Headache in Children

Question 1

What are the common causes of headaches in children?

Answer 1

1. Respiratory infections
2. Febrile illnesses
3. Other causes reflect the common causes in adults, such as:

• Psychogenic
• Migraine
• Meningitis
• Post-traumatic
• Tension or muscle contraction

Many childhood headaches are isolated but are chronic in a significant number.

Question 2

Pitfalls

Answer 2

Consider often overlooked causes such as;

1. Hair traction,
2. Eye strain (measure and record vision)
3. Hypoglycaemia:

Children who have long periods without regular eating are prone to headache including exacerbations of migraine.

They should not skip breakfast.

Question 3

Age consideration

Answer 3

Young children rarely experience sinus headache.

• The sinuses develop, around 5 years for the frontal sinuses.

Migraine is relatively common before adolescence

• From 1% of children aged 7 years to 5% or more of children aged 15 years suffer from migraine, with girls developing it at a higher rate with increasing age.

Tension or muscle contraction headache is more common after adolescence.

Question 4

Migraine

Answer 4

here is a strong family history.

As a rule the prognosis is good as the majority will have no migraines in the long term.

The type is mainly common migraine with symptoms such as malaise or nausea:

Classic migraine with the typical aura is not a feature of childhood migraine.

The rather dramatic migraine, such as vertebrobasilar migraine, is frequent in adolescent girls and hemiplegia occurs in infants and children, especially with their first migraine attack.

Vomiting is not necessarily an associated symptom in children

Question 5

Red flags

Answer 5

The possibility of cerebral space-occupying lesions requires due consideration, especially if the headaches are progressive.

These present typically in the morning and are associated with:

• vomiting
• dizziness
• diplopia
• ataxia
• personality changes and deterioration of school performance

Neonates and children aged 6–12 months are at the greatest risk from meningitis

Question 6

Pointers to a cerebral tumour or serious causes of headache in children

Answer 6

• Headache features
• Persistent or recurrent
• Present first thing in morning
• Wakes child at night
• No past history
• No family history
• Associated poor health
• Associated neurological symptoms
• Unilateral localisation

Question 7

Management

Answer 7

Management of the non-serious causes of headache includes:

Reassurance (especially of parents)

Discouragement of excessive emphasis on the symptom

Simple medications

Patients with undiagnosed and/or problematic headache should be referred.

Question 8

Pharmacological Rx for tension headache and migraine

Answer 8

Paracetamol 20 mg/kg (o) statim then 15 mg/kg 4–6 hourly up to 90 mg/kg/day (max. 4 g daily)

or Ibuprofen 5–10 mg/kg (o) statim up to 40 mg/kg/ day (not for children <6 months)

or Aspirin for the adolescent.