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Health condition · Clinically reviewed

Headaches in children, common, treatable, and worth taking seriously.

Most childhood headaches are tension-type or migraine. A careful history, a short list of red flags and a stepped plan help you tell reassurance from real risk.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a UK paediatric clinician before publication.

  • 02

    Sourced from guidance

    Checked against NICE NG150, RCPCH standards and specialist paediatric neurology consensus.

  • 03

    Current for 2026

    Reflects modern UK paediatric practice including licensed triptans, prophylaxis and CGRP research.

Key facts

Paediatric headache at a glance.

The essentials, in plain English: how common headaches are in children, the main patterns and how they are treated in the UK today.

  • How common

    Up to 60% of children experience headaches at some point. Migraine affects up to 10% of school-age children.

  • Most common type

    Tension-type headache is the commonest. Paediatric migraine is the next most common recurrent pattern.

  • Paediatric migraine

    Often bilateral in children (unlike adults), shorter attacks, and can include abdominal migraine or cyclical vomiting.

  • Red flags first

    Morning vomiting, waking from sleep, focal signs, papilloedema or ataxia mandate urgent paediatric imaging.

  • First-line acute

    Weight-based paracetamol or ibuprofen, rest in a quiet dark room. Triptans are licensed from age 12.

  • Prophylaxis

    Propranolol, topiramate, amitriptyline or pizotifen - specialist paediatric neurology decision.

Why this guide matters

Reassurance where it belongs, action where it counts.

Most childhood headaches are benign. A short, structured approach separates ordinary migraine from the small number of cases that need urgent imaging.

  • Pattern beats snapshot

    A two-month headache diary tells you more than any single consultation. Frequency, triggers and school impact drive the plan.

  • Red flags are short and specific

    Morning vomiting, waking pain, focal signs, personality change and papilloedema - these are the features that change the pathway.

  • Modern paediatric treatment works

    Licensed triptans, prophylactic options and paediatric CBT mean disabling childhood migraine no longer has to be tolerated.

How the diagnosis is made

From first attack to a clear paediatric plan.

What a GP, paediatrician or paediatric neurologist normally does, in order, so you know what to expect and why.

  1. 01

    Assessing

    History and headache diary

    Pattern, triggers, family history (migraine is highly heritable), school impact and any red-flag features.

  2. 02

    Assessing

    Full paediatric examination

    Growth, vitals, BP, fundoscopy for papilloedema, cranial nerves, coordination, neck stiffness and spine.

  3. 03

    Assessing

    Paediatric assessment tools

    Age-appropriate migraine screens and impact tools (school absence, PedMIDAS) give a shared baseline for progress.

  4. 04

    Confirming

    Rule out secondary causes

    Consider infection, sinusitis, refractive error, meningitis and, in selected cases, mood or anxiety-driven headache.

  5. 05

    Confirming

    MRI when indicated

    Not routine for typical primary headache. Reserved for red flags, focal neurology, or atypical progressive patterns.

  6. 06

    Planning

    Specialist paediatric neurology

    Referral for chronic or disabling headache, diagnostic uncertainty, or when prophylaxis is being considered.

  7. 07

    Planning

    MDT and school plan

    Paediatric neurology, psychology, school nurse and family, with reasonable adjustments and EHCP where needed.

Typical pathway: a first visit to a settled paediatric plan within weeks, not months.

Types

The main patterns of childhood headache.

Tension-type and migraine cover most of what you will see. Post-concussion, visual, medication-overuse and secondary causes complete the picture.

  • Tension-type headache

    Bilateral, band-like, mild-to-moderate pressure. Not aggravated by routine activity and rarely with nausea.

  • Migraine without aura

    Often bilateral in children, shorter attacks (1 to 72 hours), nausea, photophobia and phonophobia.

  • Migraine with aura

    Visual or sensory aura minutes before pain. See our full migraine guide for detail.

  • Abdominal migraine

    Recurrent midline abdominal pain, pallor and nausea in a child with a migraine background - a recognised variant.

  • Cyclical vomiting syndrome

    Stereotyped vomiting episodes with well periods in between - overlaps with the migraine spectrum.

  • Visual and eyestrain

    Frontal headache with reading or screen time, often improved by an up-to-date eye test and correction.

  • Post-concussion headache

    After a head injury, with attention or sleep changes. Usually settles with a graded return-to-activity plan.

  • Red flag - urgent review

    Morning vomiting, waking pain, personality change, focal signs, ataxia or papilloedema - urgent paediatric imaging.

Treatment

How paediatric headache is treated in the UK.

Lifestyle first, then age-appropriate acute treatment, then prophylaxis and specialist options for chronic or disabling migraine.

  • Lifestyle foundations

    Regular sleep, hydration, meals, exercise, sensible screen time and trigger awareness - the single biggest lever in paediatric headache.

  • Acute simple analgesia

    Weight-based paracetamol or ibuprofen taken early, with rest in a quiet dark room. Avoid frequent dosing to prevent medication overuse.

  • Triptans (age 12 and over)

    Rizatriptan, sumatriptan nasal, almotriptan and zolmitriptan are licensed for adolescent migraine and can transform attack control.

