What is the focus of the clinical history to evaluate pediatric headache?

Updated: Jan 02, 2019
  • Author: J Ivan Lopez, MD, FAAN, FAHS; Chief Editor: George I Jallo, MD  more...
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Answer

A thorough history should be obtained in any child presenting with headache. The history should describe headache onset, duration, severity, and associated symptoms. A family history of migraines may be helpful in clarifying the diagnosis. A medication history should also be sought.

One study found that a structured interview tool known as the Diagnostic Interview of Headache Syndromes–Child Version (DIHS-C) was reliable and valid for detecting migraine in children and teens in clinical and community settings. [34] The DIHS-C had a sensitivity of 98% and a specificity of 61%. [35] The study authors suggested that this tool can be used in doctors’ offices as an initial history-gathering method administered by a nonphysician, and the treating physician can then use the information obtained.

Although the minority of headaches in children are due to serious underlying pathology, early recognition is paramount for appropriate diagnosis and management. Structural headaches frequently are caused by space-occupying lesions, inflammation, and/or an increase in intracranial pressure. Frequently, neurosurgical intervention is needed.

No single sign or symptom indicates a structural etiology; however, several signs and symptoms warrant further investigation. Headaches due to increased intracranial pressure may be worse in the morning and improve as the day progresses or may be aggravated by sneezing, coughing, or straining. Headaches persistently localized to the occipital region warrant attention (as do any focal neurologic signs or symptoms with or without headache).

Worsening of headache severity and/or frequency (especially with rapid progression) may also suggest an intracranial pathologic process, as may any significant change in a previously diagnosed headache syndrome. Failure of an adequate trial of headache therapy may imply an incorrect diagnosis.

Children with a prior history of epilepsy may have a generalized or focal headache after a seizure. Headaches may also accompany the aura prior to a seizure.


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