ​​
Congestion headaches	Pain and pressure above a sinus, often above the eyebrow, behind the eye, and under the cheekbone Pain may be on just one side of the face/head Blocked or runny nose	Daily headaches Headaches caused by straining from coughing, sneezing, running or having a bowel movement. Headaches that occur along with pain in the eye or ear, confusion, nausea or vomiting, sensitivity to light and sound, or numbness. Headaches that keep coming back and get worse. Headaches following a head injury that don’t go away after a week. Headaches severe enough to wake from sleep. ​​	Sudden, severe head pain happening for the first time–especially if your child has double vision, seems confused, sleepy, hard to wake up, has numbness or projectile vomiting. Headache with a stiff neck, or complaints of neck pain, especially with a fever. ​​
Medication overuse (analgesic rebound headaches)	Pain starting behind the eyes and moving up the front of the head, or dull ache around the forehead Grogginess Irritability Flu-like aches and pains May start after pain reliever use ends Caffeine in sodas and energy drinks can also be a culprit	Daily headaches Headaches caused by straining from coughing, sneezing, running or having a bowel movement. Headaches that occur along with pain in the eye or ear, confusion, nausea or vomiting, sensitivity to light and sound, or numbness. Headaches that keep coming back and get worse. Headaches following a head injury that don’t go away after a week. Headaches severe enough to wake from sleep. ​​	Sudden, severe head pain happening for the first time–especially if your child has double vision, seems confused, sleepy, hard to wake up, has numbness or projectile vomiting. Headache with a stiff neck, or complaints of neck pain, especially with a fever. ​​
Headaches after a head injury	Pain that feels like pressure inside the head Dizziness Mental fogginess Nausea Fatigue Moodiness Blurry vision	Daily headaches Headaches caused by straining from coughing, sneezing, running or having a bowel movement. Headaches that occur along with pain in the eye or ear, confusion, nausea or vomiting, sensitivity to light and sound, or numbness. Headaches that keep coming back and get worse. Headaches following a head injury that don’t go away after a week. Headaches severe enough to wake from sleep. ​​	Sudden, severe head pain happening for the first time–especially if your child has double vision, seems confused, sleepy, hard to wake up, has numbness or projectile vomiting. Headache with a stiff neck, or complaints of neck pain, especially with a fever. ​​

Tension headache

This is the most common type of headache in children. The most likely causes are emotional upsets or stress. Your child may describe the pain as widespread or like a tight band around the head. This type of headache does not often cause nausea and vomiting. It is also not tied to other symptoms, such as fever, change in mental status, or other physiologic changes.

Tension headaches are almost always linked to stressful situations at school, competition, family friction, or too many demands by parents. The healthcare provider needs to also find out whether anxiety or depression may be present.

These headaches are often easily treatable with over-the-counter medicine, such as acetaminophen or ibuprofen. Your healthcare provider will tell you how to give these medicines safely. It is also important to identify likely triggers and make lifestyle changes in diet, sleep patterns, exercise, and study habits.

Migraine headaches

A migraine headache is sometimes one-sided and throbbing. It is sometimes accompanied by nausea and vomiting, or sensitivity to light, noise, or both. Some migraines are preceded by aura, which are often one-sided sensory changes that point to the start of a migraine. Children who have a family history of migraines have a greater chance of getting migraines themselves. The younger the child, the harder it is to make the diagnosis of migraine headaches. Fortunately, migraines may go away in some children several years after they appear. But many children who get migraine headaches will go on to have them during the rest of their lives. Research has shown that symptoms will have happened in about a fourth of migraine sufferers before the age of 5, and in about half before the age of 20.

Migraines often develop in stages:

1. Premonitory or warning phase: tiredness, stiff neck, mood changes (can last up to 24 hours).
2. Aura: seeing spots, squiggly lines, dizziness, weakness, numbness and/or confusion. These symptoms, which don’t happen with all types of migraines, may last up to an hour.
3. Headache or attack: severe, throbbing/pulsating pain with nausea, vomiting and light sensitivity.
4. Resolution: sleep ends the headache pain for some children.
5. Recovery: feeling tired (lasts hours to days).

