34 - Headaches

Abstract

The most common primary headaches in children are migraine and tension-type headache. Trigeminal autonomic cephalgia, while much less common in children, is a third primary headache classification. Characteristics that aid in diagnosing primary or secondary headache disorders include laterality, location, timing, frequency (acute, acute recurrent, chronic nonprogressive, and chronic progressive), duration, quality, severity, associated symptoms, and alleviating and aggravating factors. History and physical examination findings consistent with primary headache disorders are reviewed, as are benign secondary causes of headache and red flags for more serious secondary headache sources that warrant neuroimaging or further investigation. Normal neuroimaging or a single normal physical examination does not provide complete reassurance; patients should be re-evaluated for changes in physical examination or the development of red-flag symptoms that warrant imaging or reimaging. The diagnosis of primary headache disorders and the following causes of secondary headache are presented: those caused by trauma, intracranial disorders (both vascular and nonvascular), substances, infection, extracranial structures, homeostasis alterations, and psychologic factors.