  • Propranolol

    A common first-line prophylactic in children when attacks are frequent or disabling - screen for asthma before starting.

  • Topiramate

    Effective prophylaxis under paediatric neurology supervision, with attention to weight, cognition and mood.

  • Amitriptyline or pizotifen

    Alternative prophylactic options for selected children, particularly where sleep or mood also need support.

  • CBT and paediatric psychology

    Evidence-based for chronic headache, anxiety-driven headache and school avoidance. Often combined with medication.

  • Specialist-only options

    Botulinum toxin for chronic migraine in selected adolescents, and CGRP monoclonal antibodies as emerging paediatric evidence grows.

Selected adolescents with chronic migraine may benefit from botulinum toxin, delivered through commissioned specialist paediatric centres such as Great Ormond Street, Alder Hey and Birmingham Children’s.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist paediatric neurology standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or paediatrician knows your child and their history and can tell you which parts apply. If in doubt, get seen.

  • NICE. Headaches in over 12s: diagnosis and management (NG150).

  • RCPCH. Standards for the assessment of headache in children and young people.

  • British Association for the Study of Headache (BASH). National headache management guidelines.

  • European Academy of Neurology / European Headache Federation. Paediatric migraine consensus.

Red flags

When a child’s headache needs urgent attention.

Most paediatric headaches are safely managed in primary care. These features are the ones that shift the pathway to same-day review or urgent imaging.

  • Morning vomiting or waking pain

    Headache that wakes a child from sleep or is worst on waking can signal raised intracranial pressure - needs same-day paediatric review.

  • Progressive worsening

    Headache getting steadily worse over weeks, not episodic, warrants urgent specialist assessment and imaging.

  • Focal neurology or ataxia

    New weakness, sensory change, unsteady gait or cranial nerve signs need urgent paediatric neurology review.

  • Papilloedema

    Swollen optic discs on fundoscopy - a hard red flag for raised pressure, tumour or IIH. Same-day imaging.

  • Seizures or personality change

    New seizures, marked behavioural or personality change alongside headache require urgent workup.

  • Growth arrest or hormonal features

    Failing growth, delayed puberty or new endocrine features can point to a sellar or hypothalamic cause - specialist referral.

  • Occipital pain with neck stiffness and fever

    Consider meningitis or encephalitis - emergency assessment, not a wait-and-see situation.

  • Head injury with worsening headache

    Post-injury headache that intensifies, with vomiting or drowsiness, needs urgent A&E review.

  • Medication overuse

    Simple analgesia on 15+ days a month, or triptans on 10+ days, can drive daily headache - needs a structured withdrawal plan.

Living with it

A treatable condition, with a clear ladder.

Four things make the biggest daily difference: a settled rhythm, a diary, working with school, and knowing when to push for specialist help.

A quiet reminder

Consistency beats intensity, every time.

Small, steady habits kept up for months do more than a heroic week that doesn’t last.

  1. 01 Rhythm

    Sleep, food, water, movement

    The unglamorous four. Regular bedtimes, breakfast, hydration and daily activity prevent more attacks than any tablet.

  2. 02 Diary

    Keep a headache diary

    Two months of dates, triggers and treatments reveals patterns clinicians can act on - and reassures families.

  3. 03 School

    Work with school

    A short care plan, quiet-room access and permission to take early analgesia keep learning on track through flares.

  4. 04 Escalate

    Know when to push for help

    Frequent school absence, medication overuse or new red flags mean it is time for paediatric neurology, not another over-the-counter box.

Frequently asked

Everything parents ask about headaches in children.

Quick answers on red flags, paediatric migraine, triptans and prophylaxis.

  • How common are headaches in children?

    Very common. Up to 60% of children experience headaches at some point, and around 10% of school-age children have migraine. Most are primary headaches (tension-type or migraine) rather than a sign of serious disease.

  • How is paediatric migraine different from adult migraine?

    In children migraine attacks are often bilateral rather than one-sided, tend to be shorter (as brief as one hour), and can present as abdominal migraine or cyclical vomiting syndrome. Nausea, photophobia and the need to lie down are still typical features.

  • When should I worry about my child’s headache?

    Seek urgent review for morning vomiting, headache that wakes them from sleep, headache that is steadily worsening, new weakness or unsteadiness, personality change, seizures, or fever with a stiff neck. These features can point to raised pressure, infection or a structural cause and need paediatric imaging.

  • Can children take triptans?

    Yes, several triptans are licensed for adolescents. Rizatriptan and nasal sumatriptan are commonly used from age 12, with almotriptan and zolmitriptan as further options. They should be prescribed and reviewed by a clinician familiar with paediatric headache.

  • What about preventive medication in children?

    When attacks are frequent or disabling, prophylaxis is considered under paediatric neurology. Propranolol, topiramate, amitriptyline and pizotifen are the mainstays. CGRP monoclonal antibodies are used in adults and are being studied in adolescents.

  • How much does school stress or screen time matter?

    A lot. Poor sleep, dehydration, missed meals, high screen time and unmanaged anxiety are the most common everyday triggers. CBT and school support can be as important as medication in chronic paediatric headache.

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