Headache in childhood.

Abstract

1. Rob Forsyth, MD* 2. Kevin Farrell, MD* 1. 2. *Division of Neurology, Department of Pediatrics, University of British Columbia; British Columbia Children’s Hospital, Vancouver, British Columbia, Canada. After completing this article, readers should be able to: 1. Describe what most parents who want help for a child who has a headache are seeking. 2. List the most common cause of severe headache in children. 3. Describe what tests must be performed prior to lumbar puncture in any patient who has a headache. 4. Determine common causes of chronic daily headache. Chronic or recurrent headache is common in children, occurring in approximately 40% of children by 7 years of age and 75% of children by 15 years. Most parents who seek help for a child who has headaches are looking for reassurance that the headache is not due to a serious cause. Pain referred to the head can arise from the following structures: 1) intracranial or extracranial arteries, large intracranial veins, or venous sinuses; 2) cranial or spinal nerves; 3) basal meninges; 4) cranial and cervical muscles; and 5) extra-cranial structures such as the nasal cavity and sinuses, teeth, mucous membranes, skin, and subcutaneous tissues. The brain, most of the meninges overlying the convexity, and the bony skull are not sensitive to pain. Pain arising from the cranial circulation and supratentorial structures travels primarily via the trigeminal nerve and is referred to the anterior part of the head. Pain arising from posterior fossa structures travels mainly via the first three cervical nerves, resulting in pain in the back of the head and neck as well as the forehead. The glossopharyngeal and vagal nerves innervate part of the posterior fossa, and pain is referred to the ear and throat. There are two major hypotheses regarding the pathogenesis of migraine. The vascular hypothesis proposes that vasoconstriction results in aura or focal neurologic signs and is followed by painful vasodilatation. The neurogenic hypothesis proposes that afferent inputs to the brainstem result in a slowly spreading …