Overview of diagnosis and management of paediatric headache. Part I: diagnosis |
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Authors: | Aynur Özge Cristiano Termine Fabio Antonaci Sophia Natriashvili Vincenzo Guidetti Çiçek Wöber-Bingöl |
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Institution: | 1.Department of Neurology,Mersin University School of Medicine,Mersin,Turkey;2.Child Neuropsychiatry Unit, Department of Experimental Medicine,University of Insubria,Varese,Italy;3.University Center for Adaptive Disorders and Headache (UCADH), Unit of Pavia,Pavia,Italy;4.Department of Psychiatry of Childhood and Adolescence,Medical University of Vienna,Vienna,Austria;5.Department of Child and Adolescent Neuropsychiatry,University La Sapienza,Rome,Italy;6.Department of Psychiatry of Childhood and Adolescence,Medical University of Vienna,Vienna,Austria |
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Abstract: | Headache is the most common somatic complaint in children and adolescents. The evaluation should include detailed history
of children and adolescents completed by detailed general and neurological examinations. Moreover, the possible role of psychological
factors, life events and excessively stressful lifestyle in influencing recurrent headache need to be checked. The choice
of laboratory tests rests on the differential diagnosis suggested by the history, the character and temporal pattern of the
headache, and the physical and neurological examinations. Subjects who have any signs or symptoms of focal/progressive neurological
disturbances should be investigated by neuroimaging techniques. The electroencephalogram and other neurophysiological examinations
are of limited value in the routine evaluation of headaches. In a primary headache disorder, headache itself is the illness
and headache is not attributed to any other disorder (e.g. migraine, tension-type headache, cluster headache and other trigeminal
autonomic cephalgias). In secondary headache disorders, headache is the symptom of identifiable structural, metabolic or other
abnormality. Red flags include the first or worst headache ever in the life, recent headache onset, increasing severity or
frequency, occipital location, awakening from sleep because of headache, headache occurring exclusively in the morning associated
with severe vomiting and headache associated with straining. Thus, the differential diagnosis between primary and secondary
headaches rests mainly on clinical criteria. A thorough evaluation of headache in children and adolescents is necessary to
make the correct diagnosis and initiate treatment, bearing in mind that children with headache are more likely to experience
psychosocial adversity and to grow up with an excess of both headache and other physical and psychiatric symptoms and this
creates an important healthcare problem for their future life. |
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Keywords: | Headache Childhood Paediatric headaches Diagnosis Epidemiology Defining features |
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