Materiały źródłowe

• #1 Overview of diagnosis and management of paediatric headache. Part I: diagnosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3056001/

  Headache is the most common somatic complaint in children and adolescents. The evaluation should include detailed history of children and adolescents completed by detailed general and neurological examinations. […] A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment. The evaluation should include detailed history of children and adolescents (including parent and teacher observations, observations of child-carer, family relationships, medical history of children and parents) and completed by detailed general and neurological examinations. […] The history determines the correct diagnosis, so questions need to be directed to both the child and parents. The following questions should be included: Do you have one or more types of headache? How did the headaches begin? When did the headaches begin? Are the headaches progressive, staying the same or improving?

• #1 Headaches in children – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/headaches-in-children/diagnosis-treatment/drc-20352104

  To learn about the nature of your child’s headache, your doctor will likely look to: […] Your doctor asks you and your child to describe the headaches in detail, to see if there’s a pattern or a common trigger. […] The doctor performs a physical exam, including measuring your child’s height, weight, head circumference, blood pressure and pulse, and examining your child’s eyes, neck, head and spine. […] Your doctor checks for any problems with movement, coordination or sensation. […] If your child is otherwise healthy and headaches are the only symptom, no further testing usually is needed. In a few cases, however, imaging scans and other evaluations can help pinpoint a diagnosis or rule out other medical conditions that could be causing the headaches. […] Magnetic resonance imaging (MRI) scans help doctors diagnose tumors, strokes, aneurysms, neurological diseases and other brain abnormalities.

• #1 Patient education: Headache in children (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/headache-in-children-beyond-the-basics/print

  Headaches are a common complaint in children and adolescents, occurring in up to 75 percent of school-aged children. The frequency of headaches is greater in adolescents than in younger children. There are many possible causes of headaches, from common and nonharmful to rare but serious conditions. […] This topic reviews the causes, evaluation, and treatment of headaches in children and adolescents. […] The symptoms in a child depend upon the child’s age, the type of headache, and the underlying disorders. Headaches are generally classified as primary (ie, the headache symptom itself is the disease or disorder) or secondary (ie, the headache is a symptom of a separate underlying disease or disorder). The most common types of primary headaches in childhood are migraine and tension-type headaches, while the most common secondary headaches are associated with an infectious illness or are related to head injury.

• #1 Headaches in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0215/p625.html

  Headaches are common during childhood and become more common and increase in frequency during adolescence. The rational, cost-effective evaluation of children with headache begins with a careful history. The first step is to identify the temporal pattern of the headacheacute, acute-recurrent, chronic-progressive, chronic-nonprogressive, or mixed. The next step is a physical and neurologic examination focusing on the optic disc, eye movements, motor asymmetry, coordination, and reflexes. Neuroimaging is not routinely warranted in the evaluation of childhood headache and should be reserved for use in children with chronic-progressive patterns or abnormalities on neurologic examination. Once the headache diagnosis is established, management must be based on the frequency and severity of headache and the impact on the patient’s lifestyle. Treatment of childhood migraine includes the intermittent use of oral analgesics and antiemetics and, occasionally, daily prophylactic agents. Often, the most important therapeutic intervention is confident reassurance about the absence of serious underlying neurologic disease.

• #1 Frontiers | Management of Childhood Headache in the Emergency Department. Review of the Literature

  https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2019.00886/full

  Headache is the third cause of visits to pediatric emergency departments (ED). According to a systematic review, headaches in children evaluated in the ED are primarily due to benign conditions that tend to be self-limiting or resolve with appropriate pharmacological treatment. […] The literature describes the following red flags requiring further investigation (for example neuroimaging) for recognition of LT conditions: abnormal neurological examination; atypical presentation of headaches: subjective vertigo, intractable vomiting or headaches that wake the child from sleep; recent and progressive severe headache (<6 months); age of the child <6 years; no family history for migraine or primary headache; occipital headache; change of headache; new headache in an immunocompromised child; first or worst headache; symptoms and signs of systemic disease; headaches associated with changes in mental status or focal neurological disorders.

• #1 Headaches in children – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/headaches-in-children/symptoms-causes/syc-20352099

  Headaches in children are common and usually aren’t serious. […] It’s important to pay attention to your child’s headache symptoms and consult a doctor if the headache worsens or occurs frequently. […] Doctors use the phrase „chronic daily headache” (CDH) for migraines and tension-type headaches that occur more than 15 days a month. […] Most headaches aren’t serious, but seek prompt medical care if your child’s headaches: Wake your child from sleep, Worsen or become more frequent, Change your child’s personality, Follow an injury, such as a blow to the head, Feature persistent vomiting or visual changes, Are accompanied by fever and neck pain or stiffness. […] A number of factors can cause your child to develop headaches. […] Common illnesses such as colds, flu, and ear and sinus infections are some of the most frequent causes of headaches in children.

