Persistent Headaches in an 11-Year-Old: Causes and Solutions

An 11-year-old child experiencing persistent headaches?

I am Mrs.
Wu, and I have an 11-year-old child who frequently experiences headaches in the morning (mostly on sunny days).
Sometimes, they feel nauseous while riding in a car and need to gag, but it improves afterward.
We have seen a doctor, but no specific diagnosis was made, and it seems difficult to identify the cause.
I requested a thyroid examination since I have thyroid issues, but the results were normal.
Later, when I mentioned that my child’s nearsightedness has worsened, the doctor suggested that this might be the reason for the headaches.

Aside from the headaches, my child often has canker sores in the mouth but does not have any major illnesses.
They have a prescription for glasses due to nearsightedness of 600 degrees.
From ages 3 to 5, my child frequently had tonsillitis and often experiences gas in the stomach (when lightly tapped, it sounds hollow).
We have tried giving them electrolyte drinks in the morning and changing their glasses, but I am unsure what to do.
Last week, my child had stomach pain and headaches, and during the first visit, the doctor diagnosed a urinary tract infection.
Afterward, during a follow-up, the doctor mentioned a viral infection in the intestines and prescribed anti-inflammatory medication.

The doctor explained that the headaches might be due to insufficient blood flow to the head because the blood is concentrated in the abdomen, which seems reasonable.
However, my child has been experiencing headaches again in the mornings before school.
Sometimes, there is still a bit of pain after school.
The headaches vary in intensity, and I am wondering if I should take them to the emergency room.
I am afraid that if we go and there is no pain, the medical staff might scold us.
I am very worried! Please, doctors, could you provide some advice? Thank you!

Wu Tai, 30~39 year old female. Ask Date: 2007/10/09

Dr. Hong Shuokun reply Pediatrics

Approximately 7% of middle school students aged 13 to 15 experience migraine issues.
When it comes to headaches, it is essential to rule out the possibility of secondary headaches, which in childhood can often be caused by conditions such as colds, fever, cavities, sinusitis, vision problems, and psychological factors.
It is crucial to be aware of dangerous headaches, which, although rare, can be serious, such as those caused by meningitis, intracranial tumors, vascular malformations, and hemorrhages.

What warning signs can help us identify headaches that may have severe consequences? The following dangerous headache warning signs are worth noting:
1.
Sudden onset of severe headache.

2.
Persistent headache that worsens without relief.

3.
Headache occurring during exertion, coughing, or straining.

4.
Headache that begins after the age of 50.

5.
Accompanied by other unusual neurological symptoms, such as confusion, drowsiness, or cognitive decline; fatigue, joint and muscle pain; fever; vision changes; weakness in limbs, or coordination and balance issues.
In his case, it seems more likely to investigate conditions such as a cold, cavities, sinusitis, otitis media, vision problems, or psychological factors, rather than a dangerous headache.
Taking pain relievers may be helpful.
Wishing you good health.

Reply Date: 2007/10/09

More Info

Understanding persistent headaches in an 11-year-old can be quite challenging, especially when multiple symptoms are involved. Based on the information provided, it appears that the child experiences headaches primarily in the morning, has a history of motion sickness, and has been diagnosed with significant myopia (600 degrees). Additionally, there are concerns about recurrent abdominal issues and previous episodes of tonsillitis.

Possible Causes of Headaches
1. Primary Headaches: The most common types of primary headaches in children include tension-type headaches and migraines. Tension headaches can be triggered by stress, anxiety, or poor posture, while migraines may present with additional symptoms such as nausea or sensitivity to light and sound. Given that the child experiences headaches predominantly in the morning, it could suggest a pattern consistent with migraines, especially if there are accompanying symptoms like nausea.

2. Secondary Headaches: These headaches are caused by underlying conditions. In children, common causes include sinusitis, infections, or even issues related to vision, such as significant myopia. The mention of the child having worsening myopia could indicate that vision problems might be contributing to the headaches.
3. Other Factors: The child’s history of motion sickness and abdominal discomfort could also play a role. Motion sickness can lead to headaches due to the vestibular system's involvement, and gastrointestinal issues can sometimes manifest as referred pain in the head.

Diagnostic Steps
Given the complexity of the symptoms, it is essential to conduct a thorough evaluation. Here are some recommended steps:
1. Neurological Evaluation: A visit to a pediatric neurologist would be beneficial. They can perform a detailed neurological examination and may recommend imaging studies, such as an MRI or CT scan, to rule out any serious underlying conditions.

2. Vision Assessment: Since the child has significant myopia, a comprehensive eye exam is crucial. An optometrist or ophthalmologist can assess whether the current prescription is adequate or if there are other vision-related issues contributing to the headaches.

3. Monitoring Symptoms: Keeping a headache diary can help identify triggers and patterns. Note the frequency, duration, intensity, and any associated symptoms (like nausea or sensitivity to light) to provide the doctor with detailed information.

4. Consider Environmental Factors: Assess the child’s environment for potential triggers, such as poor lighting, screen time, or stressors at school.

Treatment Options
1. Medication: Over-the-counter pain relievers like acetaminophen or ibuprofen can be used for acute headache relief. However, it is essential to consult a physician before administering any medication regularly.

2. Lifestyle Modifications: Encourage regular sleep patterns, hydration, and a balanced diet. Reducing screen time, especially before bed, can also help improve sleep quality and reduce headaches.

3. Stress Management: Techniques such as mindfulness, relaxation exercises, or even counseling may be beneficial, especially if stress or anxiety is a contributing factor.

4. Follow-Up: Regular follow-ups with healthcare providers are essential to monitor the child’s condition and adjust treatment plans as necessary.

When to Seek Emergency Care
If the child experiences sudden, severe headaches, headaches that worsen over time, or headaches accompanied by neurological symptoms (such as confusion, weakness, or vision changes), it is crucial to seek emergency medical attention immediately.

Conclusion
Persistent headaches in children can stem from various causes, and a multidisciplinary approach is often necessary for effective management. By working closely with healthcare providers, parents can help identify the underlying issues and implement appropriate treatment strategies to improve their child's quality of life. It is understandable to feel anxious about the situation, but with the right support and information, effective management is achievable.

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