Headaches are common complaints in the pediatric office practice. Although headaches are usually not associated with serious medical conditions but a careful clinical assessment is needed as, at times, headaches may be harbingers of sinister conditions which we cannot afford to miss. The common causes of headaches are acute symptomatic headaches- i.e. headaches associated with Viral fevers, URIs, Malaria, Typhoid, various other nonspecific illnesses etc.
On the other hand,acute symptomatic headaches associated with CNS conditions like- Meningitis, Meningo-encephalitis, Space Occupying lesion(SOLs) etcare much less common but need a high index of suspicion.
Other common but less recognized typesof headaches are the Primary headaches- Migraine, Tension type headache and the less common cranial neuralgias. The good strategy to evaluate headaches is to take a detailed history regarding its onset, duration, trigger factors, how the child behaves during the headache episodes and how the headache is relieved.Look for psychogenic factors carefully.
Examination should focus on the following:
1) Focal neurological deficits-Motor deficits, Co-ordination difficulty, basic confrontation test(for field of vision)to rule out major visual field defects.
2) Blood pressure measurement
3) Fundus examination (by pediatrician or ophthalmologist) is a must in every case of headache. One should remember that presence of minor refractory errors is not a cause of headaches.
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