Headaches

If your child is having headaches, one of the first things you’ll want to do is to get a solid understanding of her symptoms. Recording her headaches in a headache diary can help you see exactly how often they’re happening, understand your child’s symptoms better, and notice possible causes or “triggers.” A record like this is also a good way for you to share information with your child’s health care providers.

In order to diagnose your child’s type of headaches, find the cause, and recommend treatment, your child’s doctor will review her medical history, talk with you and your child about the symptoms, and perform a physical and neurological exam. Questions that your doctor may ask include:

• When do the headaches happen?
• Where exactly does it hurt?
• What do the headaches feel like, and how long do they last?
• How are the headaches impacting your child’s life?
• Is she having balance problems?
• Does your child have other symptoms when she gets a headache, such as sensitivity to light or noise, nausea, dizziness, or changes in vision?
• What have you already done to try to relieve the headaches? How has it worked?
• If you used medication, how much did you give your child? How long after a headache started did she take the medication?
• Have you noticed anything that seems to cause her headaches?
• Has your child been under a lot of stress or been having problems in school?
• Has she been having other medical problems or been injured?
• Has she been taking other medications unrelated to the headaches?
• Have the headaches changed recently?
• Has anyone else in your family had headaches? Has anyone in your family had other neurological problems?

If your child’s symptoms indicate that her headaches are “primary” headaches (migraine, tension, or cluster headaches) and if her neurological exam is normal, no further diagnostic testing may be needed.

Our neurologists at Boston Children’s Hospital will obtain a detailed history and perform a careful exam to determine whether your child’s headaches could be caused by another medical problem. If needed, your child’s doctor may order diagnostic tests including:

• blood tests
• brain imaging scans

Our headache team will spend time talking with you and learning possible causes of your child’s headache pain. With your permission, we can also speak with your other health care providers or your child’s school to help us assess the situation.

If a child or teenager suffers from frequent or disabling headaches, the pain can have a big impact on her life and her whole family.

Our specialists have great expertise in diagnosing and treating children’s headaches. We take a comprehensive approach to caring for our patients. Our team includes child neurologists, pain management specialists, psychologists, and complementary care providers. We offer a wide variety of treatments and therapies including:

• medications
• cognitive-behavioral therapies, including biofeedback
• psychological counseling
• physical therapy
• complementary therapies, including acupuncture

We also work with your family to identify anything that may be triggering your child’s headaches, like stress, dehydration, or certain foods. Understanding these triggers may help you and your child take steps to prevent or manage the headaches.

Children with headache problems are evaluated in our Headache Program. If your child has chronic, hard-to-manage headaches, we may also refer her to our multi-disciplinary headache clinic.

At every step, we take the time to understand your child’s condition, talk with you about our recommendations, and answer your questions. We also coordinate care with your child’s primary care provider.

Our headache specialists see patients not only in Boston but also in Waltham, Lexington, Peabody, and Weymouth. The multidisciplinary headache clinic is in Waltham. We schedule new and urgent patients as soon as possible in the most appropriate office.

If you live outside the Boston area and it’s hard for you to come to Boston Children’s for follow-up visits, we’ll help you find health care professionals in your area who can provide ongoing care. Whether it’s here at Boston Children’s or somewhere else, we will help your child get the treatment she needs.

Since a patient may receive headache care from her pediatrician or with a neurologist, coordinating care can be a challenge. Neurologists at Boston Children’s Hospital work to develop effective plans of care for our patients and families and partner with primary care physicians so that together we can provide the best care possible.

In order to make this collaboration even more effective, neurologists from Boston Children’s and primary care physicians from Harvard Vanguard Medical Associates (HVMA) have come together to develop new ways of working together. Our new approach allows children to receive a larger portion of their ongoing headache care from their pediatricians, strengthening their connection with their primary care providers and providing for more comprehensive, well-coordinated care. This approach should also shorten wait times for appointments in our neurology department and lower medical costs for families. Together with our partners at HVMA, we aim to deliver family centered care to our patients in the most appropriate setting.

We look forward to expanding this collaborative model to include other primary care provider groups, as well. We know that when we work closely with primary care doctors, it benefits our patients.

There is a lot still to be learned about children’s headaches. So headache specialists at Boston Children’s are engaged in research to learn more about how headaches happen, their effects and how to best treat them.

Boston Children’s neurologist and pain management specialist Alyssa LeBel, MD, and her colleagues are using a type of brain scan called functional magnetic resonance imaging (fMRI) to study how the brain activity of children and teens with migraines is different from the brain activity of kids who don’t have migraines. This information may lead to a better understanding of migraines — and, we hope, better treatments for them.

Boston Children’s physicians and psychologists are also studying how effective non-drug therapies, such as biofeedback, are for children with chronic headaches including migraines. Research like this can help to improve treatment protocols for children with headaches — both at Boston Children’s and at other institutions.

We value our interactions with our patients' primary care providers and are eager to make coordination and reporting of care as productive as possible.

In 2009, a group of specialists from Boston Children's Hospital, including Scott L. Pomeroy, MD, PhD, neurologist-in-chief, and Richard C. Antonelli, MD, MS, medical director for integrated care, sat down with primary care providers from Harvard Vanguard to develop strategies of collaboration for the care of our patients. Drawing on feedback from patient families, we designed new, coordinated systems for PCPs and sub-specialists to work together.

• Our neurologists provide information and support to primary care physicians assessing their patients for headaches. As needed, neurologists provide guidance to primary care doctors to ensure their patients see a neurologist for further evaluation when necessary and help determine what imaging might be most appropriate for individual patients on a case-by-case basis.
• Whenever a child is seen in the Department of Neurology, we quickly report our findings and recommendations back to the referring provider so she can continue to coordinate care for her patients.
• We support ongoing communication between neurologists and primary care providers, strengthening connections with pediatricians and providing for more comprehensive and convenient coordination of care.

We look forward to expanding this collaborative model to include other primary care provider groups, as well.

Find out more about the innovative clinical trials available at Boston Children's.