From the Guidelines
Recurrent headaches in pediatric patients are most commonly caused by migraines, tension-type headaches, or secondary headaches from other medical conditions, and diagnosis is primarily based on medical history, with criteria slightly different from those for adults. The clinical features of migraine in children and adolescents differ somewhat from those in adults, with attacks often being shorter, headache more often bilateral and less often pulsating, and gastrointestinal disturbances commonly prominent 1. According to the International Headache Society, secondary headaches include those attributed to head and/or neck trauma, cranial or cervical vascular disorder, nonvascular intracranial disorder, a substance or its withdrawal, infection, a disorder of homeostasis, or psychiatric disorder 1.
Key Factors to Consider
- Recurrent headache of moderate to severe intensity
- Visual aura
- Family history of migraine
- Onset of symptoms at or around puberty 1
- Secondary headaches or facial pain can also be related to disorders of the cranium, neck, eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures 1
Diagnosis and Management
Diagnosis is primarily based on the medical history, although the criteria are slightly different from those for adults, with the duration of migraine attacks being 2 to 72 hours 1. Treatment typically begins with non-pharmacological approaches such as ensuring adequate hydration, regular sleep patterns, stress reduction techniques, and identifying potential triggers like certain foods, screen time, or environmental factors. For medication management, ibuprofen is recommended as first-line medication, at a dose appropriate for body weight 1.
Lifestyle Modifications
Lifestyle modifications are crucial for long-term management, including regular physical activity, balanced nutrition, and maintaining a headache diary to identify patterns and triggers. Parents should seek immediate medical attention if headaches are accompanied by neurological symptoms, persistent vomiting, or if they awaken the child from sleep, as these may indicate more serious conditions requiring urgent evaluation. It is essential to evaluate children suffering from persistent headaches by a pediatrician or pediatric neurologist to determine the underlying cause and develop an appropriate treatment plan.
From the Research
Causes of Recurrent Headache in Pediatric Patients
The causes of recurrent headache in pediatric patients can be categorized into primary and secondary etiologies.
- Primary headache types include:
- Migraine
- Tension-type headache 2
- Secondary headache causes are broad and include:
- Infections
- Trauma
- Vascular disorders
- Substance use/withdrawal
- Psychiatric conditions 2 Other factors that may contribute to recurrent headaches in children and adolescents include:
- Medication overuse 3
- Co-morbid sleep problems
- Autonomic dysfunction
- Anxiety
- Depression 3
- Psychosocial factors 4
Diagnosis and Evaluation
A thorough understanding of the approach to the pediatric headache patient is essential to ensure appropriate diagnosis, evaluation, and management 2.
- A detailed "headache history" is necessary to diagnose some life-threatening diseases that may have their initial presentation in this manner 5.
- Physical, neurological, and ophthalmologic examinations are also important in the evaluation of pediatric headaches 5.
- Neuroimaging studies may be indicated in some cases, but 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 of recurrent headaches in pediatric patients depends on the underlying cause and may include: