Shouldn't they have a scan to be sure?

Usually not, and this is the AAP's own position: imaging of the brain, blood tests and invasive procedures are not required to diagnose headaches. Scans in children are not risk-free or trivial to perform, and a normal scan does not treat the headache. What changes the plan is the pattern — waking from sleep, straining triggers, worsening over weeks, or neurological signs — which is exactly what your doctor will ask about.

How do I tell migraine from an ordinary headache?

Severity and company. Tension headache is a dull band that a child usually carries on through. Migraine tends to be throbbing, stops them doing what they were doing, and brings nausea or vomiting and dislike of light and noise. In children it is often on both sides rather than one, which is why it gets missed.

They get one nearly every day.

Daily headaches are on the AAP's list of reasons to call, on their own. It is worth going with two weeks of diary rather than an impression, because daily headaches have causes worth identifying — sleep, fluid, stress, vision, and sometimes the pain relief itself when it is being used very often.

Can I give acetaminophen or ibuprofen?

For an occasional ordinary headache in an otherwise well child, yes, at the dose for their weight. What is worth flagging to your doctor is if you are reaching for it often — frequency is itself information, and regular use for frequent headaches is something to discuss rather than settle into.

It's always on school mornings.

That is a real pattern and worth taking seriously without treating it as invented — the pain is genuinely felt. Have the ordinary causes checked, particularly sleep and vision, and then look at what those mornings involve. The same is true of headaches that only appear at the end of a long screen session.

When it happens · 5 min read

Headaches, and the ones that matter

A child saying their head hurts sends most parents somewhere dark very quickly, because the thing everyone is quietly afraid of is the rare thing.

The reassuring part is that the patterns which need attention are reasonably specific, and none of them require you to guess at a cause — they are about timing, triggers and company.

Last updated August 20, 2026

The ordinary ones, which is most of them

The AAP describes a tension headache as mild or moderate, with constant, dull or achy pain and a sensation of tightness that feels like a band or circle around the head. Children describe this badly — they will often just say it hurts and point vaguely.

Around that sit the everyday drivers, and they are worth running through before anything else: not enough sleep, not enough to drink, a missed or late meal, a long stretch of screen time, a stuffy room, or the first hours of a virus. A child who gets a headache at four in the afternoon on a hot day who has not had a drink since breakfast is telling you something simple.

Illness accounts for a large share. Headache arrives with a great many childhood infections and usually leaves with them.

Migraine looks different in a child

This is the part most parents do not know, and it is why childhood migraine gets missed: it does not have to be one-sided.

The AAP's description is throbbing pain that is often on one side of the head, but can be on both sides — particularly in children. Alongside it come nausea, vomiting, sensitivity to light and noise, fatigue and mood changes, and sometimes an aura beforehand.

Children's migraines also tend to be shorter than an adult's, and the child often wants to lie down somewhere dark and quiet and sleep, then wakes noticeably better. That pattern — severe, with nausea and light sensitivity, relieved by sleep, recurring — is worth describing to your doctor in exactly those terms.

The patterns that change the plan

The AAP's list of reasons to call the pediatrician is short and specific enough to be worth keeping:

Daily headaches. Headaches that keep coming back and get worse. Headaches severe enough to wake a child from sleep. Headaches caused by straining from coughing, sneezing, running or having a bowel movement. Headaches occurring with pain in the eye or ear, confusion, nausea or vomiting, sensitivity to light and sound, or numbness. And headaches following a head injury that do not go away after a week.

The NHS adds the same two timing signals in its own words — a child whose headache is getting worse or wakes them at night, and a headache triggered or made worse by coughing, sneezing, bending down or exercising — plus headache with vision or eye problems.

Two of those deserve emphasis because they sound mild written down. A headache that wakes a sleeping child, and a headache reliably brought on by straining or bending, are both patterns to report rather than watch.

When it is not just a headache

A headache with a fever and a stiff neck, or with bright light genuinely bothering them, needs emergency assessment now — that is the meningitis picture, and there is a separate page here about why the rash is the wrong sign to wait for.

A headache with a rash that does not fade under a glass is a 999 call.

A headache after a bang to the head follows different rules again, and the head injury page covers what actually matters in the hours afterwards. The AAP's specific marker is a post-injury headache that has not gone away after a week.

Confusion, drowsiness you cannot explain, weakness, numbness, or a change in how they are walking or talking alongside a headache is an emergency rather than a phone call.

The scan question

This is the thing parents most want and most often do not need, so it is worth stating what the AAP says directly: imaging of the brain, blood tests and invasive procedures are not required to diagnose headaches.

Headache is diagnosed from the history and the examination. What the history needs is detail you can only get by paying attention over a couple of weeks — when they happen, how long they last, what was happening beforehand, what makes them stop.

So the genuinely useful thing to do before an appointment is not to push for a scan. It is to keep a short diary: date, time, what they had eaten and drunk, how they slept, what they were doing, how long it lasted, what helped. That turns a vague complaint into something a doctor can actually work with.

Get help now if

There is a headache with a fever and a stiff neck, or bright light is hurting their eyes.

There is a rash that does not fade when pressed with a glass.

They are confused, unusually drowsy, or hard to wake.

There is weakness, numbness, or a change in their walking, speech or vision.

The headache came on very suddenly and severely, or followed a significant blow to the head.

They are vomiting repeatedly alongside it, particularly in the early morning.

Common questions

Shouldn't they have a scan to be sure?: Usually not, and this is the AAP's own position: imaging of the brain, blood tests and invasive procedures are not required to diagnose headaches. Scans in children are not risk-free or trivial to perform, and a normal scan does not treat the headache. What changes the plan is the pattern — waking from sleep, straining triggers, worsening over weeks, or neurological signs — which is exactly what your doctor will ask about.
How do I tell migraine from an ordinary headache?: Severity and company. Tension headache is a dull band that a child usually carries on through. Migraine tends to be throbbing, stops them doing what they were doing, and brings nausea or vomiting and dislike of light and noise. In children it is often on both sides rather than one, which is why it gets missed.
They get one nearly every day.: Daily headaches are on the AAP's list of reasons to call, on their own. It is worth going with two weeks of diary rather than an impression, because daily headaches have causes worth identifying — sleep, fluid, stress, vision, and sometimes the pain relief itself when it is being used very often.
Can I give acetaminophen or ibuprofen?: For an occasional ordinary headache in an otherwise well child, yes, at the dose for their weight. What is worth flagging to your doctor is if you are reaching for it often — frequency is itself information, and regular use for frequent headaches is something to discuss rather than settle into.
It's always on school mornings.: That is a real pattern and worth taking seriously without treating it as invented — the pain is genuinely felt. Have the ordinary causes checked, particularly sleep and vision, and then look at what those mornings involve. The same is true of headaches that only appear at the end of a long screen session.

If it's this, not that

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