Emergency Department Guidelines for Headaches: When to Worry

Headaches in children can stem from a variety of causes, including stress, poor nutrition, dehydration, and disruptions in daily routines. Recognizing your child’s triggers and understanding different headache types are crucial in determining whether a trip to the emergency department is necessary.

Common Types of Headaches

• Migraine Headaches: Often accompanied by nausea, sensitivity to light and sound, migraines cause pulsating pain on one side of the head and can last between 4 to 72 hours. They may also occur with sensory and visual disturbances known as auras.

• Tension-type Headaches: These headaches cause pressure felt throughout the entire head and can last from several minutes to several days, often with sensitivity to light and sound.

• Cluster Headaches: These are characterized by pain typically felt around the eye or temples and can last anywhere from 15 to 80 minutes. Cluster headaches are far more common in adults.

Is It Something Serious?

While headaches are rarely the main symptom of a brain tumor, certain risk factors and accompanying symptoms should raise concern for a serious underlying cause. These can include:

• Fever
• Sudden onset of severe headaches
• No family history of headaches
• Altered mental status
• Head trauma
• Headaches worsen when lying down

If a child presents with these symptoms, a CT scan or MRI may be necessary to rule out serious underlying causes.

Concussions are often caused by head trauma and include symptoms like headaches, nausea, and sensitivity to light and sound. A post-traumatic or post-concussive headache is a headache that begins within 7 days after a head injury. For most people, these stop with other concussion symptoms. If the headaches continue for a longer time, they are often treated like other types of chronic headaches.

Treatment and Prevention Strategies

For managing headaches and migraines, lifestyle adjustments such as identifying and avoiding triggers, maintaining a healthy diet, ensuring proper hydration, and establishing consistent sleep patterns are crucial. Avoiding caffeine and using over-the-counter medication as recommended by a care team are recommended.

When to Seek Emergency Care

An emergency room visit becomes necessary when the headache is severe, persists despite medication, is accompanied by a fever, stiff neck, vomiting, slurred speech or numbness/weakness on one side of the body these symptoms could indicate a more serious condition that requires immediate attention. Additionally, if your child is having “the worst headache of their life,” they should be taken to the emergency department immediately.

While many emergency department visits for headaches are due to chronic or unmanageable pain, it is essential to have a relationship with a primary care team that can help treat headaches or migraines. They can provide ongoing treatment for headaches, develop a personalized migraine prevention plan, and reduce the likelihood of emergency department trips.