Headache
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 |
| Migraine |
| 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 |