Headache Program

Many factors can affect your child’s headaches, so it’s important to get care from a team like ours with experts in different specialties. Our providers specialize in headache management for children. We work together — and with you — to care for your child.

Our team includes doctors called neurologists, pain psychologists and advanced practice providers (APPs) with special training and experience in treating children with headaches. All of our doctors are University of Washington faculty.

If needed, we refer your child to experts in other fields. These include:

• Social workers
• Ear-nose-and-throat (ENT or otolaryngology) doctors
• Physical therapists
• Occupational therapists
• Behavioral health therapists
• Dietitians
• Eye doctors (ophthalmologists)
• Adolescent medicine specialists
• Sleep specialists
• Psychiatrists

We provide the treatment that is right for your child. We offer:

• Recommendations for lifestyle changes
• A wide range of medicines and supplements to prevent and treat headaches, including calcitonin-gene related peptide (CGRP) targeted migraine treatment  
• Botox injections for chronic migraine
• Using numbing solution to ease pain from headache (SPG block and peripheral nerve block for headache)  
• Nerve stimulation devices to prevent and treat headaches
• Referrals to other specialists as needed, such as biofeedback therapy or mental health counseling
• Parent skills training
• School support
• Care coordination

For children and teens with headache syndromes that cause disabling pain despite other treatments, we offer cognitive behavioral therapy for pain management in our specialized Multidisciplinary Headache Clinic.

• Seattle Children’s Headache Program offers 5 convenient locations: North Clinic in Everett, Hospital campus in Seattle, South Clinic in Federal Way, Bellevue Clinic and Surgery Center and Olympia Clinic.
• Some services are available via telehealth.

• Our providers lead research studies that aim to understand causes, improve care and find cures for frequent headaches.
• We take part in registries that collect data about patients to help us learn more and improve treatments.
• Children and teens we treat have access to promising new treatments offered only in research studies. These are called clinical trials.
• See our clinical trials for children and teens with recurring headaches.

• Each child is different, and you know your child best. We work with you to give your child complete care. Members of our team have special training in their field and in the unique needs of children and teens with headache.
• We serve toddlers through young adults from around the Northwest and beyond. If your family speaks a language other than English, we have interpreters in many languages, including sign language, to help you get the care your child needs.
• If headaches are causing your child to miss school, we support you in getting accommodations to reduce the impact of headache on their school success.
• Seattle Children's can help with financial counseling, schooling, housing, transportation, interpreter services and spiritual care. Read about our services for patients and families.

Many things can trigger a headache or make things worse, such as:

• Genetics (family history of migraine)
• Poor sleep
• Not drinking enough water (dehydration) or poor nutrition
• Stress at school or home
• Anxiety, depression and trauma symptoms
• Learning disabilities such as trouble with reading, writing or math
• Problems with attention, concentration and organization
• Other medical concerns (like anemia, thyroid problems or rheumatological disorders)
• Dental problems
• Concussion
• Pregnancy
• Drug or alcohol abuse
• Pain in neck muscles, such as from slouching over a laptop or other screen
• Medicines like stimulants or antibiotics (tetracyclines)

You can help your child prevent headaches by avoiding triggers like lack of sleep, skipping meals or too much screen time. Mental health problems do not cause headaches, but anxiety, depression and attention problems are common in children and teens with headache. Working with a licensed mental health counselor in your community to treat anxiety, depression or other mental health concerns can help make your child’s headaches easier to manage.

For more information, see our handout Headache Help for Your Child or Teen (PDF) (Russian) (Spanish)

• Identifying the cause of your child’s headaches is important to providing the right treatment. We ask you and your child about their headaches to learn about the timing, pain level, lifestyle habits and any treatments you have tried.
• Before your child’s visit, we ask them to keep a headache diary. This helps identify patterns or triggers for headaches, such as sleep problems, dehydration, poor diet and stressors. That information helps us choose the best treatment for your child.
• Rarely, headaches are caused by underlying problems like a brain tumor or a build-up of fluid in the brain (hydrocephalus). Depending on your child’s symptoms, we may do imaging studies. When we need neuroimaging, most often we do a brain MRI (magnetic resonance imaging) to avoid radiation and to get a detailed image. For certain conditions, we may need to do a CT (computed tomography) scan.
• We may test your child’s blood if your provider thinks the headaches could be related to a medical problem like anemia or thyroid disease.

Certain vitamins, minerals, enzymes or herbal remedies may help prevent headaches. These work best when your child or teen takes them every day. It may take up to 3 months of regular daily use to get the best results. Use these treatments only if your healthcare provider recommends them.

• Sometimes children need to take medicine to prevent or stop headaches. We work with your child to find the medicine that works best for them with the fewest side effects.
• Rescue medicine is taken to stop a headache once it starts. This type of medicine is also called “acute medicine” or “pain reliever.” Options include over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) and a range of prescription medications. If your child’s migraines cause vomiting, we may prescribe medicines to ease nausea.
• Preventive (prophylactic) medicine is taken to prevent headaches from starting and to reduce how severe they are and how often they happen. We tailor the treatment to your child.
• If standard treatments are not effective and migraines happen more than half the days of the month for more than 3 months, we may consider injections of Botox into 30 or more spots on your child’s head, neck and shoulders to ease the pain. This may help to stop the nerves from carrying pain messages to the brain.
• In a peripheral nerve block for headache, a neurology provider injects a small amount of numbing solution over specific nerves in the head or neck related to headache.
• A sphenopalatine ganglion (SPG) block applies numbing solution near a group of nerve cells behind the nose (called sphenopalatine ganglion or SPG). Your healthcare team teaches your child or family member to use a numbing solution in the nose to reach the SPG. This helps relieve headache pain without an injection. Read about intranasal lidocaine for headaches.  
• For teens with severe migraines that have not responded to standard treatments, we may also consider newer medications that target a protein (called CGRP, which stands for calcitonin gene-related peptide) linked to migraine symptoms.
• Read about medication options in Headache Help for Your Child or Teen (PDF) (Russian) (Spanish)

Newer treatments for migraine headaches include devices that use electrical or magnetic pulses to affect how the nervous system responds to pain signals. These are called neuromodulation devices for headache. They have the benefit of avoiding side effects that sometimes happen with medicines.

Biofeedback therapy helps children, teens and young adults learn how to control their body’s response to pain and stress. While wearing sensors that show vital signs like heart rate, we have your child practice breathing exercises and other relaxation techniques. They will learn to regulate their muscle tension, heart rate, skin temperature and other body functions to decrease chronic headache pain.

This specialized clinic is for children and teens with disabling headache syndromes that don’t go away (intractable) who are referred by a Seattle Children’s neurology provider. In a single visit, your child will meet with a pain psychologist, doctor and nurse who all specialize in headache management.

Through cognitive behavioral therapy for pain management, you and your child learn ways to help control their headache and its impact on daily life. This can include training in:

• Relaxation methods (deep breathing, progressive muscle relaxation, guided imagery and mindfulness)
• Cognitive strategies
• Problem-solving skills
• Parenting techniques to help your child better control their headache symptoms and have an easier time taking part in their daily activities even when they do not feel their best

Our pain psychologist tailors these methods to your family and your child's needs.

We support you in getting accommodations for your child or teen at school to reduce the impact of headaches on their school success. This may include:

• Access to a quiet, dark place for rest
• A process for getting notes and assignments for missed classes
• Excused absences for severe migraines
• The ability to leave noisy or bright environments without penalty

Ask your provider about getting a letter for 504 accommodations for migraine headaches.

For resources to help your child get the most from their education, see Migraine At School.