Headaches

Key Messages

• Headaches are common in children, increasing from early childhood to adolescence.
• Chronic daily headache is defined as a headache experienced for over 15 days/month for 3 consecutive months.
• Headaches can be primary (no specific underlying cause) or secondary (due to underlying conditions such as hypertension or sinusitis). Primary headaches are more common in children.
• children with chronic headaches without red flags and normal examination are unlikely to have a brain tumour
• In tension type headaches lifestyle changes are more effective than analgesics.
• safety netting advice is important - if the headaches change then a medical review is warranted
• Be aware of medication overuse headaches, a condition caused by regular, long-term use of analgesia

What To Do

• Take a comprehensive history including headache details, medication history (paying attention to potential medication overuse), school absences, sleep habits, screen time, stress, and family headache history.
• Physical exam: measure and plot weight, height, blood pressure; check for potential dental, eye, ENT pathologies, including sinusitis, and perform a neurological assessment.
• Advise a visit to an optometrist to rule out visual problems potentially causing/contributing to the headaches.
• Provide lifestyle advice, including screen time and sleep hygiene, for managing headaches. Stress the importance of maintaining adequate fluid intake.
• Encourage the use of a headache diary to characterise the headache and identify triggers, if any
• For migraines, refer to NICE guidelines for management and consider psychological therapies when required.

When To Refer

• Utilize the Head Smart Decision Support Tool for assistance in brain tumour risk assessment
• Make an urgent referral if a child shows red flags like waking up due to the headache, persistent vomiting, focal neurological signs, coordination problems, behavioral changes, or progressively severe headaches.
• Have a lower threshold for referring children under 5 with chronic symptoms.

Resources

1. Headache Diary - from British Paediatric Neurological Association
2. Decision Support Tool - based on Royal College of Paediatrics endorsed guidance for Brain Tumour Assessment
3. NICE Clinical guideline: Headache in children and young people: diagnosis and management

Acknowledgents

Birmingham Children’s Hospital Chronic Headache guidance Reviewed and updates from Dr Saraswatula