Evaluation of headaches

This article aims to provide a practical guide to the common causes of headache and their assessment in children. Contrary to popular belief, headaches are very common in children. The primary headache disorders, which include migraine and tension-type headache, account for the majority of headaches, while secondary headache, that is those with underlying pathology, are much less common. A thorough history and examination is the key to determining the cause and should be the most important means of reassuring the child and family that there is no serious cause for the headaches. To manage childhood headache you need to be able to distinguish the painful from the harmful, and therefore must recognize the common headache patterns and the signs and symptoms that may indicate serious intracranial disease. Most non-acute headaches do not need further investigation. Neuroimaging is rarely necessary. Recurrent headaches, of whatever cause, are a cause of considerable morbidity especially in terms of school loss.