Children's headaches, don't take them lightly

By Donya Betancourt

SANUR, Bali (JP): Just like adults, many children suffer from headaches. It's actually one of the most common medical complaints of children.

Most headaches in children are benign, but sometimes they can be a serious medical problem.

Children experience many infections, trauma and stresses that can lead to headache. Research shows that as young people enter adolescence and face the stresses of puberty and secondary school, the frequency of headaches increases.

Today we will discuss what causes headaches, as well as symptoms and signs that we need to be concerned about.

First, let's start with areas of the head that can cause pain.

Blood vessels within the skull are sensitive to pain stimuli, as are the surrounding membranes that hold the brain in its correct position. When a blood vessel ruptures, either spontaneously or due to trauma or pressure, it usually causes a sudden, severe headache and may displace some of the brain tissue and membranes -- causing a progressive stiffness in the neck and problems with nerves that control the head, face and even the rest of the body.

There are two main sections involved:

1. Extracranial (outside the brain) structures are scalp, muscle, mucosa, teeth and vessels, which cause pain in the face or forehead; or

2. Intracranial (inside the brain) structures, such as large veins, sinuses, meninges (membranes covering the brain) and arteries.

* Brain tissue and skull are structures that cause NO pain.

* Upper part of brain can cause pain around frontal area (forehead).

* Lower part of brain can cause pain at neck. Ear inflammations, traction, increased intracranial pressure or various diseases of head and neck, such as infection of paranasal sinus, can cause headache.

Some experts divide headaches into two categories.

First are headaches that occur on their own and not as a result of some other health problem, called primary headaches, such as migraines or tension headaches, which are muscle contraction or stress headaches.

A headache may also indicate stress related to school, friends or family. Migraine headaches may occur in children and may be explained by a family history of migraine. In children, migraines are often accompanied by vomiting, light sensitivity and sleeping problems. Recovery follows within a few hours.

The second category is concerned with a cause, such as head injury, concussion, sinusitis, sore throat or tumor.

Headaches are also associated with many viral illnesses. A comprehensive history from the child and parents is very important for the physician's treatment. The history should feature information such as location of the pain, severity of pain and associated symptoms with the headache.

The headache history has two major concerns. Emotional involvement of headache is more likely determined if:

1. They are related to school attendance;

2. They have ill defined onset and termination;

3. Have recognized association with emotional upset;

4. The patient has other illness or chronic symptoms and the area of pain is ill identified or there are multiple areas; or

5. Other family members use headaches for secondary gain. If your child has any of these symptoms, you are probably looking for stress or secondary gain.

The symptoms that should be brought to your child's doctor include headaches that wake a child from sleep, early morning vomiting without nausea, worsening or more frequent headaches, headaches with fever, a stiff neck, rash, mental confusion and headaches that follow an injury.

However, if your child frequently complains of headache, even during times when they are well, consult your physician. A complete medical history and complete examination may be given. If necessary, some testing may be ordered.

There is some evidence to suggest that our blood sugar levels play a role in causing headaches and migraines. Blood sugar levels fluctuate according to intake of food and medications, and are regulated by hormones, mainly insulin and adrenaline.

All sugars, natural or refined, end up as glucose in our bloodstream. The result of consuming refined sugar is a rapid rise in blood sugar levels (it is the speed with which they get there that is important), which our body overreacts to by producing large amounts of insulin. This release of insulin then causes a rapid drop in the blood sugar level, which may then lead to a constriction of blood vessels in the brain, which could then trigger a migraine.

When the blood sugar levels are too low, the brain does not receive enough glucose to function properly. The body then responds by increasing the quantity of blood flow to the brain as well as releasing hormones, which in turn release stored glucose into the blood stream. This results in increased blood pressure, and a change in the blood vessels of the brain. It is this change in blood vessel diameter and blood flow dynamics that is believed to cause the headache pain.

The same thing happens when you have a fever. All the main parts of the body have a higher metabolism, such as the brain, heart and lungs, which blood will be pooled to, resulting in a headache, rapid heart rate and rapid respiratory rate. Children may have specific triggers for their headaches; chocolate, cheese, pizza, caffeine, sleep deprivation or poor sleeping habits also lead to headaches, especially migraine attacks.

Remember that most headaches in children are benign but when the headaches begin, a medical evaluation is important. Treatment can be as simple as paracetamol, but if the child needs it frequently, you may consider consulting your doctor. Remember your child doesn't need to suffer.

-- The writer is a pediatrician based in Sanur, Bali. Questions? Contact her at drdonya@hotmail.com or features@thejakartapost.com.