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What Do You Tell Parents who Ask why Their Child has Headaches?

There are three major types of headaches: tension, migraine, and organic. Tension headaches are the most common and are characterized by a dull ache or squeezing sensation around the head. Stress, hunger, fatigue, and eye strain are common causes of tension headaches. Eye strain may be the result of an uncorrected refractive error, problems with accommodation, or a convergence insufficiency. Migraine is a vascular headache often characterized by a throbbing or pulsating sensation. This type of headache is almost always accompanied with nausea and/or vomiting. Children describe many visual symptoms with migraine headaches and attacks are often caused by an external trigger. Organic headaches may be caused by fever, infection, inflammation, head trauma, or brain tumors—all of which require medical attention. Ophthalmologists should look for signs of papilledema, anisocoria, unexplained loss of vision, or diplopia. Headaches caused by brain tumors are typically progressive, severe in intensity, and resistant to analgesics. Children with brain tumors typically have other neurological symptoms such as dizziness, loss of coordination, numbness, tingling, or confusion. The proper diagnosis of headaches in children often hinges on the parents' ability to keep a detailed headache diary. If the headaches are frequent or severe enough that they are interfering with the child's social or emotional development, a complete physical and neurological evaluation is in order.