Headache in Children

Jessica Klein; Thomas Koch

doi:10.1542/pir.2017-0012

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Jessica Klein, MD*
Thomas Koch, MD*

^*Division of Pediatric Neurology, Medical University of South Carolina, Charleston, SC

AUTHOR DISCLOSURE
Drs Klein and Koch have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device. Dr Klein’s current affiliation is Division of Pediatric Neurology, Johns Hopkins University, Baltimore, MD.

Abbreviations:

ICHD-3:: third edition of the International Classification of Headache Disorders
IV:: intravenous
MRA:: magnetic resonance angiography
MRI:: magnetic resonance imaging
MRV:: magnetic resonance venography
NSAID:: nonsteroidal anti-inflammatory drug
OTC:: over-the-counter
PedMIDAS:: Pediatric Migraine Disability Assessment

Practice Gap

Headache is a common complaint in children and adolescents. Although an efficient, organized, and methodical approach to the patient’s history and physical examination is essential, many practitioners are not familiar with a best practices approach to headache. This can result in difficulty with decision making regarding further testing, such as brain imaging, as well as treatment options.

Objectives

After completing this article, readers should be able to:

Recognize key elements of the history and physical examination associated with headaches of various etiologies.
Understand the role of neuroimaging in the evaluation of headache in children.
Describe the appropriate management of headaches and the roles of abortive therapy and preventive therapy in patients with recurrent headaches.

Introduction

Headache is a common complaint in children and adolescents and many times leads to much anxiety for the practitioner and the parents. Therefore, it is important for providers to understand the approach to evaluation of headache. A thorough headache history and a focused neurologic examination are critical and, in most situations, allow the provider to distinguish between primary headache disorders (eg, migraine, tension, or chronic daily headache) and secondary headache disorders (eg, those seen with brain tumors, pseudotumor cerebri syndrome, chronic meningitis, hydrocephalus, hypertension, or acute febrile illnesses). The performance of ancillary diagnostic testing depends on information obtained during data collection. (1)

Headache History and Physical Examination

The initial approach to the patient with headache begins with a focused set of headache-based questions (Table 1). (2) The answers to these questions allow the provider to begin to distinguish between features characteristic of a primary headache disorder and those …