This advice sheet has been written for safety netting advice after your child has had an initial review by their GP, nurse or hospital doctor for their headache symptoms.

When should you worry?

If your child has any of the following:

  • They are very sleepy: difficult to wake up or keep awake
  • They are confused or behaving strangely

  • New, persistent blurring of vision, seeing double, a new squint or unusual eye movements
  • New weakness, loss of balance, co-ordination problems, are holding their head tilted to one side or have difficulty walking
  • Vomiting overnight or persistent daytime vomiting without diarrhoea
  • Breathing very fast or breathing that stops or pauses
  • Working hard to breathe, drawing in of the muscles below the ribs, unable to walk or noisy breathing (grunting)
  • Becomes pale, blue, mottled and/or unusually cold to touch
  • Weak, high-pitched, continuous cry or extremely agitated
  • Has a fit (seizure)
  • Has a rash that does not go away with pressure (the ‘Glass Test')

You need urgent help.

Go to the nearest Hospital Emergency (A&E) Department or phone 999

If your child has any of the following:

  • Neck stiffness or pain
  • Discomfort with bright lights
  • A headache waking them from sleep
  • A headache worse on coughing or straining
  • A headache impacting on school attendance
  • Concerns about early or late puberty
  • Needing to use paracetamol or ibuprofen more than 3 days a week for their headache
  • A headache that does not get better after advice or treatment from your doctor or nurse
  • Breathing a bit faster than normal or working a bit harder to breathe
  • Dry skin, lips, tongue or looking pale
  • Not had a wee or wet nappy in last 8 hours
  • Poor feeding in babies (less than half of their usual amount)
  • Irritable (Unable to settle them with toys, TV, food or hugs even after their fever has come down)
  • Temperature of 38°C or above for more than 5 days or shivering with fever (rigors)
  • Getting worse or you are worried about them

You need to contact a doctor or nurse today.

Please ring your GP surgery or contact NHS 111 - dial 111 or for children aged 5 years and above visit 111.nhs.uk

If none of the above features are present

  • Watch them closely for any change and look out for any red or amber symptoms
  • If your child has a long term condition or disability and you are worried please contact your regular team or follow any plans that they have given you.


Self care

Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111

How can you help your child with their headache?

Most headaches are not a problem: they are not severe, do not happen often and cause little disruption to your child’s life. It is enough simply to let them rest until it is over, or give them some paracetamol or ibuprofen. Sometimes they can be more troublesome, either because they cause severe symptoms or are happening too often; they get in the way of normal life too much. If this is happening it can be helpful to look for ‘triggers’ that make having a headache more likely.

Some common triggers include:

  • Skipping meals and/or not drinking enough water
  • Eating certain foods or drinks: for example coffee, chocolate, cheese, tea, baked beans, tomatoes (including ketchup), fizzy drinks/cola, or citrus fruit/juices (oranges, lemon, lime). Some food additives may also act as triggers (monosodium glutamate in processed food).
  • Oversleeping or not getting enough sleep (e.g. a late night)
  • Stress and anxiety are common causes of headaches
  • Hormonal changes. Headaches may start to happen more in teenagers. In girls and women there may be a clear link to their period cycle.
  • Drugs, alcohol and smoking are not only bad for health generally, they can also cause headaches to happen more often.

Keeping a headache diary that records when the headaches happen and what else is going on may help you to recognise the particular trigger(s) for your child (it will also be helpful for your doctor or nurse if you need to go back for more advice).  If you can avoid the trigger(s) the headaches will happen less often.

Even if there are no direct triggers, it really helps for your child to keep to a regular routine:

  • Have regular mealtimes
  • Take regular exercise
  • Have regular bedtimes
  • Have regular drinks (water is best!) so they do not get thirsty
  • Limit screen time

Eye strain can cause headaches – if your child has not had a recent eye check then take them to an opticians.

Finally, simple painkillers like paracetamol or ibuprofen can be used, but it is important not to do this too regularly. If they take painkillers for more than 3 days a week for headaches, week after week after week, they can get a ‘medication overuse headache’. This is a daily headache that can only be stopped by having a complete break from medication.

Tension Type Headaches and Migraines

The two main types of headache are ‘tension type headaches’ and ‘migraines.’ 

Tension type headaches are the common type of headache that most people get now and again. They can last from 30mins to several hours (occasionally several days) and usually feel like a constant ache or painful tightness throughout the head. Although unpleasant they are usually not severe enough to prevent your child continuing with every day activities.

‘Migraines’ are more severe headaches –  this type of headache can be all over the head or sometimes just one side of the head.  Your child will typically have to stop what they are doing and rest until the migraine has passed. They will often find normal light, noises and smells distressing and prefer to lie quietly in a dark room. They might look pale, feel sick or actually vomit. They may complain of a nasty taste, be a bit clumsy or sweaty.

Migraine with aura’ Sometimes there will be a warning that a migraine is coming – this is called an ‘aura’. A common ‘aura’ is to experience changes in your vision like blurriness or unusual patterns of lines or circles/dots in black and white (your child may be able to draw this for you!). You might notice that your child behaves differently leading up to a migraine: they may have a craving for certain foods (like sweets or chocolate), have mood swings, be hyperactive or the opposite - feel very tired or yawn a lot.

‘Abdominal Migraine’ Some children with migraine may have tummy pain more than headache. This can make the migraine less obvious to diagnose. Your doctor or nurse will be able to consider other possible causes for the tummy pain and can recognise abdominal migraine by the overall pattern of symptoms, particularly because there will also be other features typical to migraines described above.

There are no specific tests to diagnose migraine or tension type headaches – this is done by taking a clear history of what happens and examining the child to check for other possible causes of the headache. Scans of the head are not helpful in diagnosing migraine.

Treating migraines

Migraines usually affect your child’s gut as well as causing a headache (that’s why they can feel sick or vomit, dislike strong smells or have bad tummy pains). In this case if you are needing to use a painkiller if can be very helpful to use a soluble form that is absorbed quickly – dispersible tablets or liquid medicine. It may also be helpful for them to take anti-sickness medication at the same time – if so your doctor will have prescribed this. Taking the anti-sickness medication and painkiller early on during the attack is important for them to work best – make sure you always have them available when you are away from home.

Sometimes, if these treatments are not successful, your child will be prescribed a special migraine medication called a triptan.

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