• #1 Headaches in Children – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=headaches-in-children-90-P02603

  A headache is pain or discomfort in one or more areas of the head or face. Headaches can happen once in a while. Or they may happen often. […] Headaches are often divided into 2 groups, based on what causes them: […] Primary headaches are not linked to another health condition. They are usually caused by tight muscles, widened (dilated) blood vessels, changes in nerve signals, or swelling (inflammation) in parts of the brain. […] Secondary headaches are the least common type of headaches. They are caused by a problem in the brain, or another health condition or disease. […] The healthcare provider will ask about your child’s symptoms and health history. He or she may also ask about your family’s health history. He or she will give your child a physical exam. The physical exam may include a neurological exam.

• #1 Assessment of acute headache in children – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/825

  Headaches are common in children, increasing in incidence from early childhood to adolescence. They account for 0.7% to 1.3% of all paediatric emergency department visits. Headaches may be classified as primary or secondary. Primary headaches include migraine, tension-type, cluster, as well as the new daily persistent headache. Secondary headaches are symptomatic of an underlying intracranial or medical condition that requires treatment. The initial assessment of acute headache aims to determine whether there is a secondary cause for headache that requires urgent intervention. […] Diagnosis of migraine without aura requires: A: At least 5 attacks fulfilling criteria B-D. B: Headache attacks lasting 2 to 72 hours (when untreated or unsuccessfully treated) (note: compared with 4 to 72 hours in adults). C: Headache having at least 2 of the following characteristics: Unilateral location, may be bilateral, frontotemporal; Pulsing quality; Moderate or severe pain intensity; Aggravation by or causing avoidance of routine physical activity (e.g., walking, climbing stairs). D: During the headache, at least 1 of the following: Nausea or vomiting; Photophobia and phonophobia, which may be inferred from behaviour. E: Not attributable to another disorder.

• #1 Kids’ Headaches: The Diagnosis Is Difficult

  http://healthlibrary.touro.com/YourFamily/Women/Tools/161,5

  Tension-type headache. This is the most common type of headache in children. The most likely causes are emotional upsets or stress. Your child may describe the pain as widespread or like a tight band around the head. This type of headache does not often cause nausea and vomiting. It’s also not tied to other symptoms, such as fever, change in mental status, or other physiologic changes. Tension headaches are almost always linked to stressful situations at school, competition, family friction, or too many demands by parents. The healthcare provider needs to also find out whether anxiety or depression may be present. These headaches are often easily treatable with over-the-counter medicine, such as acetaminophen or ibuprofen. Your healthcare provider will tell you how to give these medicines safely. It’s also important to identify likely triggers and make lifestyle changes in diet, sleep patterns, exercise, and study habits.

• #1 Overview of diagnosis and management of paediatric headache. Part I: diagnosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3056001/

  The choice of laboratory tests rests on the differential diagnosis suggested by the history, the character and temporal pattern of the headache, and the physical and neurological examinations. […] In children and adolescents, the abrupt onset of severe headache is most frequently caused by upper respiratory tract infection with fever, by sinusitis or by migraine. […] Both epidemiological and clinical studies have shown that most common causes of headaches in children and adolescents are migraine and TTH. […] The diagnosis of migraine rests mainly on clinical criteria, thus a correct evaluation begins with a thorough medical history followed by a complete physical and neurological examination including examination of the optic fundus. […] TTH may be hard to differentiate from migraine in children as some of the symptoms overlap.

• #1 Headaches in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0215/p625.html

  The chronic-progressive headache pattern, the most ominous of the headache patterns, involves a gradual increase in the frequency and severity of pain over time. Intracranial pathology should be suspected, especially when the headache is accompanied by altered mental status, abnormal eye movements, optic disc distortion, motor or sensory asymmetry, coordination disturbances, or abnormal deep tendon reflexes. Most patients with chronic-progressive headache warrant neuroimaging with MRI. Management is dependent on imaging results and diagnosis.

• #1

  https://www.beaumont.org/conditions/headaches-in-children-diagnosis

  The diagnosis of a headache is made with a careful history, physical examination and diagnostic tests. […] If the history is consistent with migraine or tension type headaches and the neurological exam is normal, no further diagnostic testing may be necessary. However, if it is not a primary type headache, then other tests may be needed to determine the cause. […] Tests used to determine the cause of your child’s headache may include: blood tests-various blood chemistry and other laboratory tests may be run to check for underlying conditions. […] Headaches in Children

• #1 Headaches | Migraines – Causes, Diagnostic Tests and Treatment

  https://www.radiologyinfo.org/en/info/headache

  Your doctor may order head MRI, head CT or lumbar puncture to help diagnose and evaluate your condition. […] To diagnose the cause of headaches and to rule out underlying medical conditions, physicians obtain a patient history and conduct a careful neurological examination. Diagnostic testing may include the following imaging tests: […] MRI of the head: Magnetic resonance imaging (MRI) uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. […] Lumbar puncture (also called a spinal tap): This diagnostic test involves removing and analyzing a small amount of cerebrospinal fluid the fluid that surrounds the brain and spinal cord from the lumbar (or lower) region of the spinal column. […] If your headache is the result of an underlying medical condition or injury, your physician will discuss treatment options with you.

