Headache

Pediatric headache

Migraine is very treatable in children and adolescents. Principles of treatment include early intervention, elimination of triggers, involvement of parents and schools, and judicious use of medicines. Although there is no pediatric indication in the United States, triptans are safe and effective in this age group. Prophylactic drugs should be used when significant disability from migraine exists. Choice of drug is based upon comorbidity. Nonpharmacologic treatment has an important role.

Pediatric headaches in the emergency department

Headache is a common presenting complaint in the pediatric emergency department. Although the majority of headaches are benign in nature, headache may be secondary to more serious pathology, such as tumor, meningitis, hemorrhage, or brain abscess. A systematic history will elicit the temporal pattern of the headache, guiding the development of an appropriate differential diagnosis. Thorough physical and neurologic examinations will disclose the objective signs that dictate the need for further diagnostic testing.