It is important to realize that a migraine headache may happen after a head injury, especially after injury in sporting activities like football and baseball. The child will often recover fully over time.

There are two ways to treat migraine headaches. There are medicines used to stop an acute migraine headache. There are also others used to prevent frequently occurring headaches. Your healthcare provider will advise you on the proper medicines you can give to best control the symptoms of your child’s migraine headaches.

What is the difference between a migraine and a hea​dache?

Migraine pain usually is more severe. It often includes throbbing on one side of the head that often worsens with activity. Migraine headaches also tend to strike with other symptoms, such as nausea, vomiting, vision problems (seeing spots or flashing lights, for example), light and sound sensitivity, and tingling.

At what age can children get m​igraines?

Any child can get a migraine. About 10% of children age 5-15 and up to 28% of teens get them. Half of people who get migraines have their first attack before age of 12. Migraines have even been reported in children as young as 18 months!

What are some migraine causes, risk factors and ​triggers?

• Family history. Migraines tend to run in fam​ilies. If one parent has migraines, there is roughly 50% chance that their child will too. If both parents have them, the chance is close to 90%.
• Gender. Before puberty, boys have more migraines than girls. That flips in the teen years and by age 17, as many as 8% of boys and 23% of girls have had a migraine. For adults, migraines are more common in women.
• Stress and sleep. Irregular sleep schedules – getting too much or too little sleep – can be migraine triggers. So are changes in stress levels.
• Exercise. While exercise can sometimes trigger migraines, regular exercise may help prevent or reduce the number of attacks.
• Food and fluids. Skipping meals and eating certain foods and additives can set off migraines. Common triggers include aged cheeses and meats, chocolate, citrus fruits, red and yellow food dyes, monosodium glutamate (MSG), and the artificial sweetener aspartame. Too much caffeine and spicy foods can also trigger migraines, but sometimes help headaches because they act as vasodilators and expand blood vessels. Not drinking enough water and other beverages can cause dehydration, another migraine trigger.
• Weather. Stormy weather with changes in barometric pressure, extreme heat or cold, bright sunlight and glare, high humidity or very dry air all can be triggers.

How is a m​igraine diagnosed?

The diagnosis of a migraine​ is usually based on a thorough medical history along with physical and neurological exams. Occasionally, tests like bloodwork, MRI or lumbar punctures may be recommended.

How are mig​​raines treated?

• Lifestyle changes. Keeping healthy, regular routines can help prevent or reduce the frequency and severity of migraines:
• Sleep hygiene. Children, especially those with migraines, should get 8-10 hours of sleep daily. If your child has trouble sleeping, your pediatrician may recommend tests to monitor for snoring or sleep disorders, which have been linked to migraines. Make sure TVs, cell phones, tablets and other media devices are turned off an hour before bedtime, since they can interfere with sleep.
• ​Healthy diet. Eat three regular meals each day at consistent times. Avoid heavily processed foods, which tend contain more migraine triggers like additives and artificial colors and sweeteners. Drink plenty of water and other healthy beverages to stay hydrated.

Medications

Acute medications. Your child’s doctor may recommend or prescribe medications that can help during a migraine attack. These work best when taken at the first sign of an attack. Keep in mind that medication overuse headaches may start if these are used daily or frequently. Examples of medicines that can help during a migraine include:

• Analgesic pain medicines such as acetaminophen and products that combine ​acetaminophen, aspirin and caffeine, and nons​teroidal anti-inflammatory medicines such as ibuprofen and naproxen.
• Triptans, a category of drugs called selective serotonin receptor agonists. Evidence shows that combination sumatriptan/naproxen tablets and zolmitriptan nasal spray can stop headache pain within two hours.

Preventive medications. There are some medications that when taken daily can help reduce the severity and/or frequency of migraines. These tend to be “off-label,” meaning they are not approved by the U.S. Food and Drug Administration (FDA) for migraines. Their risks and benefits should be discussed with your doctor. Options include:

• Cardiovascular drugs: propranolol
• Antidepressants drugs: amitriptyline
• Anti-seizure drugs: topiramate
• Antihistamines: cyproheptadine

Are there any alternative therapies​​ shown to help migraines?