• #1 Headaches in children – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/headaches-in-children/diagnosis-treatment/drc-20352104

  This imaging procedure uses a series of computer-directed X-rays that provide a cross-sectional view of your child’s brain. This helps doctors diagnose tumors, infections and other medical problems that can cause headaches. […] If your doctor suspects that an underlying condition, such as bacterial or viral meningitis, is causing your child’s headaches, he or she may recommend a spinal tap (lumbar puncture). […] For headaches in children, some basic questions to ask your doctor include: Are tests needed to confirm the diagnosis? […] Your doctor is likely to ask you a number of questions, including: How often does your child experience these symptoms? […] Until you see your child’s doctor, if your child has a headache, place a cool, wet cloth on your child’s forehead and encourage him or her to rest in a dark, quiet room. […] Consider giving your child OTC pain medications such as acetaminophen or ibuprofen (Advil, Motrin IB, others) to ease symptoms.

• #1 Headaches in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0215/p625.html

  The medical evaluation of a child or adolescent presenting with headache requires a thorough history followed by a complete physical and neurologic examination. A headache assessment should generate sufficient information to make a diagnosis. The questions contained in this assessment can guide the physician in assigning a patient’s symptom complex to the appropriate temporal pattern and help identify patients who warrant further diagnostic testing. […] The role of neuroimaging is controversial. Computed tomographic (CT) scanning or magnetic resonance imaging (MRI) is indicated in patients with a chronic-progressive headache pattern and those who have abnormal findings in the neurologic examination. In the majority of patients with acute-recurrent headache or chronic-nonprogressive headache patterns and normal findings from neurologic examinations, no imaging is warranted.

• #1 Pediatric Headache Workup: Approach Considerations, Laboratory Studies, Lumbar Puncture

  https://emedicine.medscape.com/article/2110861-workup

  In the case of migraine or tension headache, a thorough history and physical examination is usually all that is needed. Laboratory, radiologic, or encephalographic studies are not useful to confirm the diagnosis of migraine but may help to exclude other causes of headache. […] Although imaging studies are not needed for every child who complains of headache, neuroimaging should be performed when the caregiver has any suspicion or concern that the headache may have a structural etiology. […] If a patient has had headaches for a long time (months to years) and the neurologic examination is normal, the likelihood of this patient harboring any serious intracranial pathology is minimal, and, therefore, neuroimaging studies should not be performed routinely. […] Electroencephalography is useful to assess the status of an underlying seizure disorder associated with headache.

• #1 Accurate Diagnosis of Headaches in Children | Valley Children’s Healthcare

  https://www.valleychildrens.org/services/neuroscience-center/refer-a-patient/accurate-diagnosis-of-headaches

  Accurate Diagnosis of Headaches in Children In this section Back […] There are many factors that make diagnosis of headaches in children a challenge for clinicians. As a physician there are several determinations to make: is it a migraine or non-migraine; is it a primary or secondary headache; is there an emotional or psychosocial component? […] The difficulty is compounded by the lack of a simple diagnostic test there is no simple blood test or imaging scan that can correctly provide a diagnosis. A physical exam may reveal the cause of some headaches, but this is not usually the case. […] Conducting a detailed clinical history provides the most helpful diagnostic information. Depending on the patient’s age, this too can be a challenge as some children do not have the verbal skills or vocabulary to describe their symptoms, or an accurate memory of the history or frequency of their headache pain.

• #1 Accurate Diagnosis of Headaches in Children | Valley Children’s Healthcare

  https://www.valleychildrens.org/services/neuroscience-center/refer-a-patient/accurate-diagnosis-of-headaches

  Your evaluation should include a detailed clinical history followed by a thorough general and neurological evaluation. It’s important to include input from all caregivers teachers, parents, other family members. Children do not always communicate openly, or even recognize their pain, so some behavior may be referred from certain activities, such as abruptly quitting a video game, wishing to be in darkened rooms in daytime. […] Another way to engage children may be to ask them to draw a picture of what the headache feels like, since some may communicate better through pictures than verbally. […] Valley Children’s Hospital recommends that you follow these guidelines for referring headaches: […] Patients with a new, severe headache of acute onset, headache with a focal neurologic deficit, or headache associated with papilledema should be referred to the Emergency Department.

• #1 Headaches in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0215/p625.html

  Lumbar puncture to identify bacterial or viral meningitis is mandatory in a febrile patient with headache with nuchal rigidity and no alteration of consciousness, signs of increased intracranial pressure, or lateralizing features. […] Referral for neurologic consultation depends on the physician’s experience and confidence. Children younger than three years infrequently have primary headache syndromes, and the complete neurologic examination, including visualization of the fundus oculi, can be difficult. These younger patients probably should be referred. Children with acute evolution of headache accompanied by focal neurologic symptoms or signs (i.e., morning vomiting, headaches that awaken the patient) should be referred, and neuroimaging should be performed. Children or adolescents with chronic-progressive headaches, a pattern associated with increasing intracranial pressure, also should be referred.

