Most Common Cause of Headache in Children
Migraine is the most common cause of headache in children presenting to medical care, accounting for approximately 55% of pediatric headache cases 1.
Evidence-Based Breakdown
The ACR Appropriateness Criteria (2018) provides clear epidemiological data from a study of 449 children with headache 1:
- Migraine: 55% (most common)
- Tension-type headache: 30% (second most common)
- Secondary headaches: 10%
- Unspecified: 5%
This distribution is consistently supported across multiple research studies. A 2010 study confirmed migraine as the most frequent cause of headache in pediatric neurology clinics (57.1% of all headache patients) 2, and a 2007 review explicitly states that "migraine is the most frequent cause of acute and recurrent headaches in children" 3.
Important Clinical Context
Age-Related Patterns
Headache prevalence increases with age 1:
- 37-51% in 7-year-olds
- 57-82% by age 15
- Prepubertal boys experience more headaches than girls
- After puberty, girls become more affected
Why the Answer is D (Migraine), Not A (Stress/Tension)
While tension-type headaches (which could be stress-related) represent 30% of cases, they are clearly second to migraine. The evidence consistently demonstrates migraine's predominance across multiple high-quality studies 1, 2, 3.
Other Options Are Less Common
- Sinusitis (C): Represents only a subset of the 10% secondary headache category. Notably, "sinus headache" is frequently a misdiagnosis in pediatric migraineurs—62% of pediatric migraine patients have cranial autonomic symptoms (like rhinorrhea) that mimic sinusitis 1.
- Myopia (B): Not mentioned as a significant cause in the evidence
- Increased intracranial pressure (E): Rare, accounting for <1% of cases with relevant imaging findings 1
Clinical Pitfall to Avoid
Do not mistake migraine with cranial autonomic symptoms for sinusitis. The trigeminal-autonomic reflex activation in pediatric migraine produces nasal symptoms that lead to frequent misdiagnosis as "sinus headache" 1. This is more common in children than adults.