Understanding Headaches in Children and Adults

By: Dhanya Venugopal, M.D., Internal Medicine Resident

Headaches are one of the most common health complaints and a leading cause of disability worldwide. While many people assume a headache means a migraine, not all headaches are migraines. Headaches can take many forms, especially in children, who may express or experience symptoms differently than adults. Before age 12, boys and girls experience headaches at similar rates. After age 12, however, headaches become more common in girls.

What are the major types of headaches?

Headaches are broadly classified into primary and secondary types.

Primary Headaches

The most common primary headaches include migraine, tension-type headache and trigeminal nerve (cluster) headache.

• Migraine in children often presents as throbbing pain on both sides of the head before puberty. In adolescents and adults, it typically affects one side of the head. Attacks are shorter in children (often <2 hours) but can last 4 to 72 hours in older children and adults. They may be accompanied by nausea, vomiting, and sensitivity to light and sound. Other associated features include motion sickness (especially when reading), sleepwalking, sleep talking, night terrors, unexplained fever, recurrent abdominal pain, and episodes of anxiety.
• Tension-type headaches typically present as non-throbbing pain of mild to moderate intensity. They do not worsen with activity and may involve sensitivity to light or sound, but usually not nausea or vomiting. They typically lasts 30 minutes to 7 days. In adults, pain may extend to the neck and jaw.
• Trigeminal Nerve Headache (Cluster) Headaches tend to be severe, unilateral pain around one side of the head, forehead, or eyes. Attacks are brief (15–180 minutes) but can recur several times a day. Associated symptoms may include watering from the eyes, eye redness, runny nose, eyelid swelling, facial sweating, drooping eyelid, or a constricted pupil. Restlessness is a typical feature in adults.

Secondary Headaches

Secondary headaches occur due to underlying causes, such as flu, upper respiratory infections, or sinusitis. They can also be caused by overuse of pain medications (leading to chronic headaches), vision problems from refractive errors and dehydration (often accompanied by dry mouth, fatigue, irritability, dizziness, and increased heart rate). Children may express pain differently, sometimes ignoring discomfort through play or showing non-specific signs such as crying, rocking, or hiding. Chronic headaches can also be linked to emotional, behavioral, or personality factors.

When should I seek medical help?

For children, seek urgent medical evaluation if headaches:

• occur in children under six years of age
• wake up the child from sleep
• is associated with persistent nausea, vomiting, or changes in mental state
• is accompanied by gait instability
• is worsened by coughing, urination, defecation, or physical activity
• is linked to neck or back pain, stiffness, fever, or rashes
• is associated with declining school performance

For adults, seek care for:

• sudden, abrupt-onset headaches
• progressive or worsening headaches
• new or onset headaches after age 50

How should headaches be treated or prevented?

Non-medical approaches include: 

• Keeping a headache diary to identify patterns and triggers.
• Avoiding common triggers: caffeine, chocolate, aged cheese, irregular sleep, dehydration, prolonged fasting, and stress.
• Adults may also be sensitive to hormonal changes, weather, wine, nitrates, or artificial sweeteners.
• Maintaining a healthy diet.
• Exercising for 30–45 minutes daily.
• Practicing relaxation techniques (deep breathing, stretching, family time).

Medical approaches include: 

• NSAIDs such as Tylenol, Advil, or Aleve
• Limiting use to fewer than 14 days per month to avoid medication-overuse headaches.
• Long-term management should emphasize non-medical measures.

In summary, headaches are common in both children and adults and can result from a variety of causes. Identifying and avoiding triggers is the most effective way to prevent them. If headaches persist, worsen, or present with red flag symptoms, medical evaluation by a primary care provider is recommended as essential to determine the underlying cause.

Dhanya Venugopal, MD, is a second-year resident in the Internal Medicine residency program at UNC Health Southeastern. In addition to offering services you’d expect from a community healthcare system, UNC Health Southeastern provides a number of specialized services that are unique to our system and not available anywhere else in the region. To schedule an appointment, call our referral line at 984-974-CARE. To learn more, visit UNCHealthSE.org. To submit questions for consideration for a Frequently Asked Questions article, email unchsoutheasterninfo@unchealth.unc.edu.