Tension Headaches in Children

Condition Basics

What are tension headaches?

Tension headaches are the most common headaches. They cause aching, tightness, pressure, and pain around the forehead, temples, or back of the head and neck. They tend to happen again and again, especially if a person is under stress. They usually aren't a sign of something serious. But they can be very painful.

What causes them?

The cause of tension headaches isn't clear. A change in brain chemistry may cause them. They can be brought on—or triggered—by stress, hunger, being tired, and not sleeping enough.

What are the symptoms?

Tension headaches usually cause a constant pain or pressure on both sides of the head. Your child may feel tightness around their forehead. They may also have aching pain at their temples or the back of their head and neck. The pain usually isn't severe.

How are they diagnosed?

Your child's doctor will do a physical exam and ask questions, such as how often the headaches occur and what the symptoms are. The doctor will also ask about your child's overall health. Other exams and tests are usually recommended only if the doctor finds signs of other health problems.

How are tension headaches treated?

Tension headaches can be treated with over-the-counter pain relievers, such as children's acetaminophen or ibuprofen. If this doesn't help, or if the headaches happen often, your doctor may prescribe other medicines. Home treatment, such as resting and managing stress, can also help your child feel better.

Cause

The cause of tension headaches isn't clear. In the past, doctors believed that tension or spasms of the muscles of the neck, face, jaw, head, or scalp played a role in causing these headaches. Now they think a change in brain chemistry may also help cause them.

Tension headaches can be brought on—or triggered—by things such as stress, hunger, being tired, and not sleeping enough. They may come on suddenly or slowly.

Chronic tension headaches are headaches that keep coming back. They can occur along with other health problems such as anxiety or depression.

Prevention

To prevent migraines and tension headaches in your child, try these tips.

• Keep a headache diary.

  This diary can help you find a link between your child's headaches and the things that trigger them. Help your child write down when each headache starts, how long it lasts, where it hurts, and what the pain is like. (Is it throbbing, aching, stabbing, or dull?)

• Help your child avoid their headache triggers.

  Triggers are things that can cause your child to have headaches. Your child may be able to prevent headaches by avoiding the triggers.

• Find healthy ways to help your child manage stress.

  Don't let your child's schedule get too busy or filled with stressful events.

• Make sure that your child drinks plenty of fluids.

  Avoid drinks that have caffeine. Many popular soda drinks contain caffeine.

• Make sure that your child gets plenty of sleep.

  Help your child keep a regular sleep schedule. Most children need to sleep about 9 to 14 hours each night, depending on their age.^{footnote 1}

• Encourage your child to get plenty of exercise.

  But your child should exercise without overdoing it.

• Limit TV, computer, and phone screen time.
• Make sure that your child doesn't skip meals.

  Try to provide regular, healthy meals.

• Keep your child away from smoke.

  Do not smoke or let anyone else smoke around your child or in your home.

• If your child is having problems with schoolwork, talk to your child's teachers.

  Make sure that the level and amount of schoolwork is appropriate for your child.

• If your doctor has prescribed a medicine to prevent headaches, have your child take it as prescribed.

  Your child may need to take it even when they don't have a headache.

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Symptoms

Symptoms of tension headaches include:

• A constant headache that doesn't throb or pulse. The pain or pressure is usually on both sides of the head.
• Tightness around the forehead that may feel like a "vise grip."
• Aching pain at the temples or the back of the head and neck.

Unlike migraines, tension headaches usually don't occur with nausea, vomiting, or feeling sensitive to both light and noise. But light or noise could make the headache worse. Pain from a tension headache usually isn't severe and doesn't get in the way of a person's school, work, or social life. But for some people, the pain is very bad or lasts a long time.

What Happens

Tension headaches may come on suddenly or slowly. They can last from 30 minutes to 7 days. They tend to come back, especially if a person is under stress.

If a person has a headache on 15 or more days each month over a 3-month period, they may have chronic tension headaches.

Most can be treated with over-the-counter pain medicines. Prescription medicines may help if headaches happen often or if the headaches are very bad.

When to Call a Doctor

Call 911 or other emergency services anytime you think your child may need emergency care. For example, call if:

• Your child has a very painful, sudden headache that's different than any your child has had before.
• Your child has a fever and a stiff neck.
• Your child has a headache with sudden weakness, numbness, trouble moving parts of the body, vision problems, slurred speech, confusion, or behavior changes.

Call the doctor or seek medical care now if:

• Your child has headaches after a recent fall or a blow to the head.
• Your child has new nausea or vomiting, or they cannot keep down food or fluids.

Watch closely for changes in your child's health. Call the doctor if:

• Your child wakes up in the morning with a headache and vomiting, and this happens more than a few times.
• Light hurts your child's eyes.

• Your child has a headache that does not get better within 1 or 2 days.

  Your child's headaches get worse or happen more often.

• Your child's headaches cause your child to take pain medicines often.
• Your child is often missing school, sports, or other activities because of their headaches.

Exams and Tests

Your child's doctor will do a physical exam and ask questions, such as how often the headaches occur and what the symptoms are. The doctor will ask about your child's overall health.

Tension headaches can be similar to other kinds of headaches, which may have different treatments. So it's important for the doctor to find out what kind of headache your child has. The doctor can rule out other health problems that may be related to the headaches.

It's common for parents to feel concerned about their child's headaches. You may feel that more testing is needed to rule out serious causes. But doctors often can find out the type and the cause of the headaches without using other tests.

In some cases, imaging and other tests may be recommended to rule out other health problems. But this isn't common. These tests include:

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Treatment Overview

Tension headaches can be treated with over-the-counter pain relievers, such as children's acetaminophen or ibuprofen. If this doesn't help, or if the headaches happen often, your doctor may prescribe other medicines. Home treatment, such as resting and managing stress, can also help your child feel better.

If your child's headaches are severe or happen often, your doctor may prescribe a daily medicine. This is to help prevent them. The medicine may also be prescribed if your child's headaches interfere with school or other activities. Have your child take the medicine every day, even if they don't have a headache.

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Self-Care

Here are some steps you can take to treat your child's tension headaches at home.

• Have your child rest in a quiet, dark room. Most headaches will go away within 24 hours with rest or sleep.
• Give acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for pain. Read and follow all instructions on the label.
• Be careful about using pain relievers too often because over time this can make your child's headaches worse.
• You can give your child water. Don't give your child drinks that contain caffeine. Fluids may help the headache go away faster.
• Put a cold, moist cloth or cold pack on the painful area for 10 to 20 minutes at a time. Put a thin cloth between the cold pack and your child's skin.
• Heat can help some children. Try a warm bath or shower. Or use a warm, moist towel or heating pad set on low on your child's shoulders and neck.
• Gently massage your child's neck and shoulders.
• Do not ignore new symptoms that occur with a headache, such as a fever, weakness or numbness, vision changes, or confusion. These may be signs of a more serious problem.

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