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4/24/23 blog post

when to be concerned about headaches

young girl with headache

in this article:

According to the National Headache Foundation, 20% of school-age children ages 5-17 in the U.S. are prone to headaches. And up to 40% have their first headache before they reach kindergarten.

Headaches can be hard to understand and describe when kids are young, so we asked pediatric neurologist and headache expert, Debra O'Donnell, MD, to help us understand when a headache is a passing pain and when it's something that needs medical attention.

what are the common causes of headaches?

There are two common types of headaches in children, tension headaches and migraines.

Tension headaches cause pain that can be described as a constant pressure around the front and sides of the head. While migraines are described as an intense throbbing pain usually in one area of the head. Migraines can also cause blurred vision, nausea and vomiting.

Most headaches are triggered by:

  • Not drinking enough fluids (dehydration)
  • Too much or too little sleep
  • Stress
  • Caffeine
  • Weather changes
  • Menstrual cycle
  • Too much screen time

what can I do to prevent and treat headaches at home?

The best way to prevent headaches is to practice good "headache hygiene." Evidence shows that practicing good headache hygiene can eliminate headaches in children. This can be done with the SMART approach.


  • Get regular sleep every night, even on the weekends - 8 to 10 hours is best
  • Turn off phone at bedtime - Use an alarm clock separate from phone
  • Turn off all devices 1 hour before bedtime
  • Go to sleep and wake up at the same time each day
  • No naps

meals and fluids

  • Eat healthy well-balanced meals at least three times a day
  • Don't skip breakfast (eat something, even if it's a small amount)
  • Try to avoid fast foods and prepackaged foods
  • Eat more fresh fruits and vegetables
  • Aim for optimal weight
  • Drink more with exercise. Pre-hydrate 1 to 2 hours before activity
  • Avoid caffeine - no more than twice a week and not after lunch


  • Get 60 minutes of physical activity each day
  • Limit screen time to less than two hours per day
  • Slowly increase activity duration and frequency to make it a habit
  • Choose an activity you enjoy and recruit a buddy - It's more fun with a friend, family member or pet


  • Stress is a normal part of life. There can be good stress and bad stress.
  • Stress is one of the most potent triggers.
  • Learn to manage stress in a healthy way. Try to resolve worries before going to bed.
  • To help manage a headache, consider some of these techniques:
    • Deep breathing
    • Tensing and relaxing muscle groups throughout the body
    • Mindfulness, meditation
    • Yoga
    • Counseling, cognitive behavioral therapy
    • Biofeedback


  • Manage triggers that contribute to your headaches.
  • Use a headache diary or app to track how often headaches happen, the intensity and the triggers.

Over-the-counter medications such as Tylenol or ibuprofen are good options for children with headaches but should not be overused. If your child needs Tylenol on a regular basis a preventive should be considered. This will help ensure that your child does not end up with rebound or medication overuse headaches in addition to their existing headaches. Some preventive measures may include supplementing with magnesium, vitamin B2 or riboflavin. These supplements have shown to be helpful in protecting against headaches. Nothing, however, can replace a good night's sleep, eating well-balanced meals and staying hydrated.

when should I seek medical attention for my child?

Any headache that is interfering with your child's day-to-day activity should be brought up to their primary care provider.

Most primary care providers are comfortable prescribing preventive medications. However, if those medications don't help your child, they may be referred to neurology for additional treatment options.

It is rare for headaches to be a sign of something more serious. The following symptoms can help you determine when to seek medical attention for your child.

Call your primary care provider if your child's headaches:

  • Happen more frequently than usual
  • Don't go away easily
  • Are very painful
  • Happen mostly in the morning when your child wakes up

Seek emergency medical attention if your child is experiencing:

  • Vision loss
  • Loss of consciousness
  • Uncontrollable vomiting
  • A headache lasting more than 72 hours (about 3 days) with less than 4 hours pain-free

If it is recommended that your child be seen by a specialist in neurology, schedule an appointment online today!

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Debra M O'Donnell, MD

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