Headache in Children.

Abstract

1. Jessica Klein, MD* 2. Thomas Koch, MD* 1. *Division of Pediatric Neurology, Medical University of South Carolina, Charleston, SC * Abbreviations: ICHD-3: : third edition of the International Classification of Headache Disorders IV: : intravenous MRA: : magnetic resonance angiography MRI: : magnetic resonance imaging MRV: : magnetic resonance venography NSAID: : nonsteroidal anti-inflammatory drug OTC: : over-the-counter PedMIDAS: : Pediatric Migraine Disability Assessment Headache is a common complaint in children and adolescents. Although an efficient, organized, and methodical approach to the patient’s history and physical examination is essential, many practitioners are not familiar with a best practices approach to headache. This can result in difficulty with decision making regarding further testing, such as brain imaging, as well as treatment options. After completing this article, readers should be able to: 1. Recognize key elements of the history and physical examination associated with headaches of various etiologies. 2. Understand the role of neuroimaging in the evaluation of headache in children. 3. Describe the appropriate management of headaches and the roles of abortive therapy and preventive therapy in patients with recurrent headaches. Headache is a common complaint in children and adolescents and many times leads to much anxiety for the practitioner and the parents. Therefore, it is important for providers to understand the approach to evaluation of headache. A thorough headache history and a focused neurologic examination are critical and, in most situations, allow the provider to distinguish between primary headache disorders (eg, migraine, tension, or chronic daily headache) and secondary headache disorders (eg, those seen with brain tumors, pseudotumor cerebri syndrome, chronic meningitis, hydrocephalus, hypertension, or acute febrile illnesses). The performance of ancillary diagnostic testing depends on information obtained during data collection. (1) The initial approach to the patient with headache begins with a focused set of headache-based questions (Table 1). (2) The answers to these questions allow the provider to begin to distinguish between features characteristic of a primary headache disorder and those …