Headaches in children

Abstract

The evaluation of the child or adolescent with a headache is one of the more common and vexing problems of pediatric practice. The expense and morbidity associated with the diagnostic evaluation are usually directly related to the physician's inability to decide whether the patient has a simple tension headache or a brain tumor. Although statistics overwhelmingly favor the former, the physician's judgment is colored by anecdotal cases or personal experiences with the latter. Following the evaluation, which in the majority of cases is both extensive and normal, the child continues to complain of headaches, forcing the physician to contemplate treatment. Unfortunately, this scenario is a daily occurrence. One must continually be reminded that the differential diagnosis of headaches and their management are based primarily on the history. A few extraminutes with the history and examination are more beneficial than additional tests. If nothing else, it demonstrated the concern for the child and the family, the therapeutic importance of which is usually underestimated.