Headache is a common complaint in pediatric patients presenting to the emergency department. Diagnosis of life-threatening pathology can be difficult due to the nonspecific symptoms for many of these conditions. Emergency clinicians must have a high index of suspicion, obtain a detailed history, and conduct a thorough physical examination to accurately identify life-threatening causes of headache.
Our recent issue An Evidence-Based Review of Life-Threatening Secondary Headaches in Pediatric Patients in the Emergency Department reviews the general approach, differential diagnosis, and initial workup and management of the most common dangerous causes of secondary headaches in pediatric patients.
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Here are a few key points:
- Most pediatric headaches are primary type (eg, migraine or tension type) or relatively benign secondary type (eg, headaches due to viral illness, concussion).
- Of all pediatric patients with headache presenting to the ED, 4% to 15% could have a serious underlying pathology such as stroke, meningitis, encephalitis, brain abscess, sinusitis, orbital cellulitis, idiopathic intracranial hypertension, or brain masses.
- A thorough history and examination of pediatric patients includes reviewing the growth chart, a general knowledge of their developmental milestones and primitive reflexes, as well as a careful skin examination.
- Various intracranial pathology (eg, stroke or brain tumors) can present as vague complaints in younger patients. Nonspecific symptoms may include vomiting, headache, seizure, or altered mental status.
- The Pediatric National Institutes of Health Stroke Scale is a standardized, validated stroke scale that has decreased time to stroke diagnosis.