• #1 Overview of diagnosis and management of paediatric headache. Part I: diagnosis | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1007/s10194-011-0297-5

  Both epidemiological and clinical studies have shown that most common causes of headaches in children and adolescents are migraine and TTH. […] The diagnosis of migraine rests mainly on clinical criteria, thus a correct evaluation begins with a thorough medical history followed by a complete physical and neurological examination including examination of the optic fundus. […] TTH may be hard to differentiate from migraine in children as some of the symptoms overlap. […] The diagnosis of TTH requires exclusion of secondary headaches. […] Secondary headaches are also called organic headaches by some clinicians. These headaches can be grouped in three different ways: aetiology, symptom complex and temporal presentation. […] Chronic headache is frequently seen in children and adolescents. […] Chronic headache has different expressions in children and adults; the different expressions may reflect several different aetiologies or a developmental continuum.

• #1 Assessment of acute headache in children – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/825

  Diagnosis of migraine with aura requires: A: At least 2 attacks fulfilling the criteria B and C. B: 1 or more of the following fully reversible aura symptoms: Visual; Sensory; Speech and/or language; Motor; Brainstem; Retinal. C: At least 3 of the following 6 characteristics: At least 1 aura symptom spreads gradually over 5 minutes; Two or more aura symptoms occur in succession; Each individual aura symptom lasts 5-60 minutes; At least 1 aura symptom is unilateral; At least 1 aura symptom is positive; The aura is accompanied, or followed within 60 minutes, by headache. D: Not attributable to another disorder.

• #1 Children and headaches: Red ­flags, triggers, and rescue treatments

  https://www.contemporarypediatrics.com/view/children-and-headaches-red-flags-triggers-and-rescue-treatments

  Once urgent headache etiologies are no longer of concern, the next objective is to distinguish between primary and secondary headaches. […] The diagnosis of primary headache is made primarily through identifying classic characteristics of the headache, as there are no confirmatory diagnostic tests. […] The diagnosis of episodic childhood migraine is adapted from adult migraine. It is defined as an episodic headache with 5 or more attacks that last 2 to 72 hours. […] Diagnosing episodic childhood tension-type headache requires 10 or more episodes lasting from 30 minutes to 7 days. […] Children and adolescents may present with both migraine and tension-type headaches, making it difficult to have separate treatment trials. […] The first step in headache treatment is to better characterize the headaches and triggers by keeping a headache diary documenting possible triggers, time of day, days per month, headache intensity, and response to treatment.

• #1 Headaches in children – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/headaches-in-children/symptoms-causes/syc-20352099

  Bumps and bruises can cause headaches. […] Stress and anxiety perhaps triggered by problems with peers, teachers or parents can play a role in children’s headaches. […] Headaches, particularly migraines, tend to run in families. […] A diary can help you determine what causes your child’s headaches. […] Your doctor may recommend preventive medication if the headaches are severe, occur daily and interfere with your child’s normal lifestyle.

• #1 Headaches in Children | Sutter Health

  https://www.sutterhealth.org/health/headaches-in-children

  Doctors who specialize in treating headaches can diagnose most headaches by performing a medical exam and asking questions that help them understand your childs headache pain, patterns and history. […] The exercise can reveal patterns and triggers, and also helps your doctor determine the headache type and which treatments are most likely to work. […] Headache care is a partnership between the doctor, patient and family, Dr. Cheyette says.

• #1 Headache

  https://www.rch.org.au/clinicalguide/guideline_index/headache/

  Children presenting with headache require careful assessment for red flag features, in order to detect serious underlying secondary causes […] Most children presenting with headache do not require investigations […] Investigations are not routinely indicated in children with headache presenting without red flag features on history or examination […] If red flags present, discuss with a senior clinician and consider intracranial imaging.

• #1 Headache – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/headache/

  For secondary headaches, it is most important to treat the problem causing the headache. For example, if the headache is caused by infection, then the infection needs to be treated. In the meantime, over-the-counter or prescription pain medicines can be used for the pain. […] Most headaches do not seriously affect a child’s function at school or play. Tension headaches usually affect function less than migraine headaches. But if either type of headache is very frequent or severe, it can start to cause problems. If untreated, this can eventually cause severe disability and affect the whole family. […] This is why it is important to work with a child’s doctor to come up with an effective treatment plan as soon as possible. Headaches can become more difficult to control the longer they go untreated. In addition, studies have shown that early treatment leads to a better lifelong outcome.

• #2 Headaches in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0215/p625.html

  Headaches are common during childhood and become more common and increase in frequency during adolescence. The rational, cost-effective evaluation of children with headache begins with a careful history. The first step is to identify the temporal pattern of the headacheacute, acute-recurrent, chronic-progressive, chronic-nonprogressive, or mixed. The next step is a physical and neurologic examination focusing on the optic disc, eye movements, motor asymmetry, coordination, and reflexes. Neuroimaging is not routinely warranted in the evaluation of childhood headache and should be reserved for use in children with chronic-progressive patterns or abnormalities on neurologic examination. Once the headache diagnosis is established, management must be based on the frequency and severity of headache and the impact on the patient’s lifestyle. Treatment of childhood migraine includes the intermittent use of oral analgesics and antiemetics and, occasionally, daily prophylactic agents. Often, the most important therapeutic intervention is confident reassurance about the absence of serious underlying neurologic disease.