There are some alternative or natural and non-pharmaceutical approaches to migraine treatment that may help. These include:

Cognitive behavioral therapy (CBT), which focuses on coping skills, positive thinking, sticking to healthy habits, and relaxation techniques to help ease migraine pain. Research also has found that CBT combined with migraine medications is more helpful in treating migraines that medication alone.

Herbs, vitamins and minerals. Certain extracts and supplements may help with migraines, although some should be avoided for safety reasons. Talk with your child’s doctor before using any herbal or vitamin supplements. Common supplements include:

• Feverfew: this plant contains parthenolide, which some small studies suggest may help prevent migraines in some people. However, the evidence remains mixed.
• Riboflavin (vitamin B-2), coenzyme Q10 and magnesium supplements may decrease the frequency of migraines.
• Butterbur extract: plant containing petasins is NOT recommended because of long-term liver disease risk.

Do Botox treatments help children with Migraines?

​​​Although botulinum toxin (Botox) is approved and shown to be effective for adults who get chronic migraines, a recent American Academy of Neurology report found that it is not effective for children and teens.

Headaches in children prevention

Headaches in a child may be prevented by things such as:

• Taking medicines recommended by your child’s healthcare provider
• Learning how to manage stress
• Staying away from foods and drinks that trigger headaches
• Getting enough sleep
• Not skipping meals
• Making changes to your child’s diet
• Getting exercise.

Dietary supplements for headache prevention

Certain nutritional and herbal dietary supplements have been studied for prevention or decreasing the pain that comes with headaches. All dietary supplements should be discussed with the child’s pediatrician before use.

Vitamin B2 (riboflavin)

Riboflavin is a B-vitamin that may reduce the number of headaches and pain. Rare side effects may include diarrhea, increased amount of urination, and yellowish discoloration of urine.

Magnesium

Magnesium supplements may also help reduce the number of headaches if taken for several months. Magnesium deficiency is related to factors that promote headaches. Teens who get migraines may have lower levels of magnesium in their bodies than those who do not. The typical diet of an American teenager may be deficient in magnesium-rich foods such as dark green leafy vegetables, beans, seeds, nuts, and whole grains. Magnesium supplements can cause diarrhea and may interact with some medications. They should be used only under the supervision of your child’s pediatrician.

Coenzyme Q10 (CoQ10)

Coenzyme Q10 (CoQ10) is an antioxidant present in each cell of our bodies; however, it was found to be deficient in one third of children with migraines. Taken as a dietary supplement, it may help lower the frequency of headaches. It is generally well-tolerated by children without significant side effects. Rare and mild GI symptoms such as nausea, vomiting, diarrhea, decreased appetite, and heartburn have occurred.

Butterbur

Butterbur is an herb extract that may reduce the number and severity of migraine headaches. The most common side effects include fatigue, belching, nausea, diarrhea, heartburn, itchy eyes or skin, and allergic reaction for those children allergic to ragweed, chrysanthemums, marigolds or daisies. Raw butterbur contains chemicals called pyrrolizidine alkaloids (PAs). Pyrrolizidine alkaloids can damage the liver and kidneys and result in serious illness. Only butterbur products that are certified as pyrrolizidine alkaloid-free should be used.

Headaches in children signs and symptoms

Children are affected by many different types of headaches, and they can range in severity from a mild ache to severe pain. Symptoms can occur a bit differently in each child.

Headaches can be thought of as primary headaches and secondary headaches.

1. Primary headaches. These are not linked to another health condition. They are usually caused by tight muscles, widened (dilated) blood vessels, changes in nerve signals, or swelling (inflammation) in parts of the brain.
2. Secondary headaches. These are a less common type of headache. They are caused by a problem in the brain or another health condition or disease commonly a mild illness (e.g. a viral infection) or dehydration.

Types of primary headaches include:

• Tension headache. These are the most common type of headache. Stress and mental or emotional conflict can trigger tension headaches.
• Migraine. Migraines may start early in childhood. Researchers estimate that nearly 1 in 5 teens has migraine headaches. The average age they can start is 7 years old for boys and 10 years old for girls. There is often a family history of migraines. Some girls may have migraines that happen with their menstrual periods.
• Cluster headaches. Cluster headaches usually occur in a series that may last weeks or months. This series of headaches may return every 1 to 2 years. These headaches are much rarer than tension headaches or migraines. They can start in children older than age 10. They are more common in teen boys.

