Headache
Abdullah Al-Anazi
Introduction
60-70% of children experience headache by the age of 7-9 years
Relatively unusual presentation in pediatric patients as an isolated complaint (0.7% to 1.3% of visits)
Essential to rule out life-threatening causes
Laboratory test and imaging modalities are rarely needed
History
Mode of onset, pattern, duration, frequency, and location of headache
Abrupt onset with extreme pain: consider rupture of AV malformation
Occipital location: consider posterior fossa tumor
Severity of pain, exacerbating and relieving factors
Headache that worsens with bending over or coughing: consider sinusitis or raised intracranial pressure
Time and circumstances of headache
Early morning headache or one that awakens a child from sleep: consider brain tumor or increased intracranial pressure
Associated symptoms (fever, vomiting, neck pain, photophobia, visual change, etc.)
Vomiting is the most commonly associated symptom in patients with intracranial pathology (present in 74%)
Analgesia and response to therapy
Any change from previous headache pattern
Recent or remote trauma
Exposure to medication or toxin
Preexisting medical problems (VP shunt, malignancy, hematologic disease)
Psychosocial history
Family history of headaches or migraine
Examination
Appearance (sick or well looking)
Vital signs including blood pressure and temperature
General physical exam, including sinus or dental tenderness, nuchal rigidity, lymphadenopathy, heart murmurs, cutaneous lesions, cranial bruits, and visual acuity
Complete neurological examination
Clinical Classification
Based on temporal pattern of headache
Five patterns: acute, acute recurrent, chronic progressive, chronic nonprogressive, and mixed pattern
Acute Headache
Single episode without prior history
Usually secondary to an upper respiratory febrile illness (e.g., URTI, sinusitis, otitis media)
In toxic-appearing patient with fever: consider meningitis (look for signs of meningeal irritation)
Suspect subarachnoid hemorrhage if sudden onset and very severe headache
Acute Recurrent Headache
Recurrent episodes of headache with symptom-free intervals
Differential includes migraine and its variants, tension headache, cluster headache, and neuralgia
Migraine Headache
Most prevalent form is migraine without aura (common migraine)
Diagnostic criteria using International Headache Society classification:Related posts:
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