Does my Toddler have Headache?

Asking "Does my toddler have headache?" is a reasonable question as unlike older children who will just tell you, toddlers may not be able to articulate what is happening to them. You need to be a bit of a detective and look at your toddler's behavior.

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Signs of a headache in a young child

If you are asking "does my toddler have headache", look out for the following that can be signs of headache in young children:

  • furrowed brow
  • grimace
  • squinting the eyes
  • holding the head
  • not liking to be in bright lights
  • not liking loud noises
  • feeling miserable
  • she says "my head hurts"

Sometimes toddlers can just be listless and not themselves. If this continues for any length of time it is best to have a medical review as this may mean that your child is ill.

In toddlers, I always like to be sure that there is not a serious cause, so if you are asking "does my toddler have headache?" and your toddler is not well or the 'headache' is not settling, please see your doctor.

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What causes headache in a toddler?

The important thing to ask after asking "does my toddler have headache?" is "Could there be a serious cause of the headache?"

As mentioned on the headache section on the pain page, headache can be caused by:

  • high pressure in the skull, eg. from tumors or cerebrospinal fluid (csf) blockage (such as hydrocephalus)
  • infection in the brain (encephalitis) or the covering of the brain (meningitis)
  • conditions where the brain is normal and the pain is self-limiting, like migraine or tension headache

As you can see some conditions are what we call pathological in that there is an abnormality or disease in the brain or the brain surrounds. Raised pressure within the skull (known as raised intracranial pressure) causes pain and is abnormal. Infection of the brain (encephalitis) or of the covering of the brain (meningitis) is also abnormal. 

On the other hand, conditions such as migraine and tension headache can cause severe pain but these are non-pathological. So there is no abnormality or disease process and the pain will resolve by itself eventually. The pain is the main concern, as compared to pathological headache where the pain is of concern, but the underlying cause of the pain is of more concern and usually requires prompt treatment.

Conditions causing raised intracranial pressure usually have signs on examination and there are clues in the history of the headache. For example, the symptoms of a brain tumor can come on over time with symptoms such as

  • headache and is vomiting particularly first thing in the morning or waking with a headache at night
  • personality change between headaches
  • headaches that are becoming more frequent and severe
  • headaches that start after coughing, laughing or straining

Imaging by CT scan (computed tomography scan) or MRI scan (magnetic resonance scan) will usually reveal or rule out conditions causing raised intracranial pressure.

Acute infection is usually diagnosed by the history and examination of the child with the symptoms usually coming on suddenly often with a fever and the child looking unwell. Additional tests such as lumbar puncture can confirm or rule out infection involving the brain.

There are no specific tests for migraine headache or tension headache in children and diagnosis is made on the history and examination and by exclusion of serious causes.

However, be reassured that even if the answer to the question "does my toddler have headache?" is "yes", the headache is more likely to be benign (non-pathological) rather than a serious (pathological) cause.

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Should I request a CT or MRI scan for my toddler?

Toddlers with headache require a full medical history and examination as mentioned. The pediatrician can then assess whether there is a likelihood of raised intracranial pressure or acute infection. If so, these must be further investigated and treated. If the pediatrician believes the headache is not pathological such as with tension headache or migraine, then treatment of the headache alone may be enough.

I have a relatively low threshold for imaging (scanning) in young children. However, if there are no initial worrying signs on the examination, I may wait and see how things progress before imaging for headache as imaging is not without its own risks.

Like all decisions in medicine, the benefit of any test or treatment must be weighed up against the risk. Research has shown that if there are no abnormal findings in children with headache (even acute headache), most imaging with CT scans will be normal.

Risks and Benefits of CT Scans in Toddlers
The CT scan gives good information about raised intracranial pressure in infants and toddlers and is usually relatively quick to perform although some toddlers may require sedation to keep still. A CT scan does involve radiation however and there is a small risk of increased malignancy later in life in infants who have repeated CT scans. The absolute risk for one CT scan (or even 2 or 3 scans) is very low, but it is not a test to be undertaken lightly without any consideration.

Risks and Benefits of MRI Scans in Toddlers
MRI scans give very good information on the brain and do not involve radiation. However, the scans take longer than CT scans. The MRI machine is loud and can be scary to toddlers and as the patient needs to be absolutely still for the scan and this is difficult for young children, MRI scans in toddlers usually involve a general anesthetic. Anesthetics carry a small risk, so again this is not a test to be undertaken lightly.

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Should I get my toddler's eyesight checked if she has headaches?

If you have concern about your child's vision, you should have it checked. However, a large study has shown that simple visual problems are unlikely to be causing headaches in children and so correcting visual disturbance with glasses is unlikely to help headache.

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When should I see my doctor?

See your doctor urgently if you are concerned your infant or toddler has a headache and there are any of the following:

  • she has vomiting, especially in the morning
  • the headache wakes her at night
  • she is unsteady on her feet
  • she can no longer perform tasks she had previously mastered
  • she looks unwell
  • she has a stiff neck
  • she seems drowsy and less alert than normal when she is awake
  • the headaches are becoming more severe or begin after coughing or straining
  • you are worried your child isn't well

Parents are very good at knowing there is something wrong with their child so trust your instincts when considering "does my toddler have headache?"

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References

  • Roth, Drack, Rychwalski. Headaches in Children Appear Unrelated to Vision Problems. American Academy of Ophthalmology (AAO) and Asia-Pacific Academy of Opthalmology 2012 Joint Meeting. Abstract #PO461. Presented November 12, 2012.
  • Lateef TM, Grewal M, McClintock W, Chamberlain J, Kaulas H, Nelson KB.Headache in young children in the emergency department: use of computed tomography. Pediatrics. 2009 Jul;124(1):e12-7.
  • Mark S Pearce et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. The Lancet, Volume 380, Issue 9840, Pages 499 - 505, 4 August 2012 doi:10.1016/S0140-6736(12)60815-0

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Last reviewed 27 November 2012

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Dr Maud MD

Dr Maud MD (MBChB, FRACP, FRCPCH), a specialist pediatrician, provides health information and medical advice for parents of babies and toddlers. Read more about Dr Maud.



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