Symptoms of tension headaches can include:

• Pain that starts slowly
• Head hurting on both sides
• Pain that is dull
• Pain that feels like a band around the head
• Pain in the back part of the head or neck
• Pain mild to moderate, but not severe
• Change in the child’s sleep habits

Signs and symptoms of migraines can include:

• Premigraine symptoms (an aura) such as seeing flashing lights, a change in vision, or funny smells
• Pain on one or both sides of the head
• Pain that may be throbbing or pounding
• Sensitivity to light or sound
• Nausea and vomiting
• Belly pain discomfort
• Sweating
• Child looking pale and being quiet

Symptoms of cluster headaches can include:

• Severe pain on one side of the head, usually behind one eye
• The eye that is affected may have a droopy lid, small pupil, or redness and swelling of the eyelid
• Runny nose or congestion
• Swelling of the forehead

Symptoms of a secondary headache may include:

• Headaches that start very early in the morning
• Pain that is made worse by coughing or sneezing
• Sudden onset of pain
• Severe pain
• Headache that is becoming more severe or continuous
• Personality changes along with headache
• Changes in vision
• Weakness in the arms or legs, or balance problems
• Seizures or epilepsy
• Recurrent episodes of vomiting without nausea or other signs of a stomach virus
• A very young child with a headache
• A child that is awakened by the pain of a headache

The symptoms of headaches can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

Headaches in children possible complications

Headaches of any type that come back again and again (recurrent) can cause:

• Behavior problems
• Problems with grades at school
• Depression

Headaches in children diagnosis

Your child’s doctor will ask about your child’s symptoms and health history. He or she may also ask about your family’s health history. He or she will give your child a physical exam. The physical exam may include a neurological exam.

Your child may be asked questions, such as:

• When do headaches happen?
• What do they feel like?
• Where is the pain?
• How long does the pain last?
• Do changes in position such as sitting up cause the headache?

You may be asked questions about your child, such as:

• Does your child have changes in walking?
• Does your child have changes in behavior or personality?
• Is your child having trouble sleeping?
• Does your child have a history of emotional stress?
• Is there a history of injury to your child’s head or face?

If a more serious condition is suspected ,your child may also have tests, such as:

• Magnetic resonance imaging (MRI). This test uses large magnets and a computer to make detailed images of organs and tissues in the body.
• CT scan. This test uses X-rays and a computer to make detailed images of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than standard X-rays.
• Spinal tap (lumbar puncture). This test measures cerebrospinal fluid (CSF) pressure. It may also be used to check for an infection in the CSF.

Imaging of the brain, blood tests and invasive procedures are NOT required to diagnose headaches. In some cases, brain imaging or a lumbar puncture is needed if a more serious condition is suspected. If necessary, the pediatrician will discuss what further tests are needed and why. The pediatrician may also recommend that your child see a pediatric neurologist who can help provide further recommendations for your child’s headache.

Headaches in children treatment

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on what type of headache your child has and how severe it is.

Treating an occasional headache can be as simple as having something to eat and drink, and a lie down to rest and relax. A cool, wet cloth placed on the forehead may help relieve the headache, and massaging or stretching the head and neck muscles if they are tight or tender may also help.

If these strategies don’t work, it may help to give your child some non-prescription pain medicine, such as paracetamol or ibuprofen (see our fact sheet Pain relief for children). Follow the instructions on the packet and do not use pain medication for more than two days in a week without advice from your GP. Overuse of pain medication can cause additional problems.

To try to prevent headaches, make sure your child is getting enough sleep and rest, regular exercise and balanced nutrition. Balanced nutrition means your child should eat plenty of vegetables and fruit, lean meats and dairy products, and limit processed foods that are high in fats and sugars.

