Headaches that keep returning deserve a review when they disrupt school, play or everyday life. The pattern and examination guide whether further tests are useful.
Your child repeatedly asks to leave class because of a headache, then seems well between episodes. It can be difficult to know whether to arrange an appointment or whether every recurring headache needs a scan.
Take the child's experience seriously. A consultation can assess the pattern and its effect on everyday life without assuming the most alarming explanation.
The direct answer
Arrange a review when headaches recur, interfere with school or play, become more frequent or change in character. A careful history and examination often guide the diagnosis. Imaging is not routinely recommended for a child with a stable recurrent pattern and a normal neurological examination; concerning findings may change that decision.
What patterns are useful to record?
Keep a brief record of when pain starts, how long it lasts, where it is felt and what the child does during an episode. Note nausea, sensitivity to light or sound, changes in vision and whether activity makes it worse. Younger children may describe discomfort through behaviour rather than precise words.
Record missed school, interrupted activities, sleep and any current treatments. Include headache-free days and relevant family history. Bring any earlier medical or eye assessments. You do not need a perfect diary before arranging a visit, and recording symptoms should not delay assessment when they change.
Does every headache mean migraine?
No. Migraine and tension-type headache are possible explanations, but the clinician also considers other causes. A family history can help the discussion but cannot confirm a diagnosis by itself. Headaches in children may differ from the adult pattern.
Discuss sleep, school pressures and usual routines without assuming that stress makes the pain imaginary. Ask about eyesight when the child struggles to see or read; not every headache is explained by a minor spectacle prescription. The review should follow the full history rather than one presumed trigger.
What does the examination involve?
The clinician assesses general health and blood pressure, then checks relevant neurological features such as strength, coordination, walking and eye movements. Vision and the back of the eyes may need assessment according to the findings. Age, developmental history and the child's ability to describe symptoms affect the approach.
No single symptom checklist replaces that examination. Tell the doctor about a recent injury, a new illness, progressive symptoms or any change in balance, behaviour or school performance. Existing health conditions can also affect how the headache is evaluated.
When are tests or referral considered?
Tests should answer a specific question. A stable history with a normal examination may not need a brain scan. An abnormal examination, a progressive pattern or another concerning feature may lead to imaging or specialist referral. The clinician selects the appropriate test and timing; parents should not have to choose between scan types online.
Ask what the proposed test might show and how its result would change care. A normal scan does not mean pain was invented or remove the need for follow-up if headaches continue to disrupt life.
Which changes need earlier assessment?
Headache waking a child from sleep, repeated early-morning vomiting, a progressive pattern or a change in walking or vision needs same-day medical assessment. Sudden severe pain, marked drowsiness, new weakness or a seizure requires urgent medical evaluation. This article covers recurring headache review, not management of an acute episode.
Frequently asked questions
Should I wait until headaches occur every day?
No. Recurrent headaches affecting school, activities or wellbeing can justify a review before they become daily.
Does every child need MRI?
No. The history and examination determine whether imaging is appropriate. A stable pattern and normal examination often do not require it.
Can migraine occur in a younger child?
Yes. Children can have migraine, although their descriptions and pattern may differ from adults. A clinician should assess it.
What if my child is well between headaches?
That is useful information, but recurring disruption still deserves review. Explain both the episodes and the periods between them.
What should we discuss at follow-up?
Discuss episode frequency, school and activity effects, any pattern changes and whether the agreed plan is helping. Ask what should bring the child back sooner.
Bring your symptom record to a paediatric consultation and agree on the next review and any tests that are actually needed.
The paediatric service can discuss the initial review. In a younger child, relevant developmental history also helps interpret an age-appropriate examination.