• #2 Overview of diagnosis and management of paediatric headache. Part I: diagnosis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3056001/

  Headache is the most common somatic complaint in children and adolescents. The evaluation should include detailed history of children and adolescents completed by detailed general and neurological examinations. […] A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment. The evaluation should include detailed history of children and adolescents (including parent and teacher observations, observations of child-carer, family relationships, medical history of children and parents) and completed by detailed general and neurological examinations. […] The history determines the correct diagnosis, so questions need to be directed to both the child and parents. The following questions should be included: Do you have one or more types of headache? How did the headaches begin? When did the headaches begin? Are the headaches progressive, staying the same or improving?

• #2 Headaches in Children – Stanford Medicine Children’s Health

  https://www.stanfordchildrens.org/en/topic/default?id=headaches-in-children-90-P02603

  Your child may be asked questions, such as: When do headaches happen? What do they feel like? Where is the pain? How long does the pain last? […] If a more serious condition is suspected, your child may also have tests, such as: MRI. This test uses large magnets and a computer to make detailed images of organs and tissues in the body. […] Your child may have an MRI or a CT scan to help diagnose what may be causing a headache.

• #2 Overview of diagnosis and management of paediatric headache. Part I: diagnosis | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1007/s10194-011-0297-5

  The examiners should keep in mind the tentative diagnosis and substantiate their clinical impression while performing general examination. […] A complete neurological examination should be performed focussing particularly on level of consciousness, meningeal signs, visual disturbances, focal neurological deficits, disorders of coordination, gait and speech, auditory disorders, measurement of head circumstances, localised tenderness of scalp or any body areas. […] The choice of laboratory tests rests on the differential diagnosis suggested by the history, the character and temporal pattern of the headache, and the physical and neurological examinations. […] In children and adolescents, the abrupt onset of severe headache is most frequently caused by upper respiratory tract infection with fever, by sinusitis or by migraine.

• #2 Headache – Child Neurology Foundation

  https://www.childneurologyfoundation.org/disorder/headache/

  A pediatric examination for headaches should include: General physical examination. During this exam, the head and neck will be carefully checked for signs and symptoms of infection. The doctor will look for otitis media, tooth abscess, acute pharyngitis, and more. The doctor will also look carefully at vital signs to check for high blood pressure. The general physical exam can help determine if the headache is primary or secondary. […] A pediatric exam for headache might occasionally include: Blood tests. Blood tests are usually not needed. However, if a child has frequent headaches, it can help to check blood vitamin levels. If they are low, taking certain vitamin supplements can help prevent headaches. […] Imaging is usually not needed. However, in some cases, a doctor may recommend it. This might be because the child is too young to describe the headaches well. Or it might be that the symptoms suggest a structural or more serious cause of headache (secondary headache).

• #2 Pediatric Headaches: Red Flags, Causes, Treatment, and More

  https://www.healthline.com/health/pediatric-headache-red-flags

  Mommy, my head hurts! Your stomach may drop when you hear your child say these words. Is it a simple headache? Could it be something more? The answer to these questions is maybe and possibly. […] Familiarizing yourself with symptoms of different types of headaches, their frequency, and certain red flags may help you understand whats wrong and when you might need to see your childs doctor. […] First, the good news: Most headaches or primary headaches are not necessarily serious. However, sometimes headaches may be a sign of another issue that needs immediate attention. These are called secondary headaches because they result from other conditions and their effects on the head. […] Contact your pediatrician if any of the following apply: Your child has hit their head or had a recent fall. This may mean they have a concussion or some other injury leading to pressure in their head that needs to be checked out. Your child has a stiff neck or fever. These may be signs of meningitis, which is inflammation of certain membranes that surround the brain and spinal cord. Your childs pain isnt responding to over-the-counter (OTC) pain relievers. Very severe or sudden-onset pain is worth taking your child to the emergency room or at least calling the pediatrician. Your child is lethargic or acting off. The same goes with a headache where your child is also acting unusual. Your child is vomiting without other signs of illness. Vomiting may be a sign of increased intracranial pressure. This can be caused by a number of things, like injury, arachnoid cysts, hydrocephalus, or tumors. Your childs headache woke them out of sleep. If the pain wakes your little one from their slumber, it may be pretty severe and out of the norm for standard headaches. Your child has a headache as soon as they wake up in the morning. This might also be a sign of increased intracranial pressure. Your childs pain gets worse when they lie down. Pressure or pain in the head when lying down is another possible sign of increased intracranial pressure. Your childs headaches happen more than twice a week. Frequent headaches or headaches that regularly interfere with play, school, or other aspects of life are also worth bringing up to your pediatrician.

• #2 Children and headaches: Red ­flags, triggers, and rescue treatments

  https://www.contemporarypediatrics.com/view/children-and-headaches-red-flags-triggers-and-rescue-treatments

  Headaches are common in children, but not all headaches are the same. This article offers a review of triggers and treatments. […] Headaches are 1 of the top 5 health problems of childhood. Because 58.4% of children and adolescents aged 1 month or older will develop headaches at some point, general pediatric practitioners may have many opportunities to evaluate and treat patients with headaches. […] Many conditions can present initially with headache, so it is important to have a list of red flag risk factors, symptoms, and exam findings to keep in mind during the initial assessment. […] Red flag symptoms include new ( 1 month) or quickly worsening headache type, focal and sidelocked headache, headache maximal at onset (thunderclap headache), infectious symptoms (eg, fever, meningismus, sinus or ear pain), or pressure-dependent features (eg, positional headache), headache worse in the middle of the night or first thing in the morning, headaches triggered by cough or Valsalva maneuvers, vomiting that is persistent and increasing in frequency.

