Abstract
Introduction
Headaches are a common occurrence in childhood and adolescence. Most children presenting with a chief complaint of headache have a self-limited infectious disorder or primary headache syndrome that should not require extensive workup.
Purpose of Review
Differentiating these conditions from other more serious causes of headache in children can sometimes be difficult. This article aims to provide information regarding “red flags” that should indicate a need for concern for disorders that require more urgent evaluation.
Recent Findings
Long-held beliefs about specific “red flags” that have been analyzed in recent years as to their validity and new criteria for the diagnosis of idiopathic intracranial hypertension have been elaborated based on study. These publications are reviewed in this article.
Summary
Knowledge of past and current literature on secondary headache in children, combined with thorough history taking and examination, should help determine when there is concern for a serious secondary cause for headache in children and adolescents and direct workup.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Bigal ME, Lipton RB. The epidemiology, burden and comorbidities of migraine. Neurol Clin. 2009;27(2):321–39.
Lewis, W., D. ; Ashwal, W., S. ; Dahl, W., G. ; Dorbad, W., D. ; Hirtz, W., D. ; Prensky, W., A. ; Jarjour, W., I. Practice parameter: evaluation of children and adolescents with recurrent headaches: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society Neurology, 2002, Vol.59(4), p.490–498.
Medina LS, Pinter JD, Zurakowski D, Davis R, Kuban K, Barnes PD. Children with headache: clinical predictors of the surgical space-occupying lesions and the role of neuroimaging. Radiology. 1997;202:819–24.
Lipton RB, Diamond S, Reed M, Diamond ML, Stewart WF. Migraine diagnosis and treatment: results of the American Migraine Study II. Headache. 2001;41:638–45.
Hirtz D, Ashwal S, Berg A, Bettis D, Camfield C, Camfield P, et al. Practice parameter: evaluating a first nonfebrile seizure in children. Neurology. Sep 2000;55(5):616–23.
Gemmete JG, Toma AK, Davagnanam I, Robertson F, Brew S. Pediatric cerebral aneurysms. Neurimag Clin N Am. 2013;23:771–9.
Di Rocco, C., Tamburrini, G. & Rollo, Cerebral arteriovenous malformations in children. Acta Neurochir (2000): 142–145.
Ruelecke BC, Erker CG, Fiedler BJ, Niederstadt T, Kurlemann G. Brain tumors in children: initial symptoms and their influence on the time span between symptom onset and diagnosis. J Child Neurol. 2008;23:178–83.
Lewis DW, Qureshi F. Acute headache in children and adolescents presenting to the emergency department. Headache. 2000;40:200–3.
Conicella E, Raucci U, Vanacore N, Vigevano F, Reale A, Pirozzi N, et al. The child with headache in the emergency department. Headache. 2008;48:1005–11.
• Bear JJ, Gelfand AA, Goadsby PJ, Bass N. Occipital headaches and neuroimaging in children. Neurology. 2017;89:469–74. This article challenges the notion that occipital headache in children alone should prompt imaging.
•• Lanphear J, Sarnaik S. Presenting symptoms of pediatric brain tumors diagnosed in the emergency department, pediatric emergency care 2014, (30):77–80. This article outlines when concern for neoplasm causing headache should occur.
•• Avery, RA LDJ, Shah SS, Huh JW, Seiden JA, Boswinkel J, et al. CSF opening pressure in children with optic nerve head edema. Neurology. 2011;76:1658–61. This article establishes new norms for intracranial pressure measurement in the pediatric population.
Friedman DI. The pseudotumor cerebri syndrome. Neurol Clin. 2014;32(2):363–96.
Toldo I, Perissinotto E, Menegazzo F. Comorbidity between headache and epilepsy in a pediatric headache center. J Headache Pain. 2010;11:235–40.
Verrotti A, Coppola G, Spalice A, Di Fonzo A, Bruschi R, Tozzi E, et al. Peri-ictal and inter-ictal headache in children and adolescents with idiopathic epilepsy: a multicenter cross-sectional study. Childs Nerv Syst. 2011;27:1419–23.
•• Rajapakse T, Buchhalter J. The borderland of migraine and epilepsy in children, Headache Curr 2016, (6) 1071–1079. This article provides a thorough review of the overlap between two common neurologic disorders in children.
• Verrotti A, Coppola G, Spalice A, Di Fonzo A, Bruschi R, Tozzi E, et al. Should migralepsy be considered an obsolete concept? A multicenter retrospective clinical? EEG study and review of the literature. Epilepsy Behav. 2011;21:52–9. This article challenges the idea that migralepsy is a migraine disorder.
Ahad R, Kossoff EH. Secondary intracranial causes for headaches in children. Curr Pain Headache Rep. 2008;12:373–8.
•• Victorio MC, Khoury CK. Headache and Chiari 1 malformation in children and adolescents. Semin Pediatr Neurol. 2016;23:35–9. This provides an excellent review of the presenting symptoms of Chiari I in the pediatric population.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Marcy Yonker declares no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
This article is part of the Topical Collection on Headache
Rights and permissions
About this article
Cite this article
Yonker, M. Secondary Headaches in Children and Adolescents: What Not to Miss. Curr Neurol Neurosci Rep 18, 61 (2018). https://doi.org/10.1007/s11910-018-0865-z
Published:
DOI: https://doi.org/10.1007/s11910-018-0865-z