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Headaches in Children

Headaches in children are quite common and can be due to many factors. Causes of headache include migraine, dehydration, hormonal changes (generally in teenagers), referred pain from sinus/ ears/ teeth or neck, stress, eye problems and very rarely brain tumours.

Generally a good place to start is your GP. He or she can do a general examination and give preliminary advice. Try to keep a diary of when the headaches are occurring, taking into consideration days and times, foods eaten and general mood (stress/tension). In doing this you may be able to pin it down to Saturday afternoons because not enough water was drunk after soccer, or Monday mornings when there is a Maths test with associated anxiety, or after certain foods. A referral to a paediatrician, ophthalmologist or neurologist is sometimes warranted.

Most eye related headaches will generally follow a pattern of coming on about 20 mins after starting a near task (reading, homework or iPad), or in the afternoons after a day of school or work. If your child plays happily on the iPad for extended periods but resists homework due to a "headache" then it almost certainly relates more to lack of interest than an ocular issue.
An eye related headache is certainly a possibility if the timeline above fits, the headache is located around the frontal and temple region and is accompanied with double vision or blurred vision (although a pre-migraine aura can present like this too). If an eye assessment is indicated then the main things that should be assessed is the child's focus (ie refraction) particularly relating to long sight and astigmatism and their convergence ability. Firstly in respect to refraction it should be noted that children are normally a little long-sighted (hypermetropic). Small amounts of hypermetropia or astigmatism do not cause headaches. If the amount of refractive error is moderate or high then glasses are probably warranted. Another possibility is what is called a convergence insufficiency. When we read or look at something at a close distance our eyes converge slightly to keep the object of regard in line with our maculae (where we see most clearly). If we are unable to comfortably do this then the effort to maintain this posture can result in symptoms of headache and eyestrain. Simple eye exercises in the form of "pencil push-ups" are usually sufficient to treat this. 

 

Migraines can begin with blurred or disturbed vision, are usually unilateral (affecting one side of the head) but can be band-like across the forehead in children, are accompanied with light or sound sensitivity and often resolve after vomiting or sleeping. No one knows what causes migraine but it often "runs in the family".

Headaches that are sinister in origin are almost always accompanied by other neurological signs such as vomiting, loss of balance and regression of ability/ milestones. Dilating eye drops can be used to check the optic nerves at the back of the eye for signs of increased pressure in the brain, in conjunction with an urgent referral to a neurologist.

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