• #2 Overview of diagnosis and management of paediatric headache. Part I: diagnosis | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1007/s10194-011-0297-5

  Both epidemiological and clinical studies have shown that most common causes of headaches in children and adolescents are migraine and TTH. […] The diagnosis of migraine rests mainly on clinical criteria, thus a correct evaluation begins with a thorough medical history followed by a complete physical and neurological examination including examination of the optic fundus. […] TTH may be hard to differentiate from migraine in children as some of the symptoms overlap. […] The diagnosis of TTH requires exclusion of secondary headaches. […] Secondary headaches are also called organic headaches by some clinicians. These headaches can be grouped in three different ways: aetiology, symptom complex and temporal presentation. […] Chronic headache is frequently seen in children and adolescents. […] Chronic headache has different expressions in children and adults; the different expressions may reflect several different aetiologies or a developmental continuum.

• #2 Migraine headache in children – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/678

  Migraine is a common neurologic disorder that often starts in childhood and teenage years, and leads to significant morbidity, emergency department visits, and school absenteeism. […] The diagnosis remains clinical, based on a suggestive history and a normal neurologic exam. When evaluating a child or adolescent with a headache, carefully considering differential diagnoses is essential to rule out serious causes. […] The IHS diagnostic criteria for pediatric headache are limited because they rely on patient descriptions of symptoms, whereas in practice, many migraine-defining features (e.g., light or noise intolerance) are inferred from child behavior rather than reported. […] Key diagnostic factors include severe episodic headache, nausea and vomiting, light and noise sensitivity, functional impact, aura symptoms, and throbbing character. […] 1st tests to order include clinical diagnosis. […] Tests to consider include brain MRI, electroencephalogram, lumbar puncture, erythrocyte sedimentation rate (ESR) and CRP, and head CT.

• #2 Kids’ Headaches: The Diagnosis Is Difficult

  https://lcmchealth.staywellsolutionsonline.com/Library/DiseasesConditions/Pediatric/NormalNewborn/1,615

  Tension-type headache. This is the most common type of headache in children. The most likely causes are emotional upsets or stress. […] Tension headaches are almost always linked to stressful situations at school, competition, family friction, or too many demands by parents. The healthcare provider needs to also find out whether anxiety or depression may be present. […] Migraine headaches. A migraine headache is sometimes one-sided and throbbing. It sometimes occurs with nausea and vomiting, or sensitivity to light, noise, or both. […] The younger the child, the harder it is to make the diagnosis of migraine headaches. […] It’s important to realize that a migraine headache may happen after a head injury. […] Migraine headaches are treated in two ways. Medicines can be used to stop an acute migraine headache. Other medicines can be used to prevent frequently occurring headaches.

• #2 Frontiers | Management of Childhood Headache in the Emergency Department. Review of the Literature

  https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2019.00886/full

  In evaluating a child or adolescent who is being treated for headache, physicians should consider using appropriate diagnostic tests. Diagnostic tests are varied, and include routine laboratory analysis, cerebral spinal fluid examination, electroencephalography, and computerized tomography or magnetic resonance neuroimaging. […] The management of headache in the ED depends on the patient’s general conditions and the presumable cause of the headache. […] The incidence of headache is variable according with age (3–8% of children aged 3 years, 19.5% of children aged 5, and 37–51.5% of children aged 7). […] Differential diagnosis of pediatric headache in the ED includes a variety of benign causes and viral infections, sinusitis, migraine, and post-traumatic headaches are the most common diagnoses.

• #2 Pediatric Headache Workup: Approach Considerations, Laboratory Studies, Lumbar Puncture

  https://emedicine.medscape.com/article/2110861-workup

  In the case of migraine or tension headache, a thorough history and physical examination is usually all that is needed. Laboratory, radiologic, or encephalographic studies are not useful to confirm the diagnosis of migraine but may help to exclude other causes of headache. […] Although imaging studies are not needed for every child who complains of headache, neuroimaging should be performed when the caregiver has any suspicion or concern that the headache may have a structural etiology. […] If a patient has had headaches for a long time (months to years) and the neurologic examination is normal, the likelihood of this patient harboring any serious intracranial pathology is minimal, and, therefore, neuroimaging studies should not be performed routinely. […] Electroencephalography is useful to assess the status of an underlying seizure disorder associated with headache.

• #2

  https://link.springer.com/article/10.1007/s11916-018-0675-7

  Certain warning signs warrant neuroimaging, but others only warrant imaging in certain clinical contexts. Brain MRI is the neuroimaging modality of choice, though there is a high rate of incidental findings and often does not change headache management. […] The contribution of brain MRI in the diagnosis and management of the children with headache is low.

