Headache
This pack has been produced with by Frimley Health NHS Trust in partnership with Healthier Together
Headaches in children are common. Most of the time they are mild and only happen from time to time.
There are plenty of things you can do to help your child to feel better such as making sure they drink plenty of water, taking regular exercise and ensuring they are sleeping well.
Stress can often play a part in children's headaches, especially the older they get so make sure you have a good chat about what is going on in their life.
Sometimes headaches can be a sign of something more worrying. Please see the table below for some of this things to look out for.
When should you worry?
12-18 months
12-18 MONTHS
Contact your health visitor or GP if your baby is 12-18 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag their leg or foot when crawling or walking
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink
- Finds it hard to stand or walk, for example:
- Can’t pull to stand
- Fall over a lot when standing still
- Doesn’t cruise (walk while holding on to furniture)
- Walk on their tiptoes a lot
18-24 months
18-24 MONTHS
Contact your health visitor or GP if your baby is 18-24 months and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your baby’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when they are awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag their leg or foot when crawling or walking
- Use one arm to pull to stand more than the other
- Rarely use one of their arms to pick up toys, or eat and drink
- Find it hard to balance when standing still, or fall over a lot
- Can’t walk by themselves
- Walk on their tiptoes a lot
- Are suddenly unsteady when walking
2 years
2 YEARS
Contact your health visitor or GP if your baby is 2 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your child’s arms or legs, making it tricky to change their nappy or clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when crawling or walking
- Rarely use one of their arms to play, eat and drink
- Find it hard to balance when standing still or fall over a lot
- Can’t walk by themselves
- Mostly walk on their tiptoes
- Are suddenly unsteady when walking
- Haven’t started to run
- Move from laying down or sitting to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing
3 years
3 YEARS
Contact your health visitor or GP if your baby is 3 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- You find it difficult to move your child’s arms or legs, making it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely uses one of their arms to play, eat and drink
- Find it hard to balance when standing still or fall over a lot
- Can’t walk by themselves
- Mostly walk on their tiptoes
- Are suddenly unsteady when walking
- Have not started to jump or run
- Move from laying down or sitting to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing
4 years
4 YEARS
Contact your health visitor or GP if your baby is 4 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- Find it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely use one of their arms to play, eat and drink
- Find it hard to balance when standing still
- Suddenly become unsteady when walking
- Find it hard going upstairs or uphill
- Trip or fall a lot
- Walk on tiptoes most of the time
- Feel pain in their arms or legs
- Move from laying down or sitting on the floor to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing.
5 years
5 YEARS
Contact your health visitor or GP if your baby is 5 years and they…
- Have lost skills which they could do before
- Feel very stiff, for example:
- Hold their arms and legs in the same position, such as always pulling their arm to their chest, or always crossing their legs
- Find it difficult to change their position on their own
- Find it tricky to change their clothes
- Feel very floppy when awake
- Move their arms or legs in repetitive, jerky, or strange ways
- Use one side of their body more than the other, for example:
- Lean to the side when they sit
- Drag one leg or foot behind them when walking
- Rarely uses one of their arms to play, eat and drink
- Find it hard to balance, or trip or fall a lot
- Persistently walk on tiptoes
- Suddenly become unsteady when walking
- Feel pain in their arms or legs
- Move from laying or sitting on the floor to standing by using their hands to push off the ground, and “walk” their hands up their legs until they are standing.
15 months
Your Child By Fifteen Months
Social/Emotional Milestones
- Copies other children while playing, like taking toys out of a container when another child does
- Shows you an object she likes
- Claps when excited
- Hugs stuffed doll or other toy
- Shows you affection (hugs, cuddles, or kisses you)
Language/Communication Milestones
- Tries to say one or two words besides “mama” or “dada,” like “ba” for ball or “da” for dog
- Looks at a familiar object when you name it
- Follows directions given with both a gesture and words. For example, he gives you a toy when you hold out your hand and say, “Give me the toy.”
- Points to ask for something or to get help
Cognitive Milestones (learning, thinking, problem-solving)
- Tries to use things the right way, like a phone, cup, or book
- Stacks at least two small objects, like blocks
Movement/Physical Development Milestones
- Takes a few steps on his own
- Uses fingers to feed herself some food
18 months
Your Child By Eighteen Months
Social/Emotional Milestones
- Moves away from you, but looks to make sure you are close by
- Points to show you something interesting
- Puts hands out for you to wash them
- Looks at a few pages in a book with you
- Helps you dress him by pushing arm through sleeve or lifting up foot
Language/Communication Milestones
- Tries to say three or more words besides “mama” or “dada”
- Follows one-step directions without any gestures, like giving you the toy when you say, “Give it to me.”
