WHY DO CHILDREN GET HEADACHES?
Headaches in children are common and usually not serious. Causes include migraines, stress and tension headaches, trauma, sinus disease, and eye problems. Occasionally, certain foods with nitrate preservatives and MSG (monosodium glutamate) can trigger headaches. Brain tumors in children as a cause for headaches are extremely rare, and are usually associated with additional neurologic symptoms such as dizziness, weakness of the arms or legs, lack of coordination, personality changes, or vision loss.
HOW ARE CHILDREN WITH HEADACHES EVALUATED?
Children should first have a thorough physical examination with a pediatrician. The pediatrician may order additional tests or refer the patient to a neurologist. It is helpful to keep a headache diary so that possible triggers (certain foods, sleep problems, or environments) can be discovered.
If no obvious medical cause for the headaches is found by the pediatrician, a referral to an ophthalmologist is required to perform a complete eye exam. The entire visual system should be examined. This includes the pupils, any refractive error (need for glasses), eye alignment, and binocularity (the ability to use both eyes together). During this examination, the pupils should be dilated, so that the optic nerves can be properly examined and the refractive error can be most accurately assessed.
HOW DO EYE PROBLEMS CAUSE HEADACHES IN CHILDREN?
Hyperopia (farsightedness) requires extra effort to focus clearly while reading. This can sometimes lead to fatigue and headache. Glasses can reduce the effort required to see clearly at near and improve the headache if significant hyperopia exists. Mild hyperopia is normal in children, however, and generally does not cause headaches or other symptoms.
When we read or perform other near activities, our eyes pull in toward each other. This is called convergence. The decreased ability to pull the eyes toward each other when viewing near objects (convergence), particularly while reading, may rarely cause headaches. This is called convergence insufficiency, and symptoms include the doubling of images or words, blurred vision, fatigue, and headaches which worsen with prolonged reading. At home eye exercises, sometimes with the help of computer software, can help treat convergence insufficiency. Glasses are sometimes prescribed. Expensive in-office eye exercises are rarely necessary. Convergence insufficiency is not a common cause of headaches in children, however.
Acute infections and inflammatory diseases of the eyes can cause eye pain and associated headaches. These problems are often accompanied by redness of the eye and/or eyelid as well as light sensitivity (photophobia). Acute glaucoma can cause headaches, but this problem rarely affects children. Pseudotumor cerebri (also known as idiopathic intracranial hypertension) is a condition caused by increased intracranial pressure (too much fluid around the brain). This causes headache and swelling of the optic nerves, but does not typically cause redness of the eyes. A complete exam by an ophthalmologist can help rule out these conditions.
If no ocular causes of headache are identified, the child may be referred back to his/her pediatrician and/or to a neurologist to look for other possible causes of the headaches.