The common causes
Tension-type headache is typically a band-like pressure on both sides, mild to moderate, and does not stop the child playing. Migraine is usually more severe, often throbbing, may be one-sided, and is commonly accompanied by nausea, dislike of light or noise, and relief with sleep. Migraine frequently runs in families.
Other everyday contributors include insufficient sleep, missed meals, dehydration, uncorrected vision problems, sinus infection, and stress around school.
Warning signs that need prompt review
Seek prompt assessment for a headache that wakes a child from sleep, is worst on waking with vomiting, is steadily worsening over weeks, follows a head injury, comes with fever and a stiff neck, is accompanied by weakness, unsteadiness, personality change, seizures or visual loss, or occurs in a child under three years.
Does my child need a scan?
Most children with headaches do not need brain imaging. A careful history and a normal neurological examination are more reassuring than a scan, and imaging is arranged when specific red flags or abnormal examination findings raise a question a scan can answer.
Managing migraine
Management combines identifying triggers, regular sleep and meals, adequate hydration, and treating attacks early with an appropriate dose by weight. Where painkillers are being used more than about twice a week, medication-overuse headache is considered, because frequent use can itself sustain daily headaches. Preventive treatment is considered for frequent, disabling attacks.
How migraine differs in children
Children's migraine does not look like the adult version described in most articles. Attacks are often much shorter, sometimes an hour or two rather than most of a day. The pain is more commonly felt across both sides or across the forehead rather than strictly one-sided, so a headache on both sides does not argue against migraine in a child.
Younger children may not describe pain clearly at all. They go pale, become quiet, lose their appetite, want to lie down in a dark room, and often fall asleep and wake recovered. Some children have abdominal migraine, in which recurrent bouts of central tummy pain with nausea and pallor occur with little or no headache, and these children frequently go on to develop more typical migraine later.
Keeping a headache diary
A two-week diary is genuinely more useful than most investigations, because the pattern is what drives the diagnosis. Record the date and time each headache started, how long it lasted, where the pain was, how severe it was in terms of whether the child kept playing or had to lie down, and what else happened, such as nausea, dislike of light or visual changes.
Note what came before it: how they slept, whether meals were missed, screen time, sport, school pressures, and in adolescent girls where it falls in the menstrual cycle. Record any medicine given, the dose, the time, and whether it helped. Bring this to the appointment. Two weeks of specifics is worth more than an attempt to summarise several months from memory.
Medication-overuse headache
This is one of the more common reversible causes of daily headache, and it is regularly missed because the treatment looks like the cause of relief. A child takes a painkiller for headaches, the headaches grow more frequent, so painkillers are taken more often, and the medicine begins sustaining the very pattern it is treating.
Suspect it where simple painkillers are being used on more than about two days a week over several weeks and headaches have become near-daily. The remedy is to stop the offending medicine, usually with a plan agreed in advance, and to expect a period of worse headaches for one to two weeks before improvement. That temporary worsening is the reason it is worth doing with support rather than alone.
Headaches, school and screens
Headaches that occur only on school days, and clear at weekends and in the holidays, are a recognisable pattern. The pain is entirely real, and the usual drivers are stress, poor sleep during term, missed breakfast, insufficient water across the day, or an uncorrected vision problem. An eye test is a reasonable early step where headaches cluster around reading or board work.
Screens are frequently blamed and the truth is more specific. Screens themselves do not cause migraine, but long unbroken periods without blinking, poor posture over a phone, and late-night use that delays sleep all contribute. Regular breaks, a sensible viewing distance, and devices out of the bedroom at night usually achieve more than an outright ban, which tends to produce conflict without addressing the sleep problem underneath.
Frequently asked questions
Could my child's headache be a brain tumour?
This is the fear behind most headache visits, and in the large majority of children the answer is no. Brain tumours very rarely present with headache alone, and are usually accompanied by other findings such as abnormal neurological examination, early-morning vomiting or steady worsening.
What should I record before the appointment?
Keep a two-week diary: when each headache started, how long it lasted, where the pain was, what the child was doing beforehand, what medicine was given, and whether it helped. This is often more informative than any test.
Can children get migraine?
Yes. Migraine is common in children and often runs in families. In younger children attacks tend to be shorter and more likely to affect both sides of the head than in adults.
My child only gets headaches on school days. Are they making it up?
Almost certainly not. This pattern is common and the pain is genuine. Stress, term-time sleep loss, skipped breakfast, not drinking enough during the day and uncorrected vision problems all cluster on school days and all produce real headaches. Treating it as fabrication misses a treatable cause and damages the child's trust, so it is worth investigating properly, including an eye test.
How much painkiller is too much?
As a working guide, simple painkillers used on more than about two days a week over several weeks risk causing medication-overuse headache. Within an individual attack, the opposite applies: treating early with a full weight-appropriate dose works better than waiting and taking repeated small doses. If your child needs painkillers most weeks, that is the point to seek review rather than continuing.
Will my child grow out of migraine?
Many children have long periods with few or no attacks, particularly once triggers are identified and sleep and meals are regular. Some find migraine settles substantially after adolescence, while for others it continues into adult life in a milder form. It is generally better framed as something to learn to manage than something to wait out, since the habits that reduce attacks are the same at any age.
Sources
Book an appointment
Consultations are by appointment at Huda, Sushant Lok 2, Sector 55, Gurugram. Tell us what is worrying you and the clinic will call you back.