The goal of treatment is to stop the headache from occurring. Treatment may include:

• Resting in a quiet, dark environment
• Taking medicines recommended by your child’s healthcare provider
• Learning how to manage stress
• Staying away from foods and drinks that trigger headaches
• Getting enough sleep
• Not skipping meals
• Making changes to your child’s diet
• Getting exercise

Migraine headaches may be treated with medicine, such as:

• Abortive medicines. These prescription medicines act on specific receptors in blood vessels in the head. They can stop a headache in progress during a migraine attack. These work best when taken at the first sign of an attack. Keep in mind that medication overuse headaches may start if these are used daily or frequently. Examples of medicines that can help during a migraine include:
  • Triptans, a category of drugs called selective serotonin receptor agonists. Evidence shows that combination sumatriptan/naproxen tablets and zolmitriptan nasal spray can stop headache pain within two hours.
• Rescue medicines. These are over-the-counter medicines such as acetaminophen and products that combine ​acetaminophen, aspirin and caffeine, and nons​teroidal anti-inflammatory medicines such as ibuprofen and naproxen that stop a headache.
• Preventive medicines. These prescription medicines are taken daily to reduce severe the severity and/or frequency of migraine headaches. These tend to be “off-label,” meaning they are not approved by the U.S. Food and Drug Administration (FDA) for migraines. Their risks and benefits should be discussed with your doctor. Options include:
  • Cardiovascular drugs: propranolol
  • Antidepressants drugs: amitriptyline
  • Anti-seizure drugs: topiramate
  • Antihistamines: cyproheptadine

In some cases, a headache may need medical attention right away. Your child may need to stay overnight in the hospital to be watched. He or she may need testing or surgery.

Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.

Keep a headache diary

There are a number of types of headaches, as well as potential causes. So, it can be helpful to see if a pattern develops. There are many different apps and online tools available to help you and/or your child. Your pediatrician will use this information to determine the best course of treatment.

Keeping a headache diary is a good way to try to identify what triggers (causes) your child’s headaches. The diary will also be helpful for your child’s doctor in determining the best way to manage and treat your child’s headaches in the future. If you find there are any specific triggers that seem to cause your child’s headaches, you can work to avoid them.

The headache diary should include:

• when the headache started and what seemed to trigger it
• how long it lasted
• which part of the head hurt
• how bad it was on a scale of 1 (mild) to 10 (severe)
• if anything helped to soothe the headache
• the time of going to bed the night before
• if there were any other symptoms with the headache
• if school was missed because of the headache.

Natural therapies for children with chronic headaches

If you are exploring natural therapies to treat your child’s headaches, it is important for you to educate yourself fully on the pros and cons of each approach and discuss the options thoroughly with your child’s pediatrician before you take any action. Your child’s pediatrician may also be able to assist in evaluating your child’s response to that treatment.

Massage

Massage therapy may be helpful for a child with chronic daily headaches and includes a variety of techniques in which practitioners manipulate the soft tissues of the body. Massage therapy can be used in conjunction with a healthy diet, regular exercise, stress management, and avoidance of headache triggers. There are relatively few side effects when massage is performed by a trained practitioner, but its use should be discussed with the child’s pediatrician to be sure they know every therapy your child is receiving.

Acupuncture

Acupuncture may also benefit a child with headaches. This ancient Chinese remedy involves a practitioner inserting thin needles through the skin, which releases endorphins, and reduces the perception of pain. Treatment usually occurs one or two times a week for 4 to 6 weeks. There are few side effects and many children tolerate acupuncture well with a practitioner trained in treating children. Due to needle insertion, rarely mild bleeding and bruising can be seen. Infection is very rare.

Biofeedback

Biofeedback is one of the treatments researched most extensively for migraines. It measures body functions so that the child can learn to control them. For example, a biofeedback device may show tension in a child’s neck muscles in the back of the head that are causing the headaches. By watching how these measurements change, the child becomes more aware of when his or her muscles are tense and learns to relax them. Several biofeedback programs and devices are available in clinics or at medical centers, but also available for home use. Biofeedback is generally safe to use and does not have any harmful side effects.

Guided imagery

Guided imagery, self-hypnosis, or relaxation can be helpful for preventing headaches. Children are often great at this technique, as it uses their imagination and mental images to promote relaxation. Some pediatricians are trained in these relaxation skills or may refer you to another trained practitioner who work with your child.