Headaches every single day

The Pediatric Insider

© 2013 Roy Benaroch, MD

Jenny wrote in about her son, who has a lot of headaches: “My 12 year old son gets them pretty much every day, and this has been going on for six months. He missed a lot of school, and now is starting to get them again in the summer. The doctor ordered a CT scan which didn’t show anything. What can this be? Could it be sinuses?”

Headaches are common in children. They’re usually “primary” headaches—meaning they’re not caused by anything specific, and they’re not associated with any specific medical condition. They’re just headaches.

Kinds of “primary” headaches in children include:

Migraine – maybe the most common of the more-severe headaches. In children they’re often bilateral and fairly brief. Sometimes they’re accompanied by vomiting, or are worsened by lights or sound; often the best “cure” is to go to sleep. Migraines often run in families.

Tension – These create a band-like, or squeezy feeling in the head, and aren’t usually severe. Yes, kids of all ages get tense.

Chronic daily headache – This sounds like Jenny’s son. They often occur on top of occasional more-severe headaches, like migraines.

The general principles of chronic daily headache:

  • AVOID daily Advil or Tylenol– if you use those more than 3 days a week, you will perpetuate the headaches. I know this sounds odd, but I promise it is true.
  • Try to maximize healthy lifestyle things: good regular sleep, diet, avoiding a lot of preservatives and chemicals, getting regular exercise. Again, I know this sounds odd, but it does help.
  • Try NOT to missschool– that inevitably makes headaches worse.
  • Consider massage/yoga/relaxation therapy.
  • If there is an overlay of depression/anxiety/mood issues, deal with that. There is often a psychological component, either contributing to the headaches, or being caused by the headaches and missing school and activities.
  • Consider a daily medicine to control the headaches– not painkillers, but other kinds of medicines that prevent headaches. You will need a physician’s guidance if daily medication is needed.

About CT scans and headaches: they’re almost never necessary for chronic, ongoing, stable headaches (or headaches that come and go in a stable pattern.) Imaging is really only useful for acute, worse-in-a-lifetime headaches, headaches associated with other symptoms (like seizures or neurologic problems), or progressive headaches that are getting worse and worse. CTs (or MRIs) are completely unnecessary in the workup of most children with headaches, and will sometimes give misleading results that lead to wild goose chases and misery.

Another headache myth: Most people out there who think they’ve got sinus headaches have been misdiagnosed.  Recurrent “sinus” headaches are genuinely uncommon. When they do occur, they’re associated with persistent nasal congestion and cough that precede the headache. Migraines themselves, which are far more common than recurrent headaches from sinusitis, can cause nasal or sinus symptoms that begin about the same time as the headache. It’s unlikely that Jenny’s son has headaches from sinus disease without other obvious persistent sinus symptoms, especially with a normal CT scan.

Yet another headache myth to dispel: vision problems rarely cause recurrent headaches in kids. Some people who are nearsighted will squint, and by the end of the day will develop tension-like pain from tightening up the muscles of their face and scalp, but that really is uncommon.

Headaches in children are common, and most commonly are caused by a minor infection, dehydration, hunger, or stress. If they’re recurrent, they’re likely to be one of the common primary headaches, like tension headaches or migraine or chronic daily headache. Headaches that are progressive (worsening), or associated with other prominent or worsening symptoms, need an urgent medical evaluation, but those are fortunately rare. More typically, headaches just need to be treated like, well, headaches. Don’t forget the simple stuff: rest, a kiss on the forehead, a cool compress, something to help relax. In the long run, those are probably better headache remedy for children than any medication.

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6 Comments on “Headaches every single day”

  1. What about an allergy or food sensitivity?


  2. Dr. Roy Says:

    Allergies or food sensitivities wouldn’t be very common triggers of headaches, at least not in children, or at least not without other symptoms. For instance, allergic rhinitis can cause headaches, but you’d expect the headaches in addition to nasal stuffiness and congestion.

    In adults, some foods are definite headache triggers — red wine and aged cheeses, for example. But most kids won’t eat those!


  3. Fay Says:

    Growing up, my family used an awesome pediatrician by the name of Dr. Susan Schulman. She knows how to think out of the box. When I complained of persistent headaches Dr. Susan told my mother to cut my hair. I had extremely thick, full hair that was worn in a tight ponytail every day. The day I got a full haircut I felt better.


  4. Dr. Roy Says:

    Fay, what a great story! I’m thinking it could very well have been the tight ponytail, pulling on your scalp, leading to a tension-type headache from the external tension.


  5. oldmdgirl Says:

    This makes me chuckle. My mom has had “sinus” headaches for years. Every time she gets one she takes some sudafed and goes to bed. I once tried to suggest that it was the nap and not the sudafed that was making her headaches feel better, and that perhaps she had migraines. She got really offended. Ha. Anyway, great article.


  6. Good info. My 5yo has regular migraines. They’re so awful. He’s had them for a year now. We tried several diet changes with no result. The only thing that helps him is darkness and sleep, although a drop of peppermint essential oil, diluted well in a carrier oil, has seemed to help when we rub it on his forehead. He refuses any oral medication once the headache sets in, but if I notice any signs that one is coming on sometimes I can get it in beforehand and head off the worst of it.

    I think we have finally figured out another possible cause, though…the poor kid is so tightly tongue tied it’s pulling in his two bottom teeth significantly and he can’t stick his tongue out or up. I think that him trying to speak and eat while compensating for that tie is causing him a lot of jaw and neck tension. Really hoping that having that released makes a difference for him. But even if it doesn’t he’ll be able to lick his ice cream cone. 😉


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