Pediatric Primary Headache From A to Z

William T. Basco, Jr., MD, MS


June 24, 2015

In This Article

A Panel of Pediatric Headache Experts

At the Pediatric Academic Societies (PAS) annual meeting in 2015, faculty members from the University of Utah School of Medicine and Primary Children's Hospital in Salt Lake City, Utah, presented a symposium on the clinical spectrum of headache in children, including diagnosis, acute treatment, the role of imaging, prevention, and future directions.

The presenters were:

  • James F. Bale, Jr, MD (Department of Pediatrics);

  • Meghan S. Candee, MD, MSc (Department of Pediatrics);

  • Lisa L. Giles, MD (Departments of Pediatrics and Psychiatry);

  • Lynne M. Kerr, MD, PhD (Department of Pediatrics);

  • Kevin R. Moore, MD (Department of Radiology); and

  • Gary R. Nelson, MD (Department of Pediatrics).

Identifying Headache Type

The most common type of chronic daily headache is migraine. The 2004 International Headache Society criteria are used to classify headaches. A pocket (short) version of the classification is available. The criteria for migraine without aura are the following:

  • Five or more attacks of headache lasting 4-72 hours;

  • At least two of the following features: unilateral location or pulsating quality, moderate or severe pain intensity, aggravation by or causing avoidance of routine physical activity;

  • At least one of the following features: nausea, vomiting, photophobia, phonophobia; and

  • Not attributed to another cause.

There are some important differences between adult and pediatric migraine, particularly the migraine variants. Adults can experience hemiplegic migraines, basilar migraines, "Alice in Wonderland syndrome" (size distortion), ophthalmoplegic migraine, or acute confusion migraine. Migraine syndromes that are more common in children include cyclic vomiting syndrome, abdominal migraine, benign paroxysmal vertigo, and benign paroxysmal torticollis.

It is also possible that infantile colic represents a migraine variant. Data demonstrate that infants born to mothers who experience migraine are 2.6 times more likely to have colic than other infants.[1]

The ID Migraine™ Screener is a quick, clinically useful approach to determine whether a child's headaches meet migraine criteria. The three features of the ID migraine screening approach include determining whether the child is experiencing nausea, is bothered by light, or has a headache that limits activity.[2]

Other headache paradigms to consider are tension headaches, exertional headaches, headaches caused by pseudotumor cerebri, and trigeminal nerve headaches. Trigeminal nerve headaches are characterized by short, stabbing pains, and other head, eyes, ear, nose, and throat findings (conjunctivitis, nasal congestion, or eye or facial swelling). Cluster headaches are an important variant of trigeminal nerve headaches.

The criteria for diagnosing pseudotumor cerebri were revised in 2013 and include the presence of papilledema, normal examination findings and imaging, and an increased opening pressure on lumbar puncture.[3]


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