Headache in Children: What Causes It and When Parents Should Be Worried

Headache in children is extraordinarily common — surveys suggest 50–75% of school-age children experience headaches at some point, and approximately 5% have recurrent significant headaches by age 7. The vast majority of childhood headaches are benign — migraine and tension-type headache — but a small number signal serious underlying conditions that must not be missed.

Most Common Causes of Childhood Headache

Migraine: Affects approximately 5% of children and 15% of teenagers. Childhood migraine often differs from adult migraine — episodes may be shorter (as little as 1–2 hours in younger children), vomiting is prominent, and the headache may be bilateral or frontal (rather than unilateral in adults). Children with migraine often look pale and want to lie in a dark, quiet room. Abdominal migraine — recurrent episodes of central abdominal pain without headache — is a migraine variant unique to childhood.

Tension-type headache: Bilateral, pressure quality, mild-to-moderate, not aggravated by activity. Associated with stress, anxiety, poor posture (screen use), and inadequate sleep. Increasingly common in school-age children in Hyderabad due to academic pressure and prolonged screen time.

Sinusitis: Facial pressure and frontal headache, worse on bending forward, associated with nasal congestion and fever. Often overdiagnosed — a sinus X-ray showing mucosal thickening in a child with a cold is not necessarily sinusitis requiring treatment.

Eye strain and refractive errors: Frontal headache during close work, relieved by rest. All children with recurrent headaches should have a vision check.

RED FLAGS — Headache Requiring Urgent Evaluation

• "Thunderclap headache": Sudden, severe headache reaching maximum intensity within 60 seconds — subarachnoid haemorrhage until proven otherwise. Emergency
• Headache that consistently wakes the child from sleep (not headache that prevents sleep — that's common in migraine — but headache that WAKES from deep sleep)
• Progressively worsening headache over days-weeks with no good days
• Headache associated with fever and neck stiffness — meningitis
• Headache associated with neurological symptoms: double vision, weakness, coordination difficulty, personality change
• Headache in a child under 5 (less common, more likely to be significant)
• New headache in a child with known cancer, HIV, or immunosuppression
• Headache with positional component (worse lying down, better sitting — raised intracranial pressure)

For paediatric headache and migraine evaluation: Sri Anand CNC, Chanda Nagar, Hyderabad. Call +91 90633 66983.