3855 Trueman Court | Hilliard, Ohio | 43026
Hilliard Pediatrics, Inc. - Dr. Tim Teller, MD
Headaches are common during childhood. Children as young as 2 or 3 years of age may have head pain related to headaches. Headaches may occur because of many things: hunger, tiredness, illness, allergies, injuries, stress, medications, and foods. Sometimes the cause of a headache is clear and at other times it is hard to determine why a headache happened. Most headaches, even chronic or recurrent ones, do not represent anything seriously wrong and will resolve with some time and treatment.
For brief head pain that does not slow your child down or keep them from being active, it is not necessary to treat the headache. Generally, a mild headache will pass without any treatment over a short time.
For all kinds of headaches that need medicine, we recommend ibuprofen (Motrin®, Advil®, and generics) or acetaminophen (Tylenol® and generics). These medications are often very helpful for children, even with more severe headaches. The usual doses on the package are appropriate for headache pain. The doses are on the package for children 24 pounds and above. Another place to find dosing information is our www.hilliardpeds.com website under “Fever” or “Over the Counter Medication Dosing”. Just as you would with treating a fever, the ibuprofen and acetaminophen can be alternated every 3 hours. For example, if you gave Motrin® at noon and the headache is still there 3 hours later, Tylenol® can be given.
Children with migraine headaches often respond to ibuprofen or acetaminophen at a young age, even if an adult with the same symptoms would require a powerful prescription medication. Prescription medications for migraine headaches are available for 11 year olds and above. If taking ibuprofen or acetaminophen and rest helps someone with migraines, we would generally continue those treatments. Taking these medications more than 3-4 times a week for headache may cause “rebound headaches” or medication withdrawal headaches. Please call our office during routine hours to discuss what to do if your child is routinely taking these over the counter medications for headaches.
The prescription strength medication that has been approved for 11 years of age and above is Imitrex® (sumatriptan), which has been available for adults since the early 1990s. This medication has the same side effects as all of the prescription migraine medications: drowsiness, dizziness, tingling, sweating and flushing, and chest or jaw discomfort. The tricky thing is that these can also be caused by the migraine itself. But for someone with severe headache pain, nausea, or vomiting from a migraine, the medication can provide some significant relief. Do not take the Imitrex and expect your child to be up and around. You should expect your child to rest or sleep. A typical recovery from a migraine might be a few hours or overnight. It can be a tough decision whether to take the medication if your child is not feeling well with a headache but has something important they wanted to do that day. I would recommend deciding by how down-and-out they feel with the headache.
Although they are used less often with children with migraine headaches than Imitrex®, two other medications that are also used in adults have been studied in and used with children: Zomig® and Maxalt®. Both of them are available as tablets and fast-melt tablets. We will discuss with you whether one of these is a good option for your child.
Children with migraines often are flushed and hot when they have a headache. Even if they are laying down in a quiet, dark room, they may feel more comfortable with a small cool, damp (run it under cold water and then wring out some of the water) towel across the forehead and eyes. If your child has vomited when they have a headache, keep a plastic bucket or trash can nearby. Sometimes the vomiting is every 10-30 minutes in waves over a couple hours. It is not uncommon for a migraine headache to improve after a few episodes of vomiting. Do not be surprised if your child vomits a few times, sleeps off the headache, and wakes up feeling better.
Imitrex® (sumatriptan) comes as both a tablet (that must be swallowed) and a nose spray. The tablet strength (for pre-teens and teens) is 25mg or 50mg. The nose spray strength is 5mg or 25mg. The tablet dosing is one tablet at the start of the headache. The tablet can be repeated every 2 hours as needed if the headache pain continues or has returned. The maximum dose of the tablet is 200mg in 24 hours. The nose spray is sprayed into one nostril (it does not matter which nostril) at the start of the headache. The spray can be repeated every 2 hours if the headache pain continues or has returned. The maximum dose of the nose spray is 40mg in 24 hours. The nose spray is a nice option for headache suffers who cannot swallow a pill or become so nauseous or vomit with their headaches. Imitrex® can be taken as the same time as ibuprofen or acetaminophen.
Zomig® (zolmitriptan) comes as a tablet and a fast-melt tablet (orange flavored). Both come as either 2.5 or 5 mg. One tablet is taken at the start of the headache. The dose can be repeated in 2 hours if the headache pain continues or has returned. The maximum dose is 10 mg. in one day. Side effects are similar to Imitrex® (see above).
Maxalt® (rizatriptan) comes as a tablet and a fast-melt tablet (peppermint flavored). Both come as either 5 or 10 mg. One tablet is taken at the start of the headache. The dose can be repeated in 2 hours if the headache pain continues or has returned. The maximum dose is 30 mg. in one day. Side effects are similar to Imitrex® (see above).
Children who have headaches regularly often have fewer headaches and less severe headaches when they take a multivitamin every day, drink more water, and exercise regularly (for at least 20-30 minutes 3 times a week). Adding an extra 16-24 ounces of water a day can really help. Whatever you may have found that triggers the headaches should be avoided as best as you can.
Children with migraine or other severe headaches sometimes need to take a preventative medicine to reduce the number of and the severity of the headaches. We often consider a preventative medication if the headaches are severe enough to change someone’s routine (missed school or other activities) and occurring more than two or three times a month. The most common medicine used is a medication called cyproheptadine (Periactin®). It commonly works well, making the migraines less common and less severe. The medication comes as a syrup or a tablet. The medication is most commonly given once in the evening for a week then a dose at breakfast is added. Thereafter, the dose is given regularly twice a day. The most common side effects are drowsiness and weight gain. The usual treatments for an active headache are fine if your child is taking cyproheptadine to prevent the headaches. Two other medicines that we use for prevention of migraines are amitryptiline (Elavil®) and propranolol (Inderal®).
One herbal supplement that has been scientifically tested is butterbur. A purified form without PAs (pyrrolizidine alkaloids) and 8mg total petasin called Petadolex® is the one I would recommend over alternatives. Side effects are considered minimal and include belching, itchy eyes, diarrhea, and headache (!). Butterbur should not be taken by those with ragweed allergy or a history of liver problems. For migraine prevention, the starting dose is 50mg capsule twice a day. The dose can be increased to 75mg twice a day if needed. On average, there were less headaches and less severe headaches, a decrease by about half. It has studied in children down to 6 years of age with success. If your child has migraine headaches, discuss with your pediatrician whether this may be something to try.
Tumors, cysts, increased fluid around the brain, or blood vessel issues can cause headaches in children. Thankfully, these very rarely occur and are almost never cause just headaches. They cause weakness on one side, abnormal reflexes, abnormal eye movements, changes on eye exam, headaches that occur with standing, and other changes. These issues can be diagnosed with a CT scan or MRI. Both tests are expensive and the CT scan exposes your child to radiation. Common reasons we will order a CT scan or MRI: (1). Sudden severe headache, (2). Headaches after head injury with vomiting or that are worsening, (3). Headaches with neurologic physical findings (weakness, abnormal reflexes, etc.), (4). Seizure with headaches, and (5). Sudden change in headache pattern.