Emergent evaluation of headache in children
- Christopher King, MD, FACEP
Christopher King, MD, FACEP
- Professor and Chair of Emergency Medicine
- Albany Medical College
- Section Editors
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Marc C Patterson, MD, FRACP
Marc C Patterson, MD, FRACP
- Section Editor — Pediatric Neurology
- Professor of Neurology, Pediatrics, and Medical Genetics
- Chair, Division of Child and Adolescent Neurology
- Mayo Clinic College of Medicine
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
This topic will review the emergent evaluation of children with headaches who do not have predisposing conditions.
Children with headaches who present nonurgently and those with well-established histories of migraine or tension-type headaches are discussed separately. (See "Headache in children: Approach to evaluation and general management strategies" and "Pathophysiology, clinical features, and diagnosis of migraine in children" and "Tension-type headache in children".)
Although headaches occur frequently among children, most do not seek medical attention [1,2]. Caretakers may bring children to the emergency department or primary care provider for headaches that are more severe or have not responded to nonprescription medications. In one retrospective series from a busy children's hospital emergency department, 1 percent of visits were for a chief complaint of headache .
The terms "primary" and "secondary" may be used to describe headaches. Primary headaches (ie, migraine, tension-type, or cluster headaches) are typically self-limited and diagnosed based on symptom profiles and patterns of headache attacks. Secondary headaches have identifiable etiologies. Although the vast majority of secondary headaches in children have benign etiologies (ie, viral infections), the goal of the emergent evaluation of children with headaches is to identify as a first priority those with serious or life-threatening causes . In most patients, this task can be accomplished with a careful history and physical examination and occasional selected ancillary testing.
Headache can be the symptom of life-threatening complications for children with various underlying conditions (ie, those with immunodeficiencies who develop opportunistic infections or patients with ventriculoperitoneal shunts that malfunction causing obstruction) (see "Hydrocephalus in children: Management and prognosis", section on 'Complications'). Evaluation of headache in these children (which is often guided by specific protocols that include neuroimaging and consultation with a specialist) will not be discussed here.
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- Life-threatening conditions
- - Infection
- - Tumor
- - Intracranial hemorrhage
- - Carbon monoxide poisoning
- - Hypertension
- Common conditions
- - Infection
- - Migraine
- - Tension-type headache
- Other conditions
- - Temporomandibular joint dysfunction
- - Idiopathic intracranial hypertension
- - Cluster headaches
- - Headache characteristics
- - Associated symptoms
- - Past medical history
- Physical examination
- Neurologic examination
- Ancillary studies
- - Neuroimaging
- - Lumbar puncture
- - Blood testing
- ALGORITHMIC APPROACH
- History of chronic or recurrent headaches
- Normal neurologic examination
- - Fever
- - No fever
- Focal neurologic examination
- - CT scan abnormal
- - CT scan normal
- INFORMATION FOR PATIENTS