Cognitive Milestones (learning, thinking, problem-solving)
- Copies you doing chores, like sweeping with a broom
- Plays with toys in a simple way, like pushing a toy car
Movement/Physical Development Milestones
- Walks without holding on to anyone or anything
- Scribbles
- Drinks from a cup without a lid and may spill sometimes
- Feeds himself with his fingers
- Tries to use a spoon
- Climbs on and off a couch or chair without help
2 years
Your Child By Two Years
Social/Emotional Milestones
- Notices when others are hurt or upset, like pausing or looking sad when someone is crying
- Looks at your face to see how to react in a new situation
Language/Communication Milestones
- Points to things in a book when you ask, like “Where is the bear?”
- Says at least two words together, like “More milk.”
- Points to at least two body parts when you ask him to show you
- Uses more gestures than just waving and pointing, like blowing a kiss or nodding yes
Cognitive Milestones (learning, thinking, problem-solving)
- Holds something in one hand while using the other hand; for example, holding a container and taking the lid off
- Tries to use switches, knobs, or buttons on a toy
- Plays with more than one toy at the same time, like putting toy food on a toy plate
Movement/Physical Development Milestones
- Kicks a ball
- Runs
- Walks (not climbs) up a few stairs with or without help
- Eats with a spoon
2.5 years
Your Child By Thirty Months
Social/Emotional Milestones
- Plays next to other children and sometimes plays with them
- Shows you what she can do by saying, “Look at me!”
- Follows simple routines when told, like helping to pick up toys when you say, “It’s clean-up time.”
Language/Communication Milestones
- Says about 50 words
- Says two or more words together, with one action word, like “Doggie run”
- Names things in a book when you point and ask, “What is this?”
- Says words like “I,” “me,” or “we”
Cognitive Milestones (learning, thinking, problem-solving)
- Uses things to pretend, like feeding a block to a doll as if it were food
- Shows simple problem-solving skills, like standing on a small stool to reach something
- Follows two-step instructions like “Put the toy down and close the door.”
- Shows he knows at least one color, like pointing to a red crayon when you ask, “Which one is red?”
Movement/Physical Development Milestones
- Uses hands to twist things, like turning doorknobs or unscrewing lids
- Takes some clothes off by himself, like loose pants or an open jacket
- Jumps off the ground with both feet
- Turns book pages, one at a time, when you read to her
3 years
Your Child By Three Years
Social/Emotional Milestones
- Calms down within 10 minutes after you leave her, like at a childcare drop off
- Notices other children and joins them to play
Language/Communication Milestones
- Talks with you in conversation using at least two back-and-forth exchanges
- Asks “who,” “what,” “where,” or “why” questions, like “Where is mommy/daddy?”
- Says what action is happening in a picture or book when asked, like “running,” “eating,” or “playing”
- Says first name, when asked
- Talks well enough for others to understand, most of the time
Cognitive Milestones (learning, thinking, problem-solving)
- Draws a circle, when you show him how
- Avoids touching hot objects, like a stove, when you warn her
Movement/Physical Development Milestones
- Strings items together, like large beads or macaroni
- Puts on some clothes by himself, like loose pants or a jacket
- Uses a fork
4 years
Your Child By Four Years
Social/Emotional Milestones
- Pretends to be something else during play (teacher, superhero, dog)
- Asks to go play with children if none are around, like “Can I play with Alex?”
- Comforts others who are hurt or sad, like hugging a crying friend
- Avoids danger, like not jumping from tall heights at the playground
- Likes to be a “helper”
- Changes behavior based on where she is (place of worship, library, playground)
Language/Communication Milestones
- Says sentences with four or more words
- Says some words from a song, story, or nursery rhyme
- Talks about at least one thing that happened during her day, like “I played soccer.”
- Answers simple questions like “What is a coat for?” or “What is a crayon for?”
Cognitive Milestones (learning, thinking, problem-solving)
- Names a few colors of items
- Tells what comes next in a well-known story
- Draws a person with three or more body parts
Movement/Physical Development Milestones
- Catches a large ball most of the time
- Serves herself food or pours water, with adult supervision
- Unbuttons some buttons
- Holds crayon or pencil between fingers and thumb (not a fist)
5 years
Your Child By Five Years
Social/Emotional Milestones
- Follows rules or takes turns when playing games with other children
- Sings, dances, or acts for you
- Does simple chores at home, like matching socks or clearing the table after eating
Language/Communication Milestones
- Tells a story she heard or made up with at least two events. For example, a cat was stuck in a tree and a firefighter saved it
- Answers simple questions about a book or story after you read or tell it to him
- Keeps a conversation going with more than three back-and-forth exchanges
- Uses or recognizes simple rhymes (bat-cat, ball-tall)
Cognitive Milestones (learning, thinking, problem-solving)
- Counts to 10
- Names some numbers between 1 and 5 when you point to them
- Uses words about time, like “yesterday,” “tomorrow,” “morning,” or “night”
- Pays attention for 5 to 10 minutes during activities. For example, during story time or making arts and crafts (screen time does not count)
- Writes some letters in her name
- Names some letters when you point to them
Movement/Physical Development Milestones
- Buttons some buttons
- Hops on one foot
Advice and Guidance
What Are Headaches?
