Bright and conscientious, the 12-year-old also appeared physically healthy and was easily "passing" her back-to-school exam. As the visit progressed, the girl and her mother wanted to share one nagging issue. The middle-schooler had been experiencing headaches for the last year, and though the pair wasn't too worried, they were still looking for a little reassurance.
The headaches occurred once or twice a week, rated about a "4" on a 10-point pain severity scale, were never debilitating, and were relieved by the occasional use of over-the-counter medications. The headache incidents also never disturbed overnight sleep, allowing the child her usual nine solid hours of nighttime rest.
I found both the tween's story and her neurological exam encouraging, even more so when mom and daughter added that headaches seemed less frequent when the girl remembered to drink plenty of water and didn't stress about her school performance.
We all felt pretty comfortable at that point, but I did ask my patient to keep a diary of her headaches, including pain scores and possible triggers, so that we could come up with strategies to limit these annoying, uncomfortable events.
In a comprehensive article in Pediatrics in Review, Dr. Heidi Blume reports that in any given year, 58 percent of children will complain of some type of headache. Tension headache, often described as an episode of "band-like" or tightening pain, is the most common type of childhood headache.
For children who experience benign types of headaches, Dr. Blume advises taking the "SMART" approach. This pediatric headache management plan involves regular and sufficient Sleep, regular, healthy Meals (including breakfast, plenty of water, and decreased caffeine intake), and regular -- but not excessive -- Activity (aerobic exercise). The author also encourages Relaxation, with efforts aimed at stress reduction and stress management, as well as avoidance of common headache Triggers, such as life stressors or insufficient hours of sleep.
The list of possible causes of headaches is quite extensive but, thankfully, most pediatric headache diagnoses are relatively benign and treatable. At the same time, to avoid overlooking more serious conditions, it is still important to ask for medical help if headaches persist.
Dr. Blume notes that "red flags" for potentially serious headaches include: the sudden onset of severe headaches; progression to more frequent, severe, or new types of headaches; increased headache with straining; or the presence of neurological findings such as eye abnormalities or mental status changes.
Other headache warning signs include: any association with systemic symptoms such as rash or fever, existence of underlying conditions such as genetic or rheumatologic disorders, or any relationship with sleep time such as when headaches wake a child from sleep or are always present on morning awakening.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.