Children and young people presenting with headaches are in our ‘Top 5’ most common outpatient presentations. It is important to try and distinguish between worrying pathology and less worrying symptoms. The ‘Headsmart’ website is very useful for this and lists the ‘red flag’ symptoms for each age group.
A neurological examination should be performed, including fundoscopy, appropriate to the child’s age and developmental stage.
A discussion with child and parents as to any personality changes, including concerns regarding new co ordination or balance problems is important. Teachers may have noticed a problem with handwriting or concentration in class.
In babies, an accurate occipito-frontal head circumference should be measured and plotted in the Red Book or other age-based centile chart.
For adolescents, a discussion about progress of puberty is important as arrested pubertal development is a ‘Red Flag’