Headaches During Childhood and Adolescence

Headaches are common in children and teenagers. By 7 years of age, 40% of children have had headaches, with 2.5% having frequent nonmigraine types and 1.4% having migraine (1). By 15 years of age, 75% have had headaches: 15.7% with frequent tension type, 5.3% with migraines, and 54% with infrequent nonmigraine headaches. The evaluation of the child with headaches is similar to the basic approach in adults, described in Chapter 1. A complete history is essential. Information from parents and other family members or caregivers, especially for younger children, is vital. In some adolescents, it is helpful to obtain the history from the child without family members present and then from family members. A psychosocial history is also important. For recurring or chronic headaches, what is the impact of the headaches on the child’s life? Has school been missed, has homework gone undone, or have other activities been curtailed? Because of the frequent familial nature of migraine, family history is also important. When you ask the parents about their own headaches, often you will diagnose their migraines for the first time. A general physical and neurological examination is also necessary. General indications for diagnostic testing are discussed in Chapter 1: Table 1-8 focuses on indications in children and Table 1-9 gives general indications for neuroimaging. This chapter covers the following topics: migraine, episodic tension-type headaches, chronic nonprogressive headaches, acute headaches, and chronic progressive headaches. Cluster headaches, the subject of Chapter 7, are not separately discussed because the onset usually occurs after 20 years of age and these headaches are rare in children. Some other causes of secondary headaches in children and adolescents, such as posttraumatic, ophthalmological causes, and pseudotumor cerebri, are also reviewed in other chapters.