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Headache Diagnosis in Children and Adolescents

  • Secondary Headache (M Robbins, Section Editor)
  • Published:
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Abstract

Purpose of Review

Headache phenotypes can differ between adults and children. While most headaches are due to primary headache disorders, in a small population, they can be an indication of a potentially life-threatening neurologic condition. The challenge lies in identifying warning signs that warrant further workup. This article reviews different types of pediatric headaches and headache evaluation in children and teens, and focuses on the approach for diagnosis of secondary headaches.

Recent Findings

Common thought is that increased frequency and severity of headache may reflect secondary pathology; however, headache phenotype may not be fully developed and can evolve in adolescence or adulthood. Headache location, particularly occipital headache alone, does not necessarily signify secondary intracranial pathology. Certain warning signs warrant neuroimaging, but others only warrant imaging in certain clinical contexts. Brain MRI is the neuroimaging modality of choice, though there is a high rate of incidental findings and often does not change headache management.

Summary

A stepwise approach is essential to avoid missing secondary headaches. There are several differences between adults and children in clinical manifestations of headache. Evaluation and diagnosis of pediatric headache starts with a thorough headache and medical history, family and social history, and identification of risk factors. A thorough physical and neurologic exam is important, with close attention to features that could suggest secondary headache pathology. Neuroimaging and other testing should only be performed if there is concern for secondary headache.

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Authors and Affiliations

  1. Department of Neurology, UCSF Child Neurology, 550 16th Street, 4th Floor, San Francisco, CA, 94158, USA

    Jasmin M. Dao & William Qubty

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  1. Jasmin M. Dao
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  2. William Qubty
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Correspondence to Jasmin M. Dao.

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Jasmin M. Dao and William Qubty declare no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Secondary Headache

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Dao, J.M., Qubty, W. Headache Diagnosis in Children and Adolescents. Curr Pain Headache Rep 22, 17 (2018). https://doi.org/10.1007/s11916-018-0675-7

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