The hammering in the head

More and more children and adolescents are complaining of headaches, not only in Switzerland but also in many other European countries. A large-scale study conducted by Dresden University Hospital in 2019 revealed that more than two thirds of all schoolchildren regularly suffer from headaches. Among secondary school pupils, the proportion is even higher than 80 per cent.

«This means that every young person in this country is familiar with headaches and the trend is rising,» says Katrin Lengnick, Head of the Paediatric Pain Outpatient Clinic and Headache Consultation at the St. Gallen Children's Hospital.

Several individual studies indicate that the number of children and adolescents with tension headaches and migraines has risen significantly over the last 30 years. «To date, there are no generally valid figures on the exact amount of the increase, but we in the headache outpatient clinic have also noticed an increase in the number of cases,» emphasises Lengnick. «While we had around ten referrals per month in 2016, there are now around five per week - that's a doubling.»

Migraines and tension headaches are the two most common types of so-called primary headaches. «This is the name given to headaches that occur independently and not as a symptom of an underlying illness,» says senior physician Katrin Lengnick. «Around 10 to 20 per cent of affected children and adolescents suffer from migraines, 60 to 80 per cent show symptoms of tension headaches - but there are often mixed forms.»

The two types of headache differ primarily in their cause, but also in their symptoms. «The distinction is important, as the two types of headache are treated differently,» explains the pain expert.

«Tension headaches are usually the result of one-sided and dysfunctional muscular tension, often triggered by physical and psychological stress.» The pain is usually pressing on both sides and of mild to moderate intensity. «Activities that have been started can usually be continued, distraction from the pain is possible and physical exercise often alleviates the symptoms,» says Lengnick.

The migraine is more stressful overall

Migraines are completely different: here the cause is a non-infectious inflammatory reaction of the blood vessels in the meninges. The predisposition is inherited and there are certain trigger factors that can cause or favour an attack.

«Migraine pain is usually moderate to severe, often pulsating or throbbing on one side. In children, however, they can also be felt on both sides of the forehead and all over the head,» says the head of the outpatient pain clinic. «The migraine often announces itself with precursor symptoms, the so-called aura, and is accompanied by other symptoms such as nausea, vomiting, sensitivity to light and sound.» Current activities can then usually no longer be continued, distraction is hardly possible and physical activities significantly worsen the symptoms.

Common painkillers can themselves cause headaches if taken too often.

Occasional headaches are usually harmless. However, if the headaches occur regularly, i.e. several times a month, and lead to restrictions such as school absences or the cancellation of leisure activities, the symptoms should always be clarified by the paediatrician or family doctor.

«Migraine symptoms are often so noticeable that parents usually consult a doctor very quickly,» emphasises Lengnick. «It is important to rule out potential other illnesses. In addition, acute pain therapy with medication should be started as early as possible, firstly to slow down the spread of the inflammation and secondly to prevent the formation of a so-called pain memory, as the symptoms can otherwise continue to increase and become chronic.»

Tension headaches, on the other hand, are often not taken seriously by parents and are often self-medicated with painkillers from the pharmacy. But many don't realise this: Common painkillers can themselves cause headaches if taken too often. A so-called drug-induced headache usually develops gradually. «Just ten days of taking painkillers per month - i.e. just over two days of medication per week - over a period of three months is enough for us to speak of harmful overuse of medication,» emphasises the senior physician.

Detective search for the causes

Frequent headaches also often result in sleep and concentration problems, which in turn can cause headaches again, creating a real vicious circle. This also increases the risk of school absences, which in turn leads to more school stress and fear of school failure. Absence from leisure activities can lead to marginalisation and even social isolation, resulting in depressive moods, which in turn promote social withdrawal.

«It is therefore important that children with frequent tension headaches also receive professional help as quickly as possible,» says Katrin Lengnick. «The search for the cause is often like detective work, as there are many different possible triggers and it is not uncommon for several factors to be responsible for the symptoms.»

Common causes of tension headaches include a high-sugar diet, too little exercise and too much screen time, but also too much sport and too little unplanned playtime, lack of sleep and psychosocial factors such as school stress, exam nerves, bullying, moving house or parental divorce. «We also often find attention disorders such as ADHD or ADD, as well as a reading and spelling disorder, visual impairment, allergies and, above all, sleep disorders in connection with tension headaches,» adds the pain specialist.

Once the causes have been identified, multimodal solutions must be developed to permanently reduce the tension. Some things are easier to eliminate or change, such as diet or exercise frequency. However, children need to learn to deal better with other circumstances such as their parents moving house or divorcing. «This includes training body awareness, taking timely breaks, setting better boundaries and practising relaxation techniques,» recommends Lengnick. Complementary medical methods such as Traditional European Naturopathy (TEN) are also well suited to supporting treatment.

Gentle behaviour, such as staying at home and swallowing tablets, should not be supported by parents.

Sabrina Lange, naturopath

Sabrina Lange, a qualified naturopath and lecturer in TEN, recommends customised mixtures of essential oils that children can apply to the pulse points or wear around their neck as a scented necklace. In her opinion, gemmotherapy with special plant bud sprays that are sprayed into the throat could bring relief. Sabrina Lange: «In addition, if you have frequent headaches, you should always look at your diet, as too much sugar and too many additives have an unfavourable effect on the gut microbiome, which can also lead to chronic headaches via the gut-brain axis.»

The naturopath also recommends breathing techniques for relaxation and better sleep, as well as stretching and loosening exercises for the shoulders and neck. «On the other hand, parents should not encourage gentle behaviour such as staying at home and swallowing tablets, as this will not help in the long term,» Lengnick also warns. «I therefore advise affected families to return to normality as quickly as possible.»