Overview of diagnosis and management of paediatric headache. Part I: diagnosis

Abstract

Headache is the most common somatic complaint in children and adolescents. The evaluation should include detailed history of children and adolescents completed by detailed general and neurological examinations. Moreover, the possible role of psychological factors, life events and excessively stressful lifestyle in influencing recurrent headache need to be checked. The choice of laboratory tests rests on the differential diagnosis suggested by the history, the character and temporal pattern of the headache, and the physical and neurological examinations. Subjects who have any signs or symptoms of focal/progressive neurological disturbances should be investigated by neuroimaging techniques. The electroencephalogram and other neurophysiological examinations are of limited value in the routine evaluation of headaches. In a primary headache disorder, headache itself is the illness and headache is not attributed to any other disorder (e.g. migraine, tension-type headache, cluster headache and other trigeminal autonomic cephalgias). In secondary headache disorders, headache is the symptom of identifiable structural, metabolic or other abnormality. Red flags include the first or worst headache ever in the life, recent headache onset, increasing severity or frequency, occipital location, awakening from sleep because of headache, headache occurring exclusively in the morning associated with severe vomiting and headache associated with straining. Thus, the differential diagnosis between primary and secondary headaches rests mainly on clinical criteria. A thorough evaluation of headache in children and adolescents is necessary to make the correct diagnosis and initiate treatment, bearing in mind that children with headache are more likely to experience psychosocial adversity and to grow up with an excess of both headache and other physical and psychiatric symptoms and this creates an important healthcare problem for their future life.

Use of orthopedic manual physical therapy to manage chronic orofacial pain and tension-type headache in an adolescent

“…42 Additionally, some authors report that primary headache types such as migraines may present differently in children and adolescents than in adults. 9,14 However, she did not clearly fit the criteria for secondary headaches either. The presence of photophobia and phonophobia and visual changes she reported as part of her headache history are atypical of pure secondary TMD headaches.…”

“…Cervicogenic and TMD-type headaches are both classified as secondary headaches and are thought to occur as symptoms of dysfunction relative to the cervical spine or TMJ regions respectively. 10,14 Numerous studies have investigated the role of orthopedic manual physical therapy (OMPT) in the treatment of cervicogenic and TMD-type headaches. 1,11,[15][16][17][18] In light of the significant overlap in symptom prevalence between TMD and primary headache types, it seems reasonable that OMPT may be similarly beneficial in the treatment of TMD and primary headache types.…”

Headache in Children and Adolescents

“…This analysis showed that around 60% of children and adolescent are prone to headaches and 8% prone to migraines, over periods varying from 3 months to lifetime [18] .In another review, covering 64 cross-sectional epidemiological studies published in 32 different countries in past 25 years, the mean prevalence of headaches and migraines in children and adolescents was 54.4% and 9.1%, respectively [19] .The prevalence of a tension-type headache in children in population and school-based surveys estimated about 31% (10%-72%) [6] .The prevalence revealed an upward trend with increasing age for overall headache causes, migraine and TTH [17,[20][21]. There was a preponderance for female sex for overall headache causes (67% in females versus 58% in males) and migraine (9.7% in females versus 6% in males) [18,[20][21][22][23] .…”

“…Headache prevalence ranges 3-8% at 3 years, 19.5% at 5years, 37-51.5% at 7 years, and26-82%in 7-15year-olds [12][13][14][15][16][17] .In a review of 50 population-based studies, the overall prevalence of a headache and migraine in children and adolescents (<20years) at any point in time, was 58.4% and 7.7%, respectively. This analysis showed that around 60% of children and adolescent are prone to headaches and 8% prone to migraines, over periods varying from 3 months to lifetime [18] .In another review, covering 64 cross-sectional epidemiological studies published in 32 different countries in past 25 years, the mean prevalence of headaches and migraines in children and adolescents was 54.4% and 9.1%, respectively [19] .The prevalence of a tension-type headache in children in population and school-based surveys estimated about 31% (10%-72%) [6] .The prevalence revealed an upward trend with increasing age for overall headache causes, migraine and TTH [17,[20][21].…”

“…It should include family history of headaches or any other neurologic, psychiatric or chronic illness, developmental history, injuries, dietary habits of early childhood, school experiences, history of substance and sexual abuse, family relationships, socioeconomic and psychosocial status both of the child and parents and evaluation of any potential co-morbid conditions [17,79] . A thorough review of lifestyle practices, including caffeine intake, regularity of meals, sleep habits, and exercise, is important in identifying possible sources of modification.…”