Differential Diagnosis for Headaches in a 5-year-old with a Family History of Migraines

• Single most likely diagnosis:
  • Migraines: Given the family history of migraines, it's plausible that the child could be experiencing migraines as well. Migraines can start at any age, including childhood, and often have a familial component.
• Other Likely diagnoses:
  • Tension headaches: These are common in children and can be triggered by stress, fatigue, or even minor head trauma.
  • Viral infections: Many viral infections can cause headaches in children, such as the common cold, flu, or sinus infections.
  • Allergies: Seasonal allergies or allergic reactions can lead to sinus pressure and headaches.
  • Refractive errors: Uncorrected vision problems can cause eye strain leading to headaches.
• Do Not Miss diagnoses:
  • Brain tumors: Although rare, brain tumors can cause headaches, especially if they increase intracranial pressure. Early detection is crucial.
  • Meningitis: An infection of the meninges, which can present with headache, fever, and stiff neck.
  • Encephalitis: Inflammation of the brain, usually due to viral infections, which can cause severe headaches among other symptoms.
  • Subarachnoid hemorrhage: Bleeding into the space surrounding the brain, which is a medical emergency.
  • Hydrocephalus: Accumulation of fluid in the brain, leading to increased intracranial pressure.
• Rare diagnoses:
  • Pseudotumor cerebri (Idiopathic Intracranial Hypertension): Increased pressure within the skull without any apparent cause, which can lead to headaches and vision changes.
  • Arteriovenous malformations (AVMs): Abnormal connections between arteries and veins in the brain, which can cause headaches and other neurological symptoms.
  • Chiari malformation: A structural defect in the cerebellum that controls balance, which can cause headaches, among other symptoms, due to increased intracranial pressure.