Headache In Children

Most paediatric headaches are primary headaches such as migraine or tension type headache.

The clinical priority is identifying secondary causes that require urgent investigation.

Migraine commonly produces episodic headache with nausea, vomiting, photophobia or phonophobia.

Children may have bilateral rather than unilateral pain and attacks may be shorter than in adults.

Red flags include:

• Progressive worsening
• Early morning vomiting
• Headache waking the child
• Focal neurological deficit
• Papilloedema
• New seizures
• Personality or school performance change
• Occipital headache with neurological signs
• Headache in a child with cancer or immunosuppression

Routine neuroimaging is unnecessary for recurrent typical migraine with normal neurological examination.

MRI is indicated when red flags, abnormal examination or altered neurological function suggest structural disease.

Check blood pressure and perform fundoscopy.

For acute migraine:

• Ibuprofen 10 mg/kg PO, maximum 400 mg per dose

or

• Paracetamol 15 mg/kg PO, maximum 1 g per dose.

Give treatment early in the attack.

Ondansetron may be used for significant nausea or vomiting.

Frequent disabling migraines require trigger management and consideration of prophylactic therapy under paediatric or neurological supervision.

Avoid medication overuse, which can itself perpetuate chronic headache.