When Your Child Has Tension Headaches

Understanding headache pain

The most common types of headaches are tension and migraine. Your child’s healthcare provider has told you that your child’s headaches are tension headaches. With a tension headache, pain can come from many areas of the head. These include the muscles, joints, eyes, blood vessels, or nerves. In some cases, your child feels pain from another part of the body. For example, tense muscles in the shoulders or neck may lead to headache pain.

What causes tension headaches?

Tension headaches can have many causes. Common causes in children are:

• Tension (physical or emotional)

• Hunger

• Trouble with eyesight

• Eyestrain due to reading, video games, or computer use

• Exposure to very strong smells (such as perfume or tobacco)

• Tiredness

• Sinus infection or allergies

• Overheating

• Fluid loss (dehydration)

What are the symptoms of tension headaches?

Every child is different. And your child’s headaches may feel different each time. Your child may have some or all of these symptoms:

• Head pain that is focused in the front of the head

• Neck pain along with head pain

• Pain behind both eyes or in both temples

How are tension headaches diagnosed?

The healthcare provider will start by ruling out migraine headaches and headaches due to other causes. They will also examine your child and ask questions.

• You will likely be asked about the times of day your child most often has headaches. You may also be asked about health issues, such as frequent sinus infections.

• You and your child may be asked to keep a “headache diary” for a short period. This means writing down what time of day your child gets headaches, where the pain is felt, how often the headaches happen, and how bad the headaches are. You may also be asked to write down things that make the headache better or worse. The diary can help the provider learn more about the headaches and find the best treatment.

How are tension headaches treated?

Treat your child at the first sign of a headache. Give your child a dose of acetaminophen or an over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen. Do this as soon as possible. Don't exceed the maximum dosage and frequency for your child. Your child may wish to lie down and rest until the headache is gone. A cold compress over the face and eyes may also be helpful.

How are tension headaches prevented?

To prevent headaches, avoid your child’s specific triggers. Triggers are things or events that cause headaches to occur. Some common triggers are hunger, eyestrain, strong odors, and tiredness. You and your child should learn their triggers and avoid them when possible. Be sure your child is eating well, getting enough sleep, getting daily physical activity, and limiting computer and TV time.

When should I call the healthcare provider?

Call your child’s healthcare provider right away if your child has any of the following:

• Fever with a stiff neck (see "Fever and children" below)

• Headache that doesn’t respond to over-the-counter medicine, including acetaminophen or ibuprofen

• Headache that seems different or much worse than past headaches

• Headache upon waking up or in the middle of the night

• Vomiting due to headache (especially vomiting when waking up)

• Dizziness, clumsiness, slurred speech, or other changes with a headache

• Blurred or double vision with headache

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

• Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

• Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

• Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

• Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

• Mouth (oral). Don’t use a thermometer in your child’s mouth until they are at least 4 years old.

Use a rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell them which type you used.

Below is when to call the healthcare provider if your child has a fever. Your child’s healthcare provider may give you different numbers. Follow their instructions.

When to call a healthcare provider about your child’s fever

For a baby under 3 months old:

• First, ask your child’s healthcare provider how you should take the temperature.

• Rectal or forehead: 100.4°F (38°C) or higher

• Armpit: 99°F (37.2°C) or higher

• A fever of ___________as advised by the provider

For a child age 3 months to 36 months (3 years):

• Rectal or forehead: 102°F (38.9°C) or higher

• Ear (only for use over age 6 months): 102°F (38.9°C) or higher

• A fever of ___________ as advised by the provider

In these cases:

• Armpit temperature of 103°F (39.4°C) or higher in a child of any age

• Temperature of 104°F (40°C) or higher in a child of any age

• A fever of ___________ as advised by the provider