Approach to Headache in Children

By | 29 March 2021

Approach Headache in children is a common complaint. Anamnesis and history are very important in approaching headaches. Children who are localized to a sudden onset region and have normal neurological examinations usually develop headaches due to reasons such as upper respiratory tract infection, sinusitis, eye disorder, and dental problems. In sudden onset and recurrent headaches; migraines should come to mind. It is seen in 3% of children aged 3-7 years, 4-11% between 7-11 years, and 8-23% in adolescence in the society.

The average age of onset is 7 years for males and 11 years for females. Day loss at school is doubled in children with migraines compared to those without migraines. In a chronic progressive headache; Increased pressure in the brain, space-occupying lesion, the tumor should be considered. In neurological examination, double vision, abnormal reflexes, balance and coordination disorder, weakness in one half of the body, seizures are signs and symptoms accompanying headache.

Approach to Headache in Children

In a chronic non-progressive headache; takes psychogenic factors such as depression, tension-type. If he can express himself in a child who comes with a headache; It is questioned what it feels (for example, is it throbbing, whether it is throbbing, like a needle puncturing, squeezing), where it is in the head, how long it lasts, its frequency, whether it has accompanying nausea, vomiting, sensitivity to sound and light, and whether it prevents daily activities.

Especially if a child wakes up from sleep at night with a headache, this space-occupying lesion in the brain is considered an alarm sign for organic cause, and brain imaging (computed tomography or MRI) is requested. Apart from this, if the neurological examination of the child is also normal in every headache, brain imaging is unnecessary. In the neurological examination of every child with headache, eye fundus examination and blood pressure measurement with ophthalmoscope should be performed in each patient.

Children may also rarely have hypertension and related headache. In blood tests, fasting blood glucose and routine complete blood count are evaluated. Child monitoring is taken. It is required to keep a headache diary for at least 21 days. In children diagnosed with migraine, if the attacks are more than once a week and may affect their daily life, 3-6 months of continuous preventive drug treatment is planned especially during the school period.

For children with tension-type headaches, ways to cope with stress are recommended to focus on sports and artistic activities.

If necessary, therapy with a psychologist, and in case of underlying depression, the opinion of a child psychiatrist is requested.