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Emergent evaluation of headache in children

Christopher King, MD, FACEP
Section Editors
Gary R Fleisher, MD
Marc C Patterson, MD, FRACP
Jan E Drutz, MD
Deputy Editor
James F Wiley, II, MD, MPH


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 [3].

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 [4]. 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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Literature review current through: Nov 2017. | This topic last updated: Oct 03, 2016.
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