The child with headache

Approximately 20 percent of children aged 4 to 18 years report having had frequent or severe headaches in the past 12 months.

●Headache in children and adolescents may be due to a primary headache syndrome (ie, migraine headache, tension-type headache, cluster headache or secondary to an underlying medical condition. Secondary headaches usually are related to fever or infection (eg, upper respiratory infection, influenza), but may be due to central nervous system infection or space-occupying lesion.

●The evaluation of headache in children includes a thorough history and physical examination, with particular emphasis on clinical features suggestive of intracranial pathology. The headache pattern helps to determine the etiology.

●Neuroimaging (head computed tomography without contrast or magnetic resonance imaging without contrast) should be performed in children with headache and neurologic signs or symptoms suggestive of intracranial pathology.

●Routine laboratory evaluation usually is not necessary for children with recurrent or chronic headaches. The laboratory evaluation for secondary headache should be tailored to evaluate conditions suggested by information from the history and examination.

●The diagnosis of primary headache disorders is made clinically, based upon the criteria of the International Headache Society. The diagnosis of chronic daily headache also is made clinically (headache on >15 days per month for >3 months in the absence of detectable organic pathology). The diagnosis of secondary headaches depends upon identification of the underlying condition.

●The treatment of chronic headaches requires a systematic approach over several months through which the child returns to normal activities of daily living. It is critical to address excessive school absence and overuse of over-the-counter analgesic medications.