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Fifteen-minute consultation: Diagnosing serious pathology in children with headaches presenting to the emergency department
  1. Roqiah Alhashem1,2,
  2. Susan Byrne3,4,
  3. Dani Hall1,5,6
  1. 1 Emergency Department, Children's Health Ireland at Crumlin, Dublin, Ireland
  2. 2 Department of Paediatrics, Qatif Central Hospital, Qatif, Saudi Arabia
  3. 3 Paediatric Neurology, Children's Health Ireland, Dublin, Ireland
  4. 4 FutureNeuro, Paediatric Department, RCSI, Dublin, Ireland
  5. 5 Blizard Institue, Queen Mary University Hospital of London, London, UK
  6. 6 University College Dublin, Dublin, Ireland
  1. Correspondence to Dr Roqiah Alhashem, Emergency Department, Children's Health Ireland at Crumlin, Dublin D12 N512, Ireland; ralhashem{at}


Headache is one of the most common presentations to the paediatric emergency department. Although challenging, it is important to differentiate serious secondary headaches requiring emergency treatment from primary headache disorders. A detailed history and neurological examination can be used to identify children at higher risk of serious underlying pathology. Neuroimaging decisions should be taken carefully, weighing risk versus benefit in each case. This article will discuss five patient scenarios highlighting red flags and differential diagnoses in children presenting with headache in the emergency department.

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.