About Headache Disorders

Important information: Diagnosis

Headaches can either occur on their own, or as a symptom of many different conditions.

Primary headache

When headaches occur without any other illness, they are called primary headache disorders because the headache itself is the primary problem.

Primary headache disorders include:

• Tension-type headache: the most common type of headache. The pain is mild to moderate and feels like pressure.

• Migraine: severe and disabling headaches that can last for hours or days along with nausea, sensitivity to light, sensitivity to sound, and/or dizziness

• Migraine with aura: migraine accompanied by changes in vision or numbness/tingling, often in one half of the body

• Chronic migraine: frequent headaches (15 days per month or more) which occur for at least three months in a row. While this only occurs in about 1-3% of patients with headaches, most of the patients we see at CHOP present with chronic headache. Often our patients report they have a milder headache most of the time, and that the pain spikes up into a migraine on top of that pain.

• New daily persistent headache (NDPH): chronic headaches that develop suddenly in children or teens with no past history of headaches

Secondary headache

Headaches caused by another condition are called secondary headaches. Serious causes of headache, like brain tumors, are extremely uncommon.

Common secondary headache disorders include:

• Infections: The common cold or flu may cause headaches.

• Post-traumatic headache: A headache that starts after a concussion and can produce symptoms like migraines or tension-type headache.

• Medication overuse headache (MOH): Taking medications, such as ibuprofen or Excedrin® to treat headache more than 3 days per week can make primary headaches worse.

• Medications/vitamins/supplements: Some medicines and supplements may cause headaches as a side effect.

Combined types

It is possible to have more than one type, (a primary plus a secondary headache) of headache or for one type of headache to turn into another type over time.

Is testing needed?

To ensure the correct diagnosis, your healthcare provider will ask many questions about your child’s history and headache patterns.

• They will also complete a thorough neurological examination to determine if further testing is needed.  

• According to the Child Neurology Society, American Academy of Neurology Practice Parameters, if your child's physical exam is normal and there are no worrisome symptoms, then no testing is recommended.

• Studies have shown that children with worrisome causes of headache have abnormalities in their physical exam, "red flags" in their story, or other neurologic changes like seizures.

• Doing extra testing could expose your child to unnecessary risks.

SNOOPY
“SNOOPY” describes some of the things we consider when thinking about testing for other headache causes. Even if your child has one of these (for example pain in the back of head), we may not always recommend testing. Whether we order tests or not will depend on your child’s whole story and physical exam.

Triggers and symptoms

Genetics can cause someone to have a hyper-excitable “migraine brain” which is sensitive to many triggers, like hormonal changes, sleep changes, fasting, dehydration, and other stress.  Even between headache attacks people with migraine may be sensitive to things like strong odors, motion sickness, loud noises, and busy situations.  Once something starts a migraine attack, the messages spread to involve more areas, in turn causing more symptoms like fatigue, mood changes, concentration problems, nausea, appetite changes, dizziness.  The nerves in the lining of the brain and the brainstem become overly sensitive, causing headache, soreness with light touch (allodynia), and pain in the neck.

Reviewed July 2024 by Christina L. Szperka, MD, MSCE