What type of headache might it be?
Migraine may cause throbbing pain with nausea or sensitivity to light and sound. In children, pain can affect both sides of the head. Tension-type headache often feels more like pressure or tightness. Illness, poor sleep, missed meals and dehydration can also be relevant. Describing the pattern helps the clinician distinguish these possibilities.
- Where is the pain and how long does an episode last?
- Does activity worsen it, and does rest help?
- Is there vomiting, altered vision or another symptom?
Symptoms that need urgent care
Seek emergency care for a sudden extremely severe headache, or headache with weakness, difficulty speaking or walking, confusion, a seizure or reduced alertness. Fever with neck stiffness also needs emergency assessment. A concerning headache after a head injury should be assessed urgently.
Seek medical advice the same day for a headache that wakes the child, is worse on waking, progressively worsens, occurs with unexplained vomiting or is triggered by coughing or bending. These features do not identify a cause by themselves, but should not wait for a routine appointment.
Age and changes in the pattern matter
Young children may struggle to describe pain and may instead stop playing, become pale or want to lie down. A headache in a child under four warrants prompt medical assessment. In older children, ask about school days and weekends, sleep and, when relevant, menstrual patterns. A new or changing headache needs reconsideration even if a previous episode was labelled migraine.
Examination and the role of tests
The clinician reviews headache history, medicines, family history and other symptoms, and performs an appropriate examination. Blood pressure, vision and neurological findings may influence the next step. Most children with a typical pattern and no concerning features do not need investigations. Imaging is considered when history or examination suggests another cause.
EEG is not routinely recommended for recurrent headache and does not distinguish migraine from other headache types. A separate concern about seizures may change the assessment; the reason for any test should be clear.
A treatment plan suited to the child
For a diagnosed migraine, rest in a quiet, dim room may help during an episode. Discuss appropriate pain relief and what to do if it does not help. Frequent medicine use can itself contribute to headaches. Children with frequent or disabling attacks may need discussion of preventive treatment. The aim is to reduce the burden and support everyday participation, with review of response.
What families can do between visits
Keep a brief diary of timing, duration, associated symptoms, missed activities and any medicines taken. Include sleep and meals without trying to prove that one food or event is the cause. Regular fluids, meals, sleep and suitable physical activity support care. Agree a school plan for access to water, rest and prescribed treatment when needed.
Common questions
Does every child with headache need a brain scan?
No. The decision follows the history and examination. Warning signs or abnormal findings may make imaging appropriate.
Is headache with vomiting always migraine?
No. Vomiting can occur with migraine but can also indicate another problem. New or unexplained headache with vomiting needs prompt medical advice.
Can repeated painkillers make headache worse?
Frequent use can contribute to medication-overuse headache. Bring the names and frequency of all medicines so a clinician can review a suitable plan.
