How is pediatric headache diagnosed?

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

In the case of migraine or tension headache, a thorough history and physical examination is usually all that is needed. Laboratory, radiologic, or encephalographic studies are not useful to confirm the diagnosis of migraine but may help to exclude other causes of headache. For example, electroencephalography may be helpful to exclude seizures in children with acute confusional migraines.

Although imaging studies are not needed for every child who complains of headache, neuroimaging should be performed when the caregiver has any suspicion or concern that the headache may have a structural etiology. Given the broad differential of structural headaches and the imaging choices that are available, many practitioners are unsure which imaging modality will yield the most information in a cost-effective manner.

If a patient has had headaches for a long time (months to years) and the neurologic examination is normal, the likelihood of this patient harboring any serious intracranial pathology is minimal, and, therefore, neuroimaging studies should not be performed routinely.

Electroencephalography is useful to assess the status of an underlying seizure disorder associated with headache.


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