HEADACHE

A headache can be serious if:

• The child has persistent headache without any obvious cause or following a head injury.
• The headache is associated with persistent vomiting, squinting, loss of balance or disturbed consciousness.
• The headache is followed by convulsions or by loss of consciousness.
• The headache is severe at onset.
• The child has headaches whose character and frequency have changed.

SYMPTOMS: While the older child will be able to tell you he has a headache, smaller ones may be fretful or bang their heads persistently. However, occasional banging of the head in a toddler is often behaviour-related.


Common Causes
Common Infections
Viral or bacterial infections can cause a headache. Usually, the child also has fever and body ache. Paracetamol relieves this type of headache for a couple of hours till the child recovers from the infection. The child is otherwise alert. He may be an obvious case of a viral cold with running nose or a bacterial infection like acute tonsillitis.


Psychogenic Factors And Fatigue 
School going children under undue stress, sleep deprivation and emotional disturbances can have frequent headaches.


Eyestrain 
A child complaining of headache towards the end of the day may need his eyes to be checked.


Sinus Infection
In persistent infection of the sinuses (hollows present in our bones nearer the nose), the headache is typically noticed on waking up.


Migraine
Repetitive stereotype headaches are usually not due to serious causes like a brain tumour. One such example of a relatively benign condition is migraine.

If there is a family history of migraine, this condition should especially be considered. While adults often have a headache that affects one half of the head, children may complain of a generalised headache in migraine. A few precipitating factors are stress, bright sunlight, cheese, chocolates, chilled food, cold drinks, ice cream and nuts. The attacks of headache are often associated with nausea or vomiting. The child is perfectly all right between attacks.

Migraine aura (which precedes an attack of migraine) without headache has also been found in some children. In this condition, the child has distortion of visual image, frequently consisting of things looking smaller than they are (micropsia), or seeing bright lights, or the appearance of distortion of body image (the Alice in Wonderland Syndrome). A positive personal history or family history of classical migraine in such cases may clinch the diagnosis. 


Head Injury
A persistent headache following a history of head injury should not be ignored. Most vomiting after mild head injury is said to be related to migraine, but a persistent headache or vomiting could be related directly to the head injury.


Meningitis
Fever, a fixed gaze, or disturbed consciousness should raise the possibility of a diagnosis of meningitis.

A small infant may have a bulging anterior fontanelle (the soft spot on the head). Neck stiffness is present in most cases of meningitis.


Brain Tumour
A persistent headache, lasting day and night, could be due to a brain tumour. Associated features like persistent vomiting, squint, loss of balance, convulsions and disturbed consciousness add to the suspicion of a brain tumour or any other space-occupying lesion in the brain.

Headaches due to migraine may be preceded by blurring of vision followed by vomiting. This should not be construed as suggestive of a brain tumour. 


High Blood Pressure
This is a rare cause of headache.

TREATMENT: In routine cases, take the child in your lap and press his head gently. If he does not object, apply a little balm on his temples. Paracetamol may also be given. Ibuprofen has been found to be more effective than paracetamol in headaches due to migraine.

Attend to any emotional factors. Make sure he has food at regular intervals, Hunger can add to the problem. Check his hours of sleep. Exercise has been found to help fight migraine by improving blood flow to the brain, by boosting blood levels of brain chemicals that suppress pain, and by conferring a general feeling of relaxation and well-being. However, sudden and vigorous exercise should be avoided. It may actually trigger or aggravate an attack.

For temporary headaches associated with fever, paracetamol and treatment of the infection with suitable drugs, if required, should be enough.

For a persistent complaint, specially associated with other worrying symptoms mentioned earlier, take your child to the doctor soon so that the proper diagnosis can be made at an early stage.

11 February, 2013