Headaches and Concussions in Children: When to Worry and What to Do

What Causes Headaches in Children

Headaches in children have many possible causes. It helps to think of them in two broad groups: things coming from outside the body, and things happening inside.

External causes include muscle tension (like waking up with a stiff neck), trauma or injury to the head, and referred pain from areas nearby — like ear infections or sinus congestion.

Internal causes can include dehydration, fever, illness, allergies, vision problems, and migraines. In rare cases, headaches are caused by more serious conditions affecting the brain.

One thing our pediatricians want parents to know: healthy children, especially younger ones, should not have frequent headaches. If your young child is getting headaches regularly, that's a reason to reach out to your care team.

Types of Headaches in Children

Tension headaches – Often described as a dull, squeezing pressure around the head. They can usually be linked to stress, poor sleep, muscle tension, or too much screen time.

Migraines – Migraines tend to cause moderate to severe throbbing pain, often on one side of the head. Those headaches may have additional symptoms such as nausea, light sensitivity, or visual disturbances.

Headaches from illness or fever – Many common illnesses (colds, flu, sinus infections, and ear infections) cause headaches as a secondary symptom. In those cases, treating the underlying illness usually helps.

Headaches from dehydration – Children can become dehydrated quickly, especially during illness or physical activity. A headache sometimes can be one of the first signs.

Concussion-related headaches – After a head injury, headache is one of the most common symptoms of a concussion. These are covered in detail below.

When Does a Headache Need Care?

Home Care

Your child's headache is likely manageable at home when:

It's connected to a mild illness like a cold or fever
Your child's behavior, gait (how they walk), and vision seem normal
The pain responds to acetaminophen (Tylenol) or ibuprofen (Motrin) and rest
There is no recent head injury

Contact the Clinic

Reach out to Zarminali Pediatrics the same day if your child:

Has a severe headache with vomiting
Has blurry or changed vision
Is walking differently than usual or falling down more
Has a headache that is not responding to medication
Is younger than 5 years old and has recurring headaches
Has headaches that are getting more frequent or more intense over time
Has had a recent head injury or suspected concussion

If you cannot reach your clinic and your child has any of the above symptoms, go to urgent care or the ER.

Seek Emergency Care

Go to the ER right away if your child:

Is unresponsive or cannot be woken up after a head injury
Lost consciousness, even briefly, after a head injury
Develops sudden swelling on the head after a fall
Has complete loss of vision in one or both eyes
Is vomiting and cannot keep fluids down
Has a sudden, severe "worst headache of their life" (especially without a known cause)
Is having trouble walking, speaking, or staying awake

Age

In babies and toddlers who can't describe pain, a headache may show up as unusual fussiness, crying, or sensitivity to light and sound. Any sign of pain or illness in very young children warrants a call to your clinician. In older children and teens, headaches may be connected to growth spurts, hormonal changes, increased school stress, or a history of past concussions.

Medications

Teens who take certain medications, including some forms of birth control, may experience headaches as a side effect. Talk to your clinician if you think a medication may be contributing.

Family history of migraines

Migraines have a strong genetic link. If migraines run in your family, be sure to mention that at your child's visit.

Chronic conditions

Children with conditions like asthma, diabetes, or allergies can be more prone to headaches. If your child has a known condition and headaches are increasing, contact your care team.

At-home Care That Helps Headaches

For headaches without red flags, these steps can help your child feel better:

Medication: Acetaminophen (Tylenol) or ibuprofen (Motrin), given according to your child's age and weight, can reduce pain. Always follow dosage instructions.
Fluids: Offer water or a low-sugar electrolyte drink like Pedialyte, especially if your child has been active, is sick, or hasn't had much to drink.
Rest in a quiet, dark space: This is especially helpful for migraines.
Heat: A warm compress on the neck or shoulders can help relieve tension headaches caused by muscle tightness.
Gentle massage: Light pressure on the temples, neck, or scalp can ease pain for some children.
Treat the cause: If the headache is from a sinus infection, fever, or ear infection, treating that condition usually helps the headache too.

If your child's headache does not improve, or gets worse despite these steps, contact your clinic.

If your child gets headaches often without an obvious cause, keeping a headache journal can be really useful.

Note the time of day, how long the headache lasts, what your child was doing before it started, and any possible triggers like certain foods, light, or activities. Over time, patterns may emerge that can help point to the cause. Bring the journal to your next visit.

Common triggers our clinicians look for include vision problems (frequent headaches during schoolwork can be a sign your child needs glasses), dehydration patterns, and stress related to school or social situations.

A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head. You don't have to lose consciousness to have a concussion. In fact, many children with concussions are awake and alert right after the injury.

Common symptoms of a concussion:

Physical signs: Headache, dizziness, nausea, vomiting, sensitivity to light or noise, balance problems or clumsy movement.
Thinking and memory changes: Feeling “foggy,” trouble concentrating or remembering events, slow responses to questions.
Emotional changes: Irritability, unusual behavior, mood swings or personality changes.
Sleep changes: Sleeping more or less than usual, trouble falling asleep, or difficulty waking up.

If you suspect a concussion, contact your pediatrician right away. Do not wait to see if it gets better on its own.

Worrisome signs that need emergency care include seizures, inability to wake your child, repeated vomiting, slurred speech, weakness or numbness, severe or worsening headaches, and changes in pupil size. Call 911 if any of these occur.

What Happens at a Concussion Evaluation

When your child is seen for a suspected concussion, the clinician will do a thorough evaluation. This typically includes questions about what happened, a brief memory check, and a neurological exam to assess how the brain and body are working together. Memory is one of the most important things clinicians evaluate after a head injury.

Based on the initial evaluation, your clinician may manage your child's recovery directly or refer you to a sports medicine specialist.

Concussion Recovery Time

The amount of recovery time depends on the injury and your child's progress through healing. It could take a few weeks to a few months. Recovery from a concussion takes time, and the right kind of rest makes a real difference.

Screen time: Limit close-up screen use during recovery, including phones, tablets, homework, and video games. Follow your clinician's guidance on when to gradually reintroduce screens.
Rest: Physical and mental rest are both important in the early days after a concussion. Avoid strenuous activity, and ease back into school gradually. Many schools have concussion protocols in place. Connect with your school nurse.
Hydration: Staying well hydrated supports recovery.
Pain management: Tylenol or Motrin can help with headache pain during recovery.
Watch for warning signs: If symptoms get worse — particularly increased dizziness, ringing in the ears, worsening drowsiness, or significant mood changes — contact your clinician.

Returning to Sports After a Concussion

This is one of the most important things to understand: your child should never return to sports, play, or high-impact activity until they have been cleared by a clinician.

Most children need to be out of activity for at least one to two weeks. Return to play happens gradually, following a step-by-step protocol recommended by pediatric sports medicine guidelines. Your child will need a follow-up visit to receive final clearance.

Re-injury before full healing is the biggest risk with concussions. Each concussion also increases the risk of future ones, so protecting your child's recovery time is critical.

If symptoms persist or your child has had multiple concussions, your clinician may refer you to a specialist in sports medicine, vestibular therapy (a type of physical therapy for dizziness and balance), or cognitive rehabilitation.