See:
Headache
Some of the following is based on an excellent review article on the Great Ormond Street Hospital website.
Epidemiology
- up to 50 per cent of 7-year-olds and up to 80 per cent of 15-year-old have experienced at least one headache
- equally as common in boys/girls until puberty then strong (3:1) female preponderance
Migraine
Migraine without aura is the most common cause of primary headache in children. The International Headache Society (IHS) have produced criteria for paediatric migraine without aura:
| A |
>= 5 attacks fulfilling features B to D |
| B |
Headache attack lasting 4-72 hours |
| C |
Headache has at least two of the following four features: |
| • bilateral or unilateral (frontal/temporal) location |
|
| • pulsating quality |
|
| • moderate to severe intensity |
|
| • aggravated by routine physical activity |
|
| D |
At least one of the following accompanies headache: |
| • nausea and/or vomiting |
|
| • photophobia and phonophobia (may be inferred from behaviour) |
|
Acute management
- ibuprofen is thought to be more effective than paracetamol for paediatric migraine
- triptans may be used in children >= 12 years but follow-up is required
- sumatriptan nasal spay (licensed) is the only triptan that has proven efficacy but it is poorly tolerated by young people who don't like the taste in the back of the throat
- it should be noted that oral triptans are not currently licensed in people < 18 years
- side-effects of triptans include tingling, heat and heaviness/pressure sensations
Prophylaxis
- the evidence base is limited and no clear consensus guidelines exist
- the GOSH website states: 'in practice, pizotifen and propranolol should be used as first line preventatives in children. Second line preventatives are valproate, topiramate and amitriptyline'
Tension-type headache (TTH)
Tension-type headache is the second most common cause of headache in children. The IHS diagnostic criteria for TTH in children is reproduced below: