Headache in childhood

Primary:

– Tension Type

– Migraine

– Cluster headache

– other

Secondary:

– Tumour, IIH

– Meningitis / Encephalitis

– Blocked shunt

– Trauma

– Vascular/ Haemorrhage

– ENT, Eye causes etc

History:

– Onset (weeks or months)

– Duration of each episode (minutes, hours or days)

– Frequency of episodes (daily or infrequent)

– Location & type of pain

Pattern over time:

– Isolated acute headache e.g. illness

– Acute recurrent e.g Migraine/ tension

– Chronic Progressive e.g. raised ICP

– Chronic non-progressive

Any known triggers: dietary, hunger, stress, etc

Any associated symptoms: nausea, visual aura, pins & needles, weakness, etc

What helps to relieve headache?

Any psychosocial stress factors (at home or school)? Impact on daily activities, school days

Examination:

– ABC if acutely unwell

– Blood Pressure

– Meningism

– Signs of raised ICP

– ENT, Rashes

– Cranial N- incl Fundus, pupils

– Full Neurology- incl Gait, Co-ordination

– Systems exam

Red Flags in Headache:

– Age <4y

– Sudden severe ‘thunderclap’ headache

– New neurological deficit (diplopia, squint, ataxia, etc)

– Recent (<3m) head trauma

– Worsening headache with fever, photophobia

– Wakeing up with headache or Vomiting

– Worsened by cough or valsalva or lying down

– Headache in patient with malignancy or low immunity

Investigations to consider:

– Urgent CT / MRI Brain

– LP with opening pressure

– EEG?

– Bloods- ESR, FBC, Coagulation profile