An approach to the child with headaches

Types of headache in children are reviewed. In young children, migraine and its variants account for most of the cases of headaches referred to the child neurologist. Differentiating migraine, particularly when associated with transient neurological deficits, from seizure disorders is discussed with emphasis on clinical rather than laboratory criteria. The issue of posttraumatic headaches in young children is reviewed. Criteria differentiating headache associated with brain tumors or increased intracranial pressure, or both from more benign headache syndromes are presented with an emphasis again on clinical criteria, particularly the presence or absence of associated neurological deficits. Criteria for neuroimaging and other laboratory evaluations are presented. These should be needed in only a small minority of patients. Treatment should emphasize reassurance, prevention of trigger factors and mild analgesics. In older children biofeedback is often helpful. When more intensive pharmacotherapy is needed, emphasis is placed on prophylactic agents such as propranolol and amitriptyline. The long-term prognosis is favorable in the majority of cases.