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Best practice
Fifteen-minute consultation: Management of primary headaches in children
  1. Roqiah Alhashem1,2,
  2. Susan Byrne3,4,
  3. Dani Hall5,6,7,
  4. Daniel E Lumsden8,
  5. Prab Prabhakar9
  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 Paediatrics and FutureNeuro, RCSI, Dublin, Ireland
  4. 4 Paediatric Neurology, Children's Health Ireland, Dublin, Ireland
  5. 5 Department of Emergency Medicine, Children's Health Ireland at Crumlin, Dublin, Ireland
  6. 6 Faculty of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
  7. 7 Women's and Children's Health, University College Dublin, Dublin, Ireland
  8. 8 Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
  9. 9 Paediatric Neurology, Great Ormond Street Hospital, London, UK
  1. Correspondence to Dr Susan Byrne, Paediatrics, RCSI, Dublin, Ireland; suabyrne{at}rcsi.com

https://doi.org/10.1136/archdischild-2022-324085

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    Abstract

    Headache is a common presentation among children, and is classified as either primary or secondary, with secondary headaches caused by underlying pathology. Tension type headache and migraine are common primary causes. This article discusses common primary headaches seen in children and the management.

    Introduction

    Headache is classified as either primary or secondary, with secondary headaches caused by underlying pathology. Once a secondary headache due to serious underlying pathology is ruled out, it is important to use clues in the history to differentiate between different primary headaches so the correct management can be initiated.1 The most common primary headache types in children are migraine and tension-type headaches. Trigeminal autonomic cephalgia (TAC) is rare in children but must be recognised and differentiated from other types as the treatment differs.2 Using clinical scenarios, this article will discuss the management of these headache disorders in children.

    Case 1

    An 11-year-old girl presents with a history of headaches for the last 18 months. She was recently diagnosed with dyslexia. The headache occurs most days of the week and is worse during term time. She describes it as frontal and squeezing in nature, typically starting at school after lunch and lasting until evening. She takes paracetamol and ibuprofen every day when she gets home. She is able to do her homework and play with her friends. She denies photophobia, phonophobia, nausea or vomiting. She had a normal optician review last month. There is no family history of migraine. Her neurological examination is unremarkable.

    What is the diagnosis?

    The chronic and non-progressive nature of this girl’s symptoms, combined with normal clinical examination, suggests that primary headache is the most likely diagnosis. Table 1 lists features of headache histories differentiating between primary headache disorders. The absence of photophobia, phonophobia and limitations in daily activities all lend support to the diagnosis of tension headache. …

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    Footnotes

    • X @danihalltweets

    • Contributors DH and SB participated in writing, editing and as scientific advisors. PP and DEL both participated as scientific advisors.

    • 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.