The younger the child, the less able he or she is to tell us accurately what is being felt. A "headache" can be the most logical description to a child for multiple problems. This especially applies to the toddler and preschool age groups. Take an ear infection causing deep ear pain, for example. A child may call it a headache, but grab the area right behind or above the ear, or even the ear itself. Likewise with sinus pain, which is located above or between the eyes or over the cheekbones. Throat or tooth pain can also become a "headache".

Another possibility is that the complaint of a headache is actually a young child's way of verbalizing emotional upset, anxiety, depression or stress. Children, especially those who live with adults who frequently complain of head pain, can describe in physical terms what is really an emotional difficulty.

A true headache in a child, like pain elsewhere in the body, deserves an explanation. Sometimes the reason is obvious. A vague headache is often the first symptom of an infection. The flu, a common cold, or strep throat can all begin with a headache, but other symptoms soon follow and provide the explanation. Headaches are also very common after concussions. Even a seemingly mild concussion can lead to a headache. At times, these post-concussive headaches can go on for weeks.

In a school-aged child whose headache comes on towards the end of the school day or after reading, vision difficulties are often the reason. The eye strain/headache in these cases disappears with the right pair of glasses. Older children, like adults, can experience both tension headaches and migraines. A tip-off to a tension headache is achiness and tenderness in the muscles of the neck and shoulders. Migraines are trickier to detect in children and are probably under-diagnosed. Migraines are rare before five years, but one study estimated that between seven and ten percent of school-aged children were affected, though perhaps as few as ten percent of those children were accurately diagnosed.

Compared to adult migraines, childhood migraines usually don't last as long, are less likely to be accompanied by nausea and vomiting and are more likely to involve both sides of the head.

Though some children experience the typical "aura" preceding a migraine, others will show a change in behaviour, such as irritability.

The ultimate goal for headache management is to uncover and treat the cause, relieve the pain and send the child off to resume his normal day.

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