Headache? It's No Child's Play

A headache, which is never pleasant, becomes more problematic when toddlers or children, who are not always capable of saying "what hurts," are involved. Headaches in older children and teens are equally complex. Dr. Muhammad Muhajnah, Director of the Child Development Institute at Hillel Yaffe Medical Center, explains

"When infants or toddlers suffer from a headache, they can't always point to the source or the problem or pain." 

"When infants or toddlers suffer from a headache, they can't always point to the source of the problem or pain," explains Dr. Muhammad Muhajnah, Specialist in Pediatric Neurology and director of the Child Development Institute at Hillel Yaffe Medical Center. "It's not only because they are unable to put it into words (if they are not talking yet), but also because a headache triggers other phenomenon that obscures the primary cause of the pain. This is also why pediatric neurologists frequently intervene only after symptoms such as pallor, sensitivity to light, apathy, drowsiness accompanied by an inability to sleep, become worse."

How does a headache experienced by children differ from a headache experienced by adults?   

"Previous studies have shown that close to 50% of the population have complained or suffered from a major headache in their lives that required medical attention. Like complaints of headaches by adults, a headache is one of the most common complaint by children, and particularly adolescents. The difference between the two populations stems from the fact that headaches in adults are frequently attributed to emotional causes (stress, tension, etc.), while in children and adolescents, the cause is frequently physical, indicating diseases such as sinusitis, anemia or has various hormone components.    

"It is important to note," said Dr. Muhajnah, "that in the vast majority of cases, no unequivocal or significant organic proof can be found for a headache. Therefore, we cannot prevent them, but can just alleviate the symptoms when they appear." 

What are the most common causes of headaches among infants, children and adolescents?

Various statistical studies have revealed that complaints of headaches were identical among boys and girls up to the age of 10-11. At this stage, and through the end of adolescence, the frequency of headaches becomes more significant among adolescent girls than adolescent boys. The reasons are attributed to intensive hormonal changes adolescent girls experience as well as to emotional aspects. Studies have found that girls and women are more emotionally affected by the environment than are men and boys, which might also affect physical problems such as headaches.

Causes of headaches are divided into two groups: 

1. Mild, benign causes. Headaches attributed to a lack of fluids, lack of sleep, fatigue and emotional difficulties as well as problems in social adjustment. These headaches can be treated with simple pain killers without medical intervention and are resolved with a good night's sleep, sufficient intake of fluids and specific treatment of the stressful emotional situation. 

2. Serious causes that require intervention. There are several possible physical phenomena that may cause stress and headaches:   

a. Migraine. A migraine is a recurring event of headaches, with no other complaints identified between episodes. A migraine attack will generally be accompanied by nausea, sensitivity to light and drowsiness. The causes of a migraine cannot always be identified, not even by tests such as blood tests, brain imaging and EEG (test that scans the electrical activity of the brain). In most children who suffer from migraines, non-specific changes in the EEG tests can be seen, but in most cases of migraines, the episodes are irregular and treatment involves encouraging the patient to drink fluids (water), sleeping well and avoiding caffeine-rich foods, chocolate, preservatives and the like. In cases of severe migraines, prescription drugs are prescribed by the doctor.

Stressful situations can trigger a migraine attack, such as when tests are taken or in the case of adolescent girls – menstruation.           

Dr. Muhajnah explains that the ideal solution for migraines (as well as for many headaches), a solution that has even been proven by research – is "to drink plenty of water and go to sleep." Another solution, although not proven empirically, but does have an alleviating effect – is drinking an orange or lemon beverage that contains Vitamin C, which has positive impact on headaches.

How are migraines and headaches identified in babies and toddlers? 
Even a one-year-old can experience a migraine. The scientific name of the phenomenon is benign paroxysmal vertigo. A headache in a baby is expressed in prolonged crying, extreme clinginess to one of the parents (not willing to be put down), pallor and inability to sleep. For two-year-olds, there is a phenomenon known as paroxysmal torticollis, which is manifested in sitting accompanied by a leaning of the neck for several consecutive hours (the child appears to have a stiff neck). This phenomenon is an early indicator that the child will suffer from migraines in the future.

b. Sinusitis, Rhino-sinusitis. These diseases are manifested as severe headaches that frequently accompany children who suffer from chronic sniffles or other respiratory tract problems. These diseases develop as a result of various fevers and are accompanied by severe headaches that only get worse when not diagnosed in time. They are diagnosed by a doctor and x-ray of the sinuses. Treatment involves antibiotics if the infection is bacterial in nature or adjuvant therapy if the infection is viral. 

c. Anemia (blood deficiency). Anemia is caused by an iron deficiency in the body that produces various clinical symptoms such as general weakness, pallor, performance difficulties (in studies) and, of course – headaches. "When a parent notices these symptoms in their child," said Dr. Muhajnah, "They should contact a pediatrician, get blood tests and obtain adjuvant treatment for anemia."  

d. Headache attributed to brain tumors. Although relatively rare, it must be noted that brain tumors are the second most common form of tumors in children (after leukemia). The incidence of tumors in the central nervous system of children under the age of 15 is approximately 2.5 incidents per 100,000 residents. Early diagnosis is critical to obtain optimal treatment and prognosis. Headaches that are suspected of being caused by tumors include prolonged headaches that worsen over time, accompanied by vomiting, sleeplessness and blurred vision. Toddlers will experience loss of appetite, deterioration in general state of the body and disproportionate growth of head circumference. 

e. Trauma and bruising. Children fall and get up in the park, playground or at home from playing. A headache is the result of a bump or trauma as a result of a fall or hit, if it does not require visible medical treatment, it does not have to be significant, but definitely requires parental monitoring. When a healthy child begins to cry, complain of pain, vomit, etc. medical attention must be sought. In most cases, monitoring the child's behavior and making sure that none of the symptoms described above develops, that the child does not lose consciousness and that the site that was hit does not develop significant swelling.  

"As a pediatric neurologist, I see an increasing number of children and adolescents who suffer from headaches and come for treatment beyond the standard painkillers," said Dr. Muhajnah. "Everyday life and strong awareness that various areas of life are stressful not only adults, but for children as well, as is evidenced in the frequency in headaches. Although in more than a few cases, particularly those who find themselves visiting a neurologist, the problem is physical, and the solution ranges from simple to complex, balance in a child's life and environment – also plays an important role in treatment of headaches. In any case, parents should check with a professional regarding the appropriate dose for an over-the-counter painkiller they can give their child based on the child's age and weight."   


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