What are the most common etiologies of cephalalgia (headache) in pediatric patients?

From the Guidelines

The most common etiologies of cephalalgia (headache) in pediatric patients are tension-type headaches, migraines, viral illnesses, dehydration, and stress, as evidenced by the most recent study 1. These conditions typically present with distinct symptoms, such as mild to moderate pain in tension-type headaches, and moderate to severe throbbing pain in migraines, often accompanied by nausea, sensitivity to light and sound, and sometimes vomiting. The prevalence of headaches in children increases with age, ranging from 37% to 51% for children 7 years of age and gradually increasing to 57% to 82% by 15 years of age, as reported in a study by 1. Some key points to consider in the diagnosis and management of headaches in pediatric patients include:

• Tension-type headaches typically present as mild to moderate pain that feels like pressure around the head
• Migraines cause moderate to severe throbbing pain often accompanied by nausea, sensitivity to light and sound, and sometimes vomiting
• Viral illnesses frequently cause headaches as part of general symptoms
• Dehydration headaches develop when children don't drink enough fluids, especially during physical activity or hot weather
• Stress-related headaches often occur during school pressures or family changes
• Other causes include sinus infections, vision problems requiring glasses, concussions, medication side effects, and rarely, more serious conditions like brain tumors or meningitis
• Treatment typically involves rest, adequate hydration, and appropriate doses of acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6-8 hours) for pain relief, as recommended in a study by 1
• Warning signs requiring immediate medical attention include severe headaches that wake a child from sleep, early morning vomiting, headaches that worsen with position changes, or headaches accompanied by neurological symptoms like confusion or weakness. It is essential to note that the evidence base for medication therapy in children and adolescents is confounded by a high placebo response in clinical trials, as mentioned in a study by 1. Therefore, a thorough medical history and physical examination are crucial in diagnosing and managing headaches in pediatric patients, as emphasized in a study by 1.

From the Research

Etiologies of Cephalalgia in Pediatric Patients

The most common etiologies of cephalalgia (headache) in pediatric patients can be categorized into primary and secondary headache types.

• Primary headache types include:
  • Migraine
  • Tension-type headache 2, 3
• Secondary headache causes are broad and include:
  • Infections
  • Trauma
  • Vascular disorders
  • Substance use/withdrawal
  • Psychiatric conditions 2
  • Structural problems (e.g., tumor, hydrocephalus, Chiari malformation)
  • Infection (encephalitis or meningitis)
  • Inflammatory (acute disseminated encephalomyelitis, multiple sclerosis, vasculitis)
  • Epilepsy 4

Specific Etiologies

Specific etiologies of headaches in pediatric patients include:

• Non-cranial infections (43.1%)
• Migraines (14.6%)
• Tension-type headaches (9.2%)
• Traumatic injury (8.1%)
• Sinusitis (5.4%)
• Serious causes (4.9%), with a predominance of tumors and infections of the central nervous system 5

Stress as a Trigger

Stress is considered to be the most common factor reported to trigger headaches in children and adolescents 6