Headaches in the paediatric population are common, with estimates of the prevalence of headaches in children varying from 50-70% [1]. In younger children migraines are the most common cause, with tension headaches being the most common in adolescents. [2] 1% of presenting complaints in the ED will be headaches [3],with more forming part of the presentation.

The causes of headache are extensive, with the role of the EP to decide which are benign and which are a symptom of a more significant underlying cause.

Causes of Headache in Children
Tension   and Cluster Headaches
Vascular- SAH, HTN, AV malformation
Raised ICP- Tumours, hydrocephalus, benign ICH, subdural haematoma
Inflammatory- Meningitis, vasculitis
Referred pain- sinusitis, optic neuritis, otitis media
Other- CO poisoning, substance abuse, refractive errors


Red flags in children’s headaches
Occipital headache Signs/symptoms of meningism
Focal neurological signs Seizures
Progressive nature Papilloedema
Persistent vomiting Ataxia
Presence of VP shunt <3 year old
Early morning headaches that wake child
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