Headache Diagnostic Approach

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Headache in children

All causes of adult headache (except in retrobulbar neuritis, glaucoma, temporal arteritis and cervical spondylosis) may cause headache in children. In this age group, the commonest type of headache is that accompanying any febrile illness or infection of the nasal passages or sinuses.

The clinician must not take a complaint of headache lightly; the younger the child, the more likely the presence of an underlying organic disease. Pyrexia may not only represent a mild 'constitutional' upset, but may result from meningitis, encephalitis or cerebral abscess. The presence of neck stiffness and/or impaired conscious level indicates the need for urgent investigation.

Although intracranial tumours are uncommon in childhood, when they occur they tend to lie in the midline (e.g. medulloblastoma, pineal region tumours.) As a result, obstructive hydrocephalus often develops acutely with headache as a prominent initial symptom.

In a child with 'unexplained' headache, CT scan should be performed:

- if the presentation is acute

- if the severity progressively increases

- if school performance declines, or other symptoms, e.g. personality change, develop

- if the head circumference increases

- if the child is under 5 years.

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