Tension Headaches
This is the most common type of headache, and occurs more in teenagers and adults, especially women. It can feel like a constant ache affecting both sides of the head. This is typically accompanied with the neck muscles tightening and pressure behind the eyes. These symptoms usually last less than 15 days out of a single month and the cause is unknown.
Tension headaches can be caused by cold or flu, stress, skipping meals, and dehydration. Some females experience headaches as a symptom of the drop in oestrogen levels just before their periods.
Cluster Headaches
Cluster headaches are severe attacks of pain over one side of the head, often felt around the eye. These headaches are more common in men and typically occur in adulthood. They begin very quickly, and unlike some migraines, have no warning. The pain has been described as a sharp, burning or piercing sensation on one side of the head, around the eye temple and/or face. These attacks can make you feel agitated, anxious and stressed. Cluster headaches are sometimes accompanied by a red watery eye, swelling of one eyelid, constriction of one pupil, sweating and a blocked or runny nostril.
The causes of cluster headaches is still unclear, some research suggests a genetic component, sensory triggers and smoking, whereas others suggest the cause lies in brain activity levels.
Migraine Headaches
Migraines are usually a moderate to severe ‘throbbing’ headache on one side of the head. Many people have symptoms such as feeling nauseated and being sick, as well as increased sensitivity to light and sound. Migraines are a common health condition which affects around 1:5 women and 1:15 men. They usually being occurring in the late teenage years/early adulthood.
There are several types of migraine:
- Migraine with an aura – this is when there is a specific clue that a migraine is about to being, for example seeing flashing lights or spots.
- Migraine without an aura – this is when a migraine occurs without any warning signs.
- Migraine aura without the accompanying headache – this is also known as a silent migraine; an aura or other migraine symptoms are experienced, but a headache does not occur.
Migraines have been linked to the hormone changes occurring during menstruation. Furthermore, migraines can be triggered by stress, fatigue and the ingestion of some foods including chocolate.
Occasionally, headaches can be a sign of something more worrying. Click here for information about what to look out for.
The Connections Between the Thoughts, Feelings, and Behaviour
Some people experiencing headaches can get caught in an unhelpful cycle. It is important to recognise what this cycle is so we can break it.
Tips: For younger children exploring their emotions using this model, try using a smiley face system.
Physiological Self Help for Headaches
Water
Headaches caused by dehydration may occur after sweating, especially on a hot day or after lots of physical activity! The body loses essential fluids which contribute towards its functioning. Most of the time, the amount of fluid lost is balanced through the consumption of water and fluid-rich foods. However, in some cases, the body loses water quicker than it is replenished. This can lead to dehydration, with one of the main symptoms being a headache. Research has suggested that dehydration is a trigger for migraine, therefore, water is found to be effective in migraine frequency and severity reduction. Drinking too quickly can sometimes cause vomiting in those with dehydration, so it is best to take slow steps; sucking on an ice cube has been found useful in younger children.
Electrolyte Drinks
Electrolytes are minerals your body requires to function, your body gets them through dietary intake. Dehydration can disrupt the important balance of electrolytes in your body, so replenishing them with a low-sugar sports drink may make you begin to feel better.
Regular Meals
The body needs energy to function, most of the body’s energy comes from the consumption of carbohydrates. The body converts carbohydrates into glucose, which is then transported through the blood into areas where energy is required. The brain requires a constant supply of glucose to function. If glucose levels fall the brain is one of the first organs affected, hence why headaches can appear shortly after skipping meals. Thus, it is important to have regular meals, meeting the ‘Healthy Living Plate’ guidelines. For some, eating regular meals means eating breakfast, having a small snack mid-morning, eating at lunch time, having a mid-afternoon snack, and eating at dinner time. Foods should be healthy and low in sugar.
Menstrual Headaches
Many headaches are linked to changing levels of hormones, specifically oestrogen and progesterone, which occur during menstruation. Whilst some birth control may worsen headaches for some women, they can actually lessen them for others. you suffer from headaches and are using, or planning to use, a hormonal method of contraception, you should discuss this with your GP or a family planning nurse.
