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Management of children and young people with headache
  1. William P Whitehouse1,2,
  2. Shakti Agrawal3
  1. 1Department of Paediatric Neurology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2School of Medicine, University of Nottingham, Nottingham, UK
  3. 3Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
  1. Correspondence to Dr William P Whitehouse, Division of Academic Child Health, School of Medicine, E Floor East Block, Queen's Medical Centre, Nottingham NG7 2UH, UK; william.whitehouse{at}nottingham.ac.uk

Abstract

Headache is very common in children and young people. The correct advice and treatment requires consideration of a wide differential diagnosis between primary and secondary headaches, and also of the different types of primary headache. The International Classification of Headache Disorders gives useful descriptions and diagnostic criteria that are especially useful for primary headaches. The National Institute for Health and Care Excellence (NICE) Clinical Guideline 150 provides evidence-based recommendations on treatments for adults and young people from age 12 years. However, the same principles can be applied to younger children when a specific diagnosis can be made. Key recommendations from the NICE Quality Standards include, establishing a precise diagnosis if possible, avoiding, diagnosing and treating medication overuse headache, and combining a triptan with a non-steroidal anti-inflammatory drug or paracetamol as the first-line acute/rescue treatment for migraine with or without aura. Although rare in children and young people, it is important to diagnose new daily persistent headache, as it responds poorly or not at all to medication; and paroxysmal hemicrania as it responds very well to indomethacin but not to other commonly used analgesics. When faced with difficulties in reaching a precise diagnosis or in finding effective therapies, further advice should be sought from a children's headache clinic or specialist.

  • diagnosis
  • treatment
  • migraine
  • paroxysmal hemicrania
  • primary headache

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Footnotes

  • Contributors WPW reviewed the literature, wrote most of the first draft and reviewed and edited the article following editor's and reviewer's suggestions, read and approved the final version. SA reviewed the literature, compiled the first draft of the tables and helped edit the article following the editor's and reviewer's comments, read and approved the final version.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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