What are the causes of headache in pediatric patients (children)?

From the Guidelines

Pediatric headaches should be managed with a combination of lifestyle modifications, non-pharmacological approaches, and medications when necessary, prioritizing ibuprofen as the first-line medication for acute treatment, as recommended by the most recent study 1.

Key Considerations

• The approach to pediatric headaches differs from adults due to developmental considerations, medication dosing based on weight, and different presentations of primary headache disorders in children.
• For acute treatment, ibuprofen is recommended as the first-line medication, at a dose appropriate for body weight, as stated in the study 1.
• Non-pharmacological approaches, such as maintaining regular sleep schedules, staying hydrated, practicing relaxation techniques, and avoiding identified triggers, are also essential in managing pediatric headaches.
• A headache diary can help identify patterns and triggers, allowing for more effective management.

Medication Management

• For children with frequent migraines, preventive therapy may be considered, including topiramate or amitriptyline, although their effectiveness in children and adolescents has not been proven in clinical trials, as noted in the study 1.
• The evidence base for medication therapy in children and adolescents is confounded by a high placebo response in clinical trials, making it essential to carefully evaluate treatment responses, as discussed in the study 1.

Imaging and Referral

• Imaging is usually not necessary for primary headaches in children, unless there are red flags or abnormal findings on physical examination, as recommended by the study 1.
• For severe, sudden, or headaches associated with neurological symptoms, immediate medical evaluation is necessary to rule out serious conditions like meningitis, intracranial hemorrhage, or tumors.
• Referral to specialist care may be indicated if acute medication provides insufficient pain relief or if there are concerns about the diagnosis or management, as stated in the study 1.

From the Research

Pediatric Headache Overview

• Headache is a common medical complaint in children and adolescents, with the majority having experienced some type of headache by their teenage years 2.
• Pediatric headache presentations often differ compared to adults, and children may have difficulty describing their symptoms 2.

Primary and Secondary Headache Types

• Common primary headache types include migraine or tension-type headache 2.
• Secondary headache causes are broad and include infections, trauma, vascular disorders, substance use/withdrawal, and psychiatric conditions 2.
• Primary headache disorders, such as migraine, tension-type headache, cluster headache, and other trigeminal autonomic cephalgias, are characterized by headache being the illness itself, not attributed to any other disorder 3.
• Secondary headache disorders, on the other hand, are characterized by headache being a symptom of an identifiable structural, metabolic, or other abnormality 3.

Diagnosis and Evaluation

• A thorough understanding of the approach to the pediatric headache patient is essential to ensure appropriate diagnosis, evaluation, and management 2.
• The evaluation should include a detailed history of children and adolescents, completed by detailed general and neurological examinations 3.
• 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 3.
• Red flags, such as the first or worst headache ever, recent headache onset, increasing severity or frequency, occipital location, and awakening from sleep because of headache, necessitate further workup 3, 4.
• Current American Academy of Neurology (AAN) guidelines recommend against routine lab studies, lumbar puncture, electro-encephalogram (EEG), or neuroimaging in patients with no headache red flags by history and a normal neurologic examination 2.

Treatment and Management

• Treatment modalities for pediatric headache include lifestyle modifications, behavioral techniques, and abortive and preventive medications 5.
• A holistic approach to the child presenting with headache, including a detailed headache history, physical and neurologic examinations, and diagnostic evaluation, is essential for effective management 5.
• Emerging therapies may alter the way we manage headache in the pediatric population 6.