- assessment of a child with a headache is mainly clinical - radiological imaging is rarely required
- history of the headache should assess:
- nature and quality of pain
- intensity of pain
- site and spread of pain
- frequency and duration of headache
- associated symptoms
- trigger or predisposing factors
- aggravating and relieving factors
- ideally a full neurological examination should be undertaken - including visual field testing and fundoscopy
- growth, blood pressure and visual acuity should be assessed
In general, neurological examination and investigations reveal no abnormalities in children with migraine (1).
Indications for imaging include:
- abnormal neurological findings - especially if accompanied by nystagmus, papilloedema or gait or motor abnormalities
- headaches that repeatedly wake a child from sleep or occur immediately on awakening
- persistent headache associated with substantial episodes of confusion, vomiting or disorientation
- also "imaging is also probably worth carrying out in children whose symptoms develop before the age of 5 years "
Note: migraine is approximately 50% more likely in relatives of people with the condition than in those whose relatives do not have migraine.
Reference:
- Szperka C. Headache in Children and Adolescents. Continuum (Minneap Minn). 2021 Jun 01;27(3):703-731.