Changing How I Cope with Pain: Doing too Much or Too Little
Pacing
Some people who suffer with headaches choose to do less activity. This makes sense; however, it can result in you missing out on important and fun activities. However, we know that missing out can negatively impact your mood. Some people try to stay very active on days they feel better. Again, this approach makes sense but can be counterproductive. You may push yourself too hard and end up suffering, resulting in exhaustion and low mood. This is referred to as a boom-and-bust pattern:
Pacing is a skill which enables you to consistently carry out activities without causing excessive tiredness or inactivity. Pacing is the middle ground between doing nothing and doing too much. Over time you may notice that pacing enables you to do more.
- Choose an activity, such as seeing your friends or school work.
- Measure the length of time you feel physically and emotionally comfortable doing this. Do this at least 3 separate times on good and bad days.
- Take the average of these times. This helps you find your comfortable starting point (amount of time) to spend on these activities. Try to stick to this time, no more and no less.
Remember:
- Pacing can give you more control.
- Pacing is about judging when to stop an activity based on time and not mood.
- The comfortable starting point should be used on both good, and bad days. It is normal to find it difficult to limit yourself on good days.
- Using a comfortable starting point leads to improved tolerance and achievement.
Changing How I Cope with headaches
Headaches can prevent us from doing things we like, such as going to the cinema, swimming, or spending time with friends. However, you cannot let them stop you, it is important that you practice fighting against avoidance! Ultimately, you need to face your fears if you want to overcome your headaches. It may seem overwhelming in the beginning, however, it is much easier if you break the process down into smaller steps.
Construct a ladder of places or situations that you avoid because of your headaches. At the top of the ladder, state the situation that you are most anxious about. At the bottom of the ladder, put places or situations you avoid , but don’t bother you as much. Give each item a rating of 0-10 according to how anxiety provoking the situation is.
Overcome your headaches by approaching these situations, starting from the bottom of the ladder. Make sure you write down what you think will happen, before approaching the task, and compare this with what happened.
For a printable version of this exercise, please click here.
Contents: Guided Self Help Worksheets
Calming The Body - Feeling relaxed can help reduce symptom severity
Progressive Muscle Relaxation (PMR)
Muscle tension is commonly associated with stress and anxiety, it is the body’s natural response to potentially dangerous situations. Even when there is no danger, our bodies can still respond in the same way. You may not always realise that your muscles are tense, it may be as subtle as your jaw clenching, or as obvious as your shoulders feeling tight and hunched. PGR is a deep relaxation technique which is based upon the simple practice of tensing one muscle group at a time . This is followed by a relaxation phase with release of tension. This is very useful before bedtime.
You can do this standing up, sitting in a supportive chair, or lying down comfortably. Let your breath flow deep into your stomach without forcing it. Breath in through your nose and out through your mouth. Counting to five will help you to breath calmly and regularly. Hold your breath for five seconds, as you exhale say ‘relax’. Repeat this process for 3-5 minutes.
Calming The Mind - Strategies for managing the anxiety and stress that is often associated with abdominal pain
Worry Trees are helpful in reducing levels of anxiety surrounding both hypothetical situations and current problems.
Help yourself to feel more relaxed by thinking about things that make you feel calm and rested. For example, picturing your favourite place. This can be either independent, or you can take a guided visualisation approach. A guided visual imagery relaxation task has been provided in this pack.
A powerful stress reduction and relaxation tool, that can be applied at any time, in any location.
This is a useful technique for remaining grounded in the present, to alleviate symptoms of stress and anxiety.
These are phrases that you can say to yourself that are supportive. For example “Just because it has happened before it does not mean it will happen again”
Other Resources
Apps:
- Mindfulness and Sleep:https://www.smilingmind.com.au/
- Meditation and Sleep:https://www.calm.com/
- Meditation: https://www.headspace.com/kids
- Progressive Muscle Relaxation: https://www.thinkpacifica.com/
Other useful websites:
- Resources for Teachers, Parents, Carers, and Children: http://www.youngminds.org.uk/
- Free Online Counselling: https://www.kooth.com/
- Stress and Anxiety: https://www.moodcafe.co.uk/for-children-and-young-people/feeling-worried,-frightened,-stressed-or-anxious.aspx
- Anxiety and Depression: https://www.nhs.uk/conditions/stress-anxiety-depression/anxiety-in-children/
- Mindful Breathing: www.getselfhelp.co.uk/mindfulness.htm
- Mindful Activity: www.getselfhelp.co.uk/mindfulness.htm
- Relaxation Techniques: www.getselfhelp.co.uk/relax.htm
- Relaxing Imagery: www.getselfhelp.co.uk/imagery.htm
- Thought Distancing: www.getselfhelp.co.uk/cbtsetp6.htm
- Supporting Sleep: www.getselfhelp.co.uk/sleep.htm
- Self Help (Insomnia): https://www.getselfhelp.co.uk/sleep.htm
- Headache Information: https://www.migrainetrust.org/
- Social Anxiety UK: www.social-anxiety.org.uk
Self care and Prevention
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