Anxious and worried, the whole family is in disarray, for the daughter or son is having headaches.
Parents fear the worst, even though it is a common condition, MediScene understands, and only in rare instances that such headaches may be due to a serious issue.
“Headaches are common in children and occur at least annually in around 40% by the time they are seven years of age and in 75% by the time they are 15 years old,” says Consultant Paediatric Neurologist, Dr. Anuruddha Padeniya quoting global figures. Adult headaches are different to headaches in children, he adds.
Up to 90% of school-age children have had headaches, he stresses, referring to the Oxford Specialist Handbook of Paediatric Neurology which points out that most parents who seek help for a child with headache are looking for reassurance that it is not due to a serious cause.
Many parents are fearful that the child may be having a brain tumour or a haemorrhage into the brain and need reassurance that it is not so in a majority of cases, says Dr. Padeniya, explaining that when parents go here and there with a child who is complaining of a headache, not only is their family and school life -- both academic and extra-curricular activity -- disrupted, but also their work life. This will have an unseen impact even on the development of the country.
Headaches may signal a learning disability or stress, says this Paediatric Neurologist, highlighting the fact that the pain in the head is “a good window” through which doctors get a glimpse of whether there are learning, behavioural or social issues affecting the child.
He cites a study carried out by Consultant Child Psychiatrist, Prof. Hemamali Perera, which indicates that a significant proportion of unexplained illnesses in children presented themselves as either headaches or abdominal (stomach) pain.
Being a parent himself, Dr. Padeniya focuses on the rigorous routines followed by children these days. They get up early morning and leave for school, sometimes without a proper breakfast or even a scrap meal, and nothing to drink, not even water.
A heavy workload of lessons is followed by sports and also long tuition hours. “It is a complicated life for children and parents see them only late at night,” he laments, adding that when headaches join this, “it’s a real mess”.
A good clinical examination is essential and to aid the doctor some specifics are needed, MediScene learns. Blood tests, Computed Tomography (CT) or Magnetic Resonance Imaging (MRIs) of the brain are only necessary in very few cases.
For the doctor to make a qualitative and quantitative assessment on the “gravity of the problem”, the parents must keep a ‘Headache Diary’, urges Dr. Padeniya, for in 80% of the children with headaches he has seen, not medication but a simple adjustment in lifestyle has been the answer.
A few important questions:
- What is a headache? It is a pain that occurs in the ‘head’. However, pain from the teeth, ears, throat and eyes may also be called a “headache” by a child.
- Are headaches hereditary?
Some types are.
What are the common types of headaches? Headaches can be primary or secondary to underlying causes. Primary causes may be migraine and tension headaches while secondary causes may be due to viral illness, sinusitis, upper respiratory tract infections, emotional factors such as stress, anxiety or problems at school, vision problems and over-use of medications. Mostly, however, headaches are non-specific.
- Are there risk factors for
headaches?
Headaches may be common in girls after they reach puberty and also children who have a family history of headaches. Other risk factors may include a change in sleep patterns, skipping meals, watching TV for long hours, listening to loud music, smelling strong odours such as perfume, smoke or paint and exposure to bright light such as over-use of computers.
- What are the pointers to ‘tension headaches’?
Pain described as constant pressure, also as constricting, dull or aching, around the front and sides of the head, like a rubber band being tightened.
- What are the pointers to migraine?
Described as “hurting” it could be throbbing or pulsatile (vibrating) pain, occurring at intervals, with symptoms absent in-between. Migraines could last from 30 minutes to several hours and sometimes even a couple of days. They are also associated with abdominal pain, nausea or vomiting and may have a positive family history.
There could also be visual disturbances, seeing spots or having blurred vision, as well as weakness such as stumbling, unsteadiness and muscle weakness and cyclical vomiting and sensation of spinning (paroxysmal vertigo). Older children may experience an aura including blurred vision or seeing spots, jagged lines or flashing lights or a certain odour before a migraine. Younger children may be cranky, less active, vomit or look pale or flushed before a headache.
Migraines are made worse by bright light and noise and may be triggered by stress, certain types of food, lack of sleep, menstruation and exertion. They are eased by sleep and resting in dark, quiet places.
- What are the pointers to
sinusitis-causing headaches?
Pain in the face over the sinuses, a blocked nose with thick green/yellow nasal discharge and nasal congestion.
- What is an analgesic
headache?
A ‘medication over-use headache’ may be the result of an interaction between an exposure (such as over-use of analgesics) and a vulnerable individual. Parents should avoid dosing their children with analgesics without seeking medical advice.
- What are uncommon, worrying causes of headache?
An infection such as meningitis or encephalitis that involves the central nervous system; brain tumours; bleeding into the brain etc.
- When should a doctor be
consulted?
Prompt attention should be sought if it is the “first” or “worst” headache (see diagram on Page 1); occurs at least once a week; a worsening headache; an early morning headache that gets worse when coughing, bending or straining; following an injury such as a blow to the head; a headache with persistent vomiting or visual changes; personality changes and decrease in alertness; if the headache is accompanied by fever, neck pain or stiffness or seizures.
- What can be done at home to ease a child’s headache?
Ensure a healthy lifestyle; get the child to have adequate rest and relaxation and also sleep; lots of water to drink; timely, nutritious meals; and occasional use of over-the-counter medicines.
Headache clinics at LRH
Knowing the burden that parents bear, the premier Lady Ridgeway Hospital for Children in Colombo has launched dedicated ‘Headache Clinics’ every Friday morning under Consultant Paediatric Neurologist Dr. Anuruddha Padeniya.
These ‘Paediatric Headache Clinics’ at the LRH are a first in Sri Lanka.
Taking up referrals from other hospitals and the Outpatients Department of the LRH itself, the ‘Headache Clinics’ opened on December 2 under the guidance of LRH Director Dr. Rathnasiri A. Hewage, will have the support of a multidisciplinary team.
For support has been assured by Consultant Child Psychiatrist Prof. Hemamali Perera, Professor in Psychiatry, Faculty of Medicine, University of Colombo; Consultant Neurologist Dr. Sunethra Senanayake, President of the Sri Lanka Association of Neurologists; Consultant Paediatrician Prof. Asvini Fernando, President of the Sri Lanka College of Paediatricians; and visual and other fields as well as Ear, Nose and Throat Specialists. |
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