• #2 Pediatric Headache Workup: Approach Considerations, Laboratory Studies, Lumbar Puncture

  https://emedicine.medscape.com/article/2110861-workup

  Neuroimaging (eg, computed tomography [CT] scanning, MRI) usually is not indicated for the routine care of patients with headache except possibly in the very young child and if absolutely no family history can be found despite thorough review. […] If the baseline neurologic examination changes, neuroimaging should be considered. Neuroimaging is also warranted, despite normal baseline examination findings, if a patients first seizure is coincident with a headache, to exclude the possibility of an intracranial mass. […] Diagnosis of sinus headache may be made by sinus radiographs depicting air-fluid levels in the sinuses. However, this test is not sensitive, and false-negative results are common. […] A CT brain scan with contrast can define most structural lesions. […] CT scanning is the best initial study to demonstrate intracranial hemorrhage from malignant hypertension or vascular lesions. […] CT scan findings may be normal or may show slit-like ventricles in patients with benign intracranial hypertension (pseudotumor cerebri). […] All patients who present with any features of a structural headache should undergo high-quality imaging, preferably an MRI scan with gadolinium enhancement.

• #2 Pediatric Headache Red Flags and When to Seek Treatment

  https://www.verywellhealth.com/pediatric-headaches-red-flags-5198191

  To diagnose pediatric headaches, your child’s provider will take a medical history, do a physical exam, and possibly run some diagnostic tests. […] Your answers to these questions may match up with the typical signs and symptoms of a migraine or tension-type headaches. If your provider does a neurological exam on your child and it is normal, they may not do any more tests. […] Other tests that can be used to diagnose pediatric headaches include: Blood tests: Checking the levels of certain nutrients in the body, such as iron or ferritin (a blood protein that carries iron), as well as the function of the thyroid (a gland at the base of the neck that makes hormones) can help your child’s provider figure out what could be causing their headaches. They can also run a complete blood count to get a better picture of your child’s overall health. Brain scans: Magnetic resonance imaging (MRI) or computed tomography (CT) scans take pictures of your child’s brain. The images can help your child’s provider spot any abnormalities that could be causing headaches. Polysomnogram: Not getting enough sleep or getting poor sleep can trigger headaches. Your child may have a test in a sleep lab that records their breathing and muscle movements as they sleep. A polysomnogram might be done if your child’s provider thinks they could have a sleep disorder such as sleep apnea (which causes breathing to repeatedly stop and start during sleep). […] If your child is getting headaches from an underlying health condition, treating that condition will often help relieve their headache pain.

• #2 Headaches in Children and Adolescents | AAFP

  https://www.aafp.org/pubs/afp/issues/2002/0215/p625.html

  Lumbar puncture to identify bacterial or viral meningitis is mandatory in a febrile patient with headache with nuchal rigidity and no alteration of consciousness, signs of increased intracranial pressure, or lateralizing features. […] Referral for neurologic consultation depends on the physician’s experience and confidence. Children younger than three years infrequently have primary headache syndromes, and the complete neurologic examination, including visualization of the fundus oculi, can be difficult. These younger patients probably should be referred. Children with acute evolution of headache accompanied by focal neurologic symptoms or signs (i.e., morning vomiting, headaches that awaken the patient) should be referred, and neuroimaging should be performed. Children or adolescents with chronic-progressive headaches, a pattern associated with increasing intracranial pressure, also should be referred.

• #2 Phenotypes May Aid Diagnosis and Treatment of Pediatric Headache – Neurology Advisor

  https://www.neurologyadvisor.com/features/pediatric-headache-phenotypes-used-to-aid-headache-diagnosis-and-treatment/

  Headaches in children are among the most frequent complaints leading to pediatric office and urgent care visits. According to a 2015 editorial in Headache by Andrew D. Hershey, MD, PhD, FAAN, FAHS, director of neurology at the Headache Center at Cincinnati Childrens Hospital Medical Center in Ohio, as many as 75% of children will experience a notable headache by the time they are teenagers. […] The headache phenotypes in children differ from adults, reflecting growth activity of the brain during childhood and adolescence. Evaluation of the variations in temporal patterns in children may be useful for headache diagnosis, especially since children are often unable to clearly describe what their pain feels like or where it comes from. It is essential to include the child in the description of their headaches as parents may introduce their own headache bias, Dr Hershey told Neurology Advisor.

• #2 Children and headaches: Red ­flags, triggers, and rescue treatments

  https://www.contemporarypediatrics.com/view/children-and-headaches-red-flags-triggers-and-rescue-treatments

  If headaches continue to be troublesome despite lifestyle management, good rescue therapy, and a sustained trial of nutraceuticals, it is reasonable to consider pharmacologic preventatives. […] Instances in which consultation with a neurologist could be helpful would include headaches that are severe, prolonged, or intractable. […] After excluding dangerous causes, it is important to provide the patient and caregiver with a plan for headache management that includes education on lifestyle management, rescue plan, and preventive measures.

