Some of the most painful questions I get are about headaches in children, and when parents should be concerned. Let me ease some of the tension surrounding this topic by providing some information.

Most of the time, there are good reasons for your child’s head to ache, such as staying up too late, playing in the sun too long, or bumping his or her head. Ear and sinus infections can also be a culprit.

Children can also get migraines and tension headaches. Migraines, which can run in families, are caused by blood vessels contracting and expanding and produce a localized throbbing headache pain. Migraines are also associated with abdominal pain, nausea, vomiting and dizziness. They can get worse with rapid motion or activity. Chocolate, nuts, caffeine or cheeses might also trigger migraines, as can sleep deprivation and stress.

Tension headaches can occur with prolonged use of video games or computers, or as a reaction to stress as well. They feel like a band around the head and may be a form of migraine, but usually do not come with nausea and vomiting, and are not worsened by motion or activity.

Treatment of a simple migraine or tension headache includes lying down in a cool dark room and giving your child acetaminophen or ibuprofen. Preventive treatment may also involve daily treatment with acetaminophen to reduce the frequency of these types of headaches, as well as relaxation and stress reduction techniques. If the pain does become severe, a prescription medication may be recommended by your child’s doctor to treat the discomfort.

So when do we worry? You should call your child’s doctor if:

• the pain is severe and causes crying

• the headache lasts for over 24 hours and is associated with fever

• there is lots of vomiting, especially in the early morning hours

• your child is confused and difficult to awaken

• their speech is slurred

• they have blurry vision

In rare cases, your child might have trouble moving an arm or leg. This might indicate a more serious type of headache that warrants an emergency call to your child’s doctor or trip to the emergency department at your local hospital for further testing and treatment

Hopefully tips like this will give you a head start, and put you ahead of the game - or is that ahead of the pain - when it comes to dealing with headaches.

Lewis First, M.D., is chief of Pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care and chair of the Department of Pediatrics at the University of Vermont College of Medicine. You can also catch "First with Kids" weekly on WOKO 98.9FM and on WCAX-TV Channel 3. Visit the First with Kids video archives at http://www.FletcherAllen.org/firstwithkids