• #2 Migraine Headache in Childhood – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK557813/

  Migraine is the most frequent primary headache disorder in children and adolescents. The diagnosis of migraine in children and adolescents remains a clinical diagnosis. The clinician must obtain a detailed and comprehensive headache history that focuses on the pain’s location, quality, severity, and duration. […] Acute treatment recommendations for children include using over-the-counter analgesics and triptan medications approved by the US Food and Drug Administration. Preventive treatment strategies involve lifestyle modifications, behavioral approaches, and consideration of preventive medications with the lowest side effect profiles. […] The most common symptom in children is headache; therefore, a detailed history and a thorough physical examination are vital in diagnosing. The patient must have at least 5 attacks that fulfill the criteria of migraine, which include duration of at least an hour to 72 hours, unilateral location, pulsating quality, moderate to severe in intensity, aggravated by activity, and at least 1 of the following: nausea or vomiting or photophobia and photophobia.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Pediatric-Migraine-e28093-Diagnosis-and-Treatment.aspx

  The management of pediatric migraines is primarily focussed on acute/ chronic therapy and preventive treatment in known cases. […] In chronic cases, which are defined as 15 or more days with headache per month over three months, management should be tailored to focus on prevention. […] Simple adjustments to lifestyle to avoid migraine triggers are crucial in the management of pediatric migraines.

• #2 Children and headaches: Red ­flags, triggers, and rescue treatments

  https://www.contemporarypediatrics.com/view/children-and-headaches-red-flags-triggers-and-rescue-treatments

  Once urgent headache etiologies are no longer of concern, the next objective is to distinguish between primary and secondary headaches. […] The diagnosis of primary headache is made primarily through identifying classic characteristics of the headache, as there are no confirmatory diagnostic tests. […] The diagnosis of episodic childhood migraine is adapted from adult migraine. It is defined as an episodic headache with 5 or more attacks that last 2 to 72 hours. […] Diagnosing episodic childhood tension-type headache requires 10 or more episodes lasting from 30 minutes to 7 days. […] Children and adolescents may present with both migraine and tension-type headaches, making it difficult to have separate treatment trials. […] The first step in headache treatment is to better characterize the headaches and triggers by keeping a headache diary documenting possible triggers, time of day, days per month, headache intensity, and response to treatment.

• #2

  https://healthychildren.org/English/health-issues/conditions/head-neck-nervous-system/Pages/Headaches-When-to-Call-the-Pediatrician.aspx

  „My head hurts.” Across the U.S., parents hear this complaint from their children and teenagers at a rate so frequent that it can be hard to know whether it is, in fact, a painful headache (or just an excuse to stay home from school). […] While most headaches are harmless and go away within a few hours, recurrent headaches of any type can cause school problems, behavioral problems, and/or depression. In this article, learn when to involve your pediatrician. It’s important to know when headaches may be a symptom of something more serious. […] A detailed history and physical exam help your pediatrician figure out what kind of headache your child has. Based on your child’s diagnosis, your pediatrician will create a plan with you on how to best relieve your child’s pain. […] Imaging of the brain, blood tests and invasive procedures are NOT required to diagnose headaches. In some cases, brain imaging or a lumbar puncture is needed if a more serious condition is suspected. If necessary, the pediatrician will discuss what further tests are needed and why. The pediatrician may also recommend that your child see a pediatric neurologist who can help provide further recommendations for your child’s headache. […] But, be sure to call your pediatrician any time you have concerns about your child’s headache pain.

• #2

  https://link.springer.com/article/10.1007/s11916-018-0675-7

  Headache phenotypes can differ between adults and children. While most headaches are due to primary headache disorders, in a small population, they can be an indication of a potentially life-threatening neurologic condition. The challenge lies in identifying warning signs that warrant further workup. […] A stepwise approach is essential to avoid missing secondary headaches. There are several differences between adults and children in clinical manifestations of headache. Evaluation and diagnosis of pediatric headache starts with a thorough headache and medical history, family and social history, and identification of risk factors. A thorough physical and neurologic exam is important, with close attention to features that could suggest secondary headache pathology. Neuroimaging and other testing should only be performed if there is concern for secondary headache.

• #2 Headaches in Children: Causes, Types & Pain Relief

  https://my.clevelandclinic.org/health/diseases/4225-headaches-in-children

  When treating headaches in children, healthcare providers keep the following in mind: The age of your child. The type of headache. How often the headaches happen. The cause of your childs headache. […] Your healthcare provider may teach your child about certain headache triggers. […] Avoiding triggers and taking preventative medications can help reduce the risk of headaches. […] Headaches can affect your child in several ways. They can reduce their quality of life at school and home. […] As your child grows, headaches may disappear. But they may return later in life. […] When your child has more than the occasional headache. […] Remember, its not uncommon for a child to have headaches.

• #2 Childrens Headache Disorders | National Headache Foundation

  https://headaches.org/resources/childrens-headache-disorders/

  Determining the cause and type of headache can be challenging even to an experienced physician. […] In order to develop an accurate diagnosis, the evaluation process should include a very detailed history from the child and parents, a thorough physical examination, and a complete neurological examination. […] If the symptoms persist, or are not adequately handled through medication or treatment without medication, then you should consider consulting a specialist. […] When children experience chronic headaches, it affects them at home and in school. Their success in life depends not only on a correct diagnosis and effective treatment but also on understanding responses from parents